Remark code M70 indicates that the National Drug Code (NDC) provided on the claim has been converted to the corresponding Healthcare Common Procedure Coding System (HCPCS) code for the purpose of processing the claim. However, it also serves as a reminder to continue submitting the original NDC for any future claims related to this item or service. This ensures that the claim submissions remain consistent and that all necessary drug information is captured for proper reimbursement and reporting purposes.
Common causes of code M70 are:
1. The National Drug Code (NDC) submitted on the claim does not have a direct crosswalk to a Healthcare Common Procedure Coding System (HCPCS) code, necessitating a translation by the payer for processing purposes.
2. The NDC may be outdated or incorrect, but the payer has enough information to determine the appropriate HCPCS code for the service provided.
3. The claim form may have been filled out incorrectly, with the NDC placed in the wrong field or formatted improperly, yet the payer was able to infer the correct HCPCS code.
4. The payer's claims processing system automatically converts NDCs to HCPCS codes as a standard procedure, even when the NDC is submitted correctly.
5. The NDC submitted is for a drug that is typically billed under a HCPCS code, and the payer is providing guidance to continue submitting the NDC for tracking and data collection purposes, despite the conversion for payment.
6. The pharmacy benefit manager or insurer has specific billing guidelines that require the conversion of NDC to HCPCS codes for certain medications or therapeutic classes.
Ways to mitigate code M70 include ensuring that the National Drug Code (NDC) is accurately and consistently reported on all future claims alongside the Healthcare Common Procedure Coding System (HCPCS) code. It's important to verify that the NDC is current and valid for the date of service and that it matches the drug or product administered. Additionally, staff should be trained to understand the importance of including both the NDC and the HCPCS codes on claims to avoid any confusion or delays in processing. Regular audits of claim submissions can also help identify and correct any discrepancies in the reporting of NDCs before claims are submitted.
The steps to address code M70 involve verifying that the National Drug Code (NDC) was correctly submitted with the claim and ensuring that the NDC is included on all future claims for the item in question. It's important to cross-reference the NDC with the Healthcare Common Procedure Coding System (HCPCS) code to confirm that the translation was accurate. Additionally, review your billing software or process to ensure that the NDC is automatically included on claims for the relevant items. If there are discrepancies or if the translation to the HCPCS code resulted in any issues with claim processing, contact the payer for clarification and guidance on how to prevent similar issues in the future. Keep documentation of the NDC to HCPCS translation for reference and for potential audits.