Billing and coding / Overview

Guide to coding for buy-and-bill drugs

  • Under the buy-and-bill model, HCPs are responsible for billing and coding to ensure reimbursement

  • Specialty pharmacies are generally responsible for billing and coding when they have acquired the drug, and may also conduct BIs in addition to HCP verifications

  • Accurate coding in claims is essential to ensure timely reimbursement by payers

This is an overview of the types of codes that may be familiar to most HCPs:

Code

Type

Description

ICD-10-CM1

Diagnosis

  • International Classification of Diseases, 10th revision

  • Coding for all diseases, disorders, injuries, infections, and symptoms

NDC2

Drug

  • National Drug Code

  • A unique 10- or 11-digit, 3-part number used as a universal product identifier for drugs in the US

  • The first 4 or 5 digits identify the labeler (eg, manufacturer), followed by the product (3 or 4 digits) and package (1 or 2 digits) codes

HCPCS3

Procedure

  • Healthcare Common Procedure Coding System

  • Used for drugs, supplies, services, and equipment (eg, C-codes and J-codes)

CPT3

Procedure

  • Current Procedural Terminology

  • Reports medical services and procedures provided by HCPs

Revenue codes4

Payment

  • Indicates the cost center for an individual service on an institutional/facility claim

Code

Type

Description

ICD-10-CM1

Diagnosis

  • International Classification of Diseases, 10th revision

  • Coding for all diseases, disorders, injuries, infections, and symptoms

NDC2

Drug

  • National Drug Code

  • A unique 10- or 11-digit, 3-part number used as a universal product identifier for drugs in the US

  • The first 4 or 5 digits identify the labeler (eg, manufacturer), followed by the product (3 or 4 digits) and package (1 or 2 digits) codes

HCPCS3

Procedure

  • Healthcare Common Procedure Coding System

  • Used for drugs, supplies, services, and equipment (eg, C-codes and J-codes)

CPT3

Procedure

  • Current Procedural Terminology

  • Reports medical services and procedures provided by HCPs

Revenue codes4

Payment

  • Indicates the cost center for an individual service on an institutional/
    facility claim

Codes are subject to change. Verify current coding prior to any claim submission.

THIS INFORMATION IS PROVIDED FOR EDUCATIONAL PURPOSES ONLY AND IS NOT A GUARANTEE OF COVERAGE. IT IS THE SOLE RESPONSIBILITY OF THE HEALTH CARE PROVIDER TO SELECT THE PROPER CODES AND ENSURE THE ACCURACY OF ALL STATEMENTS USED IN SEEKING COVERAGE AND REIMBURSEMENT FOR AN INDIVIDUAL PATIENT.

References: 1. Torrey T. Accessed June 23, 2020. https://www.verywellhealth.com/finding-icd-codes-2615311 2. American Academy of Pediatrics. Accessed June 23, 2020.
https://www.aappublications.org/news/aapnewsmag/2016/04/21/Coding042116.full.pdf 3. Medical Billing & Coding Certification. Accessed June 23, 2020. https://www.medicalbillingandcoding.org 4. Value Healthcare Services. Accessed October 20, 2020. https://valuehealthcareservices.com/education/understanding-hospital-revenue-codes

BACK TO TOP