DUR Codes

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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.

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:

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