Retired - Correct Coding – NOC Codes for Enteral (B9998) and Parenteral (B9999) Nutrition

DME MAC Joint Publication

Recent claims analysis of the “Not Otherwise Classified” (NOC) codes used with enteral and parenteral nutrition claims identified errors in the use of these codes.  This article will discuss the correct use of these NOC codes.  The codes are:

• B9998 NOC FOR ENTERAL SUPPLIES
• B9999 NOC FOR PARENTERAL SUPPLIES

Correct coding requires the use of a specific HCPCS code for an item when a specific code exists.  Use of a NOC code in place of a specific code represents incorrect coding.

Enteral Nutrition

The analysis of B9998 reviewed 909 claim lines finding that:

• 628 claim lines were identified as extension tubing. 
• 61 claim line descriptions could not be deciphered to identify a specific item. 
• 20 claim lines contained B9002 with MS, RR and/or KJ modifiers.
• 50 claim lines were identified as “per diem charges”

These claim lines are incorrectly coded.

The Enteral Nutrition Related Policy Article CODING GUIDELINES describe the requirements applicable to supplies used with enteral nutrition.  The applicable supply allowance codes are:

• B4034 ENTERAL FEEDING SUPPLY KIT; SYRINGE FED, PER DAY, INCLUDES BUT NOT LIMITED TO FEEDING/FLUSHING SYRINGE, ADMINISTRATION SET TUBING, DRESSINGS, TAPE
• B4035 ENTERAL FEEDING SUPPLY KIT; PUMP FED, PER DAY, INCLUDES BUT NOT LIMITED TO FEEDING/FLUSHING SYRINGE, ADMINISTRATION SET TUBING, DRESSINGS, TAPE
• B4036 ENTERAL FEEDING SUPPLY KIT; GRAVITY FED, PER DAY, INCLUDES BUT NOT LIMITED TO FEEDING/FLUSHING SYRINGE, ADMINISTRATION SET TUBING, DRESSINGS, TAPE

From the Coding Guidelines:

The codes for enteral feeding supplies (B4034-B4036) include all supplies, other than the feeding tube itself, required for the administration of enteral nutrients to the beneficiary for one day. Codes B4034-B4036 describe a daily supply fee rather than a specifically defined “kit”. Some items are changed daily; others may be used for multiple days. Items included in these codes are not limited to pre-packaged “kits” bundled by manufacturers or distributors. These supplies include, but are not limited to, feeding bag/container, flushing solution bag/container, administration set tubing, extension tubing, feeding/flushing syringes, gastrostomy tube holder, dressings (any type) used for gastrostomy tube site, tape (to secure tube or dressings), Y connector, adapter, gastric pressure relief valve, declogging device, etc.  These items must not be separately billed using the miscellaneous code (B9998) or using specific codes for dressings or tape. The use of individual items may differ from beneficiary to beneficiary and from day to day. Only one unit of service may be billed for any one day. Units of service in excess of one per day will be rejected as incorrect coding. (Emphasis added)

The supply allowance codes B4034-B4036 are all-inclusive, other than the feeding tube.  Extension tubing and “per diem” charges for supplies must not be unbundled.  “Per diem” charges for professional services associated with the provision of enteral nutrition likewise are not separately billable.  Payment for professional services is included in the payment for all DMEPOS items.

Use of a NOC code to bill for an enteral pump is incorrect coding.  B9000 (ENTERAL NUTRITION INFUSION PUMP - WITHOUT ALARM) and B9002 (ENTERAL NUTRITION INFUSION PUMP - WITH ALARM) are separately billable, specific HCPCS codes to be used for these items.

Suppliers are reminded to be sure that the submitted product information clearly identifies the item for which the NOC code is being used.

Parenteral Nutrition

The analysis of B9999 reviewed 1196 claim lines finding that:

• 754 claim lines were identified as “per diem charges” 
• 313 claim lines were identified as an IV securement device.  An IV securement device is used to secure an IV to the beneficiary to ensure it is not dislodged.
• 26 claim lines were identified as the BioPatch®.  The BioPatch® is a round antibacterial dressing with a slit to fit around the IV site in order to prevent infection.

These claim lines are incorrectly coded.

The applicable supply allowance codes for parenteral nutrition are:

• B4220 PARENTERAL NUTRITION SUPPLY KIT; PREMIX, PER DAY
• B4222 PARENTERAL NUTRITION SUPPLY KIT; HOME MIX, PER DAY
• B4224 PARENTERAL NUTRITION ADMINISTRATION KIT, PER DAY

The supply allowance codes B4220-B4224 are all-inclusive.  Intravenous securement devices, the BioPatch® dressing, and “per diem” charges for supplies must not be unbundled.  “Per diem” charges for professional services associated with the provision of parenteral nutrition likewise are not separately billable.  Payment for professional services is included in the payment for all DMEPOS items.

Refer to the Enteral Nutrition and Parenteral Nutrition LCDs and their related Policy Articles for additional information.

For questions about correct coding, contact the Pricing, Data Analysis and Coding (PDAC) contractor Contact Center at (877) 735-1326 during the hours of 8:30 a.m. to 4:00 p.m. CT, Monday through Friday, or e-mail the PDAC by completing the DME PDAC Contact Form.