RJ Health - NDC vs. Code Units: Vaccines - Webinar Segment

This segment is from RJ Health's On-Demand Webinar:

Presented by:
Christopher Webb, CPhT
Director, Product Development
&
Laura Benson, PharmD, RPh
Clinical Informatics Pharmacist

Laura: Chris, are these problems limited to the influenza vaccines or do they extend beyond the flu vaccine?

Chris: Unfortunately they are not limited. There are other examples where dosing NDC and HCPCS code units don’t agree. Pay special attention when billing for a pediatric dose, that the NDC is billed under the pediatric code if one exists.

Laura: I see on the bottom there we’ve got the pediatric code of 90633, and for the adults, they have their code of 90632. I’m starting to understand that each has a different dose, each has a different NDC unit, and that they cross back to the single HCPCS value which makes sense to me, but if you billed it under the wrong code, you might get the wrong reimbursement.

Chris: Exactly, you will be paid under reimbursement or over reimbursement which could open yourself up to audits.