DUR Codes: Difference between revisions
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==Drug Utilization Review Codes== | ==Drug Utilization Review Codes== | ||
DUR codes are sometimes required to override specific rejections. These codes change from prescription to prescription, so it is usually safer to call the insurance company and get the appropriate sequence of codes from them. Additionally, insurance reject messages might also specify what code they want in what field. | DUR codes are sometimes required to override specific rejections. These codes change from prescription to prescription, so it is usually safer to call the insurance company and get the appropriate sequence of codes from them. Additionally, insurance reject messages might also specify what code they want in what field. DUR codes can sometimes be referred to in a reject as '''HX PPS''' codes. | ||
A DUR code is comprised of three parts; the Conflict code, the Professional Service code, and the Result of Service code. To send the DUR code, go to any SIG line and put the following: | A DUR code is comprised of three parts; the Conflict code, the Professional Service code, and the Result of Service code. To send the DUR code, go to any SIG line and put the following: | ||
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|DM || Apparent Drug Misuse | |DM || Apparent Drug Misuse | ||
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|DR || Dose Range Conflict | |||
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|DS || Tobacco use precaution | |DS || Tobacco use precaution | ||
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|3H || Follow-up/Report, Verbal and/or Written information was communicated from the Pharmacist to the Prescriber or Patient. | |3H || Follow-up/Report, Verbal and/or Written information was communicated from the Pharmacist to the Prescriber or Patient. | ||
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|3J || Patient Referral | |||
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|3K || Instructions Understood | |||
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|3M || Compliance Aid Provided | |||
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|3N || Medication Administered | |||
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|4A || Prescribed with Acknowledgments | |||
|- | |||
|4B || Dispensed, Palliative Care | |||
|- | |||
|4C || Dispensed, Hospice | |||
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|4D || Dispensed, Cancer Treatment | |||
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|4E || Dispensed, Chronic Pain | |||
|- | |||
|4F || Dispensed, Exempt Per Prescriber | |||
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|4G || Dispensed, Surgery/Trauma | |||
|- | |||
|4H || Dispensed, Hospital Admission/Discharge | |||
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|4J || Dispensed, Patient Is Not Opioid Naïve | |||
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|4K || Prescriber Specialty Exemption-Oncology or non-hospice Palliative Care | |||
|- | |||
|4L || Prescriber Specialty Exemption-Hospice | |||
|} | |} |
Latest revision as of 14:27, 20 October 2022
Drug Utilization Review Codes
DUR codes are sometimes required to override specific rejections. These codes change from prescription to prescription, so it is usually safer to call the insurance company and get the appropriate sequence of codes from them. Additionally, insurance reject messages might also specify what code they want in what field. DUR codes can sometimes be referred to in a reject as HX PPS codes.
A DUR code is comprised of three parts; the Conflict code, the Professional Service code, and the Result of Service code. To send the DUR code, go to any SIG line and put the following:
/DURxxyyzz
xx = Conflict code NCPDP Field 439-E4
yy = Professional Service Code (Formerly Intervention code) NCPDP field 440-E5
zz = Result of Service Code (Formerly Outcome code) NCPDP field 441-E6
NOTE: If someone needs to send just the conflict, intervention, or outcome codes, they may use /DUC, /DUI, or /DUO and the respective code.
Conflict Codes
Code | Description |
AD | Additional Drug needed |
AN | Prescription Authentication |
AR | Adverse Drug Reaction |
AT | Additive Toxicity |
CH | Call HELP Desk |
CS | Patient Complaint/Symptom |
DA | Drug-Allergy Alert |
DC | Drug-Disease Inferred precaution |
DD | Drug-Drug Interaction |
DF | Drug-Food Interaction |
DI | Drug Incompatibility |
DL | Drug-Lab Conflict |
DM | Apparent Drug Misuse |
DR | Dose Range Conflict |
DS | Tobacco use precaution |
ER | OverUse precaution |
EX | Excessive Quantity |
HD | High Dose Alert |
IC | Iatrogenic Condition Alert |
ID | Ingredient duplication |
LD | Low Dose Alert |
LR | UnderUse precaution |
MC | Drug-Disease (Reported) precaution |
MN | Insufficient duration Alert |
MS | Missing Information/Clarification |
MX | Excessive duration Alert |
NA | Drug Not Available |
ND | New Disease/Diagnosis |
NF | Non-formulary Drug |
NN | Unnecessary Drug |
NP | New Patient Processing |
NR | Lactation/Nursing Interaction |
NS | Insufficient Quantity |
OH | Alcohol precaution |
PA | Drug-Age precaution |
PC | Patient Consultation/Education |
PG | Drug-Pregnancy Alert |
PN | Prescriber Consultation |
PP | Plan Protocol |
PR | Prior adverse drug reaction |
PS | Product Selection Opportunity |
RF | Health Provider Referral |
SD | Suboptimal Drug/Indication |
SE | Side Effect Therapy |
SF | Suboptimal Dosage Form |
SR | Suboptimal Regimen |
SX | Drug-Gender Alert |
TD | Therapeutic duplication |
TN | Laboratory Test Needed |
TP | Payer/Processor Question |
Professional Service Codes
Code | Description |
00 | No Intervention |
AS | Patient Assessment |
CC | CoordinatIon of Care |
DE | Dosing Evaluation/Determination |
FE | Formulary Enforcement |
GP | Generic product selection |
M0 | Prescriber Consulted |
MR | Medication Review |
P0 | Patient Consulted |
PE | Patient Education/Instruction |
PF | Patient Referral |
PH | Patient Medication History |
PM | Patient Monitoring |
PT | Perform Laboratory Test |
R0 | Pharmacist Consulted other source |
RT | Recommend Laboratory Test |
SC | Self-Care Consultation |
SW | Literature Search/Review |
TC | Payer/Processor Consulted |
TH | Therapeutic Product Interchange |
Result of Service Codes
Code | Description |
Blank | NOT Specified |
00 | NOT Specified |
1A | Filled as is, False positive. |
1B | Filled prescription as is. |
1C | Filled with different Dose. |
1D | Filled with different Directions. |
1E | Filled with different Drug. |
1F | Filled with different Quantity. |
1G | Filled with Prescriber approval. |
1H | Brand to Generic change. |
1J | Rx to OTC change. |
2A | Prescription NOT filled. |
2B | NOT filled, directions clarified. |
3A | Recommendation Accepted |
3B | Recommendation Not Accepted |
3C | Discontinued Drug, Prescriber authorized Discontinuance of drug |
3D | Regimen Changed |
3E | Therapy Changed |
3F | Therapy Changed--Cost increase acknowledged |
3G | Drug Therapy Unchanged |
3H | Follow-up/Report, Verbal and/or Written information was communicated from the Pharmacist to the Prescriber or Patient. |
3J | Patient Referral |
3K | Instructions Understood |
3M | Compliance Aid Provided |
3N | Medication Administered |
4A | Prescribed with Acknowledgments |
4B | Dispensed, Palliative Care |
4C | Dispensed, Hospice |
4D | Dispensed, Cancer Treatment |
4E | Dispensed, Chronic Pain |
4F | Dispensed, Exempt Per Prescriber |
4G | Dispensed, Surgery/Trauma |
4H | Dispensed, Hospital Admission/Discharge |
4J | Dispensed, Patient Is Not Opioid Naïve |
4K | Prescriber Specialty Exemption-Oncology or non-hospice Palliative Care |
4L | Prescriber Specialty Exemption-Hospice |