What is the significance of National Drug Code, NDC’s in medical coding?
The NDC, or National Drug Code, is a unique 10-digit, 3-segment number. It is a universal product identifier for human drugs in the United States. NDC is a universal number that identifies a drug. The code is present on all nonprescription (Over The Counter) and prescription medication packages and inserts in the US. It should be noted that the NDC are displayed in a 10- digit format. Proper billing of NDC number consists of 11 digits in a 5-4-2 format. The 10-digit NDC is converted to 11-digit NDC by proper placement of zero. Hyphens are not used when the actual data is entered in the claim.
Some packages will display fewer than 11 digits, but leading zeroes can be assumed and need to be used when billing. For example:
XXXX-XXXX-XX = 0XXXX-XXXX-XX
XXXXX-XXX-XX = XXXXX- 0XXX-XX
XXXXX-XXXX-X = XXXXX-XXXX- 0X
The NDC is found on the drug container (i.e., vial, bottle, or tube).
The 3 segments of the NDC identify the
- Labeler,
- The product, and the
- Commercial package size.
The first set of numbers in the NDC identifies the labeler (manufacturer, re-packager, or distributor).
The second set of numbers is the product code, which identifies the specific strength, dosage form (i.e, capsule, tablet, liquid) and formulation of a drug for a specific manufacturer.
Finally, the third set is the package code, which identifies package sizes and types. The labeler code is assigned by the FDA, while the product and package code are assigned by the labeler.
For example, if the NDC for a 100-count bottle of Prozac 20 mg is 0777-3105-02.
- The first segment of numbers identifies the labeler. In this case, the labeler code “00777” is for Dista Products Company, the labeler of Prozac.
- The second segment, the product code, identifies the specific strength, dosage form (i.e, capsule, tablet, liquid) and formulation of a drug for a specific manufacturer. In our case, “3105” identifies that this dosage form is a capsule.
- The third segment is the package code, and it identifies package sizes and types. Our example shows that the package code “02” for this bottle of Prozac identifies that 100 capsules are in the bottle. The FDA maintains a searchable database of all NDC codes on their website.Since there are often several NDCs linked to a single HCPCS code, the Centers for Medicare & Medicaid Services (CMS) deems that the use of NDC numbers is critical to correctly identify the drug and manufacturer in order to invoice and collect the rebates.
Other important points to be noted are:
- Billing and companion guides specifically for the practice will help to add the NDC information to claims.
- The NDC submitted must be the actual NDC number on the package or container from which the medication was administered, in case not sure which NDC was used. Picking another NDC under J code is not a good option.
- It depends if the drugs require an NDC information which are billed through a hospital outpatient department.
- Radiopharmaceuticals and contrast media do not require NDC information.
- Vaccines do not require NDC information.
- Providers are required to submit NDC information, including the NDC, NDC units, and unit descriptor on claims billed to Medicare for dually eligible members (Medicare and MassHealth), when billing for Level II HCPCS for physician-administered drugs.
- Dentists do not need to bill HCPCS and NDC numbers.
- In cases where the patient brings the drug, the physician will only bill for the administration of the drug.
- In case a partial vial was administered, then HCPCS code is billed with the corresponding units. When calculating the NDC units, the HCPCS code units should be converted to the NDC units, using the proper decimal units.