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Sherry Posted 3 month(s) ago
we are billing 90688 and 90471 and getting denial from UHC that 90688 non-covered , number of max units exceeds . this is the corrected CPT and ICD 10 codes Could you please help me and tell me why we are getting denial
SuperCoder Posted 3 month(s) ago

HELLO

  • >Recent refund requests have highlighted the importance of noting the way units are applied in conjunction with the National Drug Code (NDC) and what information payers are using to adjudicate claims. In particular, physicians who reported vaccine and drug products have noted receipt of refund requests going back several years due to payment of an incorrect number of units of service based on the NDC code description for vaccines. While >CPT®> codes for vaccines are reported with one unit because the code descriptor identifies the vaccine dose, units in the NDC are often milliliters (ML). For a vaccine product that is provided as a 0.5 ML dose, the unit of service for the CPT>®> code is one but the unit of service for the NDC code is 0.5 ML. While many payers will adjudicate the claim based on one unit of the product as described by the >CPT> code, payers may utilize the units reported with the NDC number. It is necessary to be aware of reporting instructions for each payer or claims administrator.  If one unit is submitted in the NDC units field for a vaccine given in a 0.5 ml dose, an overpayment may be made for two 0.5 ml doses. (It is also important to enter the number of units in the required format (e.g., 0.5 units for a 0.5 ML dose as opposed to .5 or 5.) To avoid incorrect payments and potential refund requests, be sure that you know how the units of service are reported on your claims. If you report directly to a payer through their online claims submission tools, it is very important to know how each field is defined (i.e., Does the NDC units field require milliliters or other measurement?).
  • >As per NDC-CPT crosswalk from SuperCoder, CPT code 90688 cannot exceed more than 10 units per service.

HOPE THIS HELPS!

 

Posted by Sherry, 3 month(s). There are 2 posts. The latest reply is from SuperCoder.

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