Local Coverage Article Billing and Coding

Billing and Coding: Brain Natriuretic Peptide (BNP) Level

A56565

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Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.

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Note History

Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A56565
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Brain Natriuretic Peptide (BNP) Level
Article Type
Billing and Coding
Original Effective Date
05/30/2019
Revision Effective Date
10/01/2023
Revision Ending Date
N/A
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2022 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

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CMS National Coverage Policy

Title XVIII of the Social Security Act, §1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, §80.1 Clinical Laboratory Services

Article Guidance

Article Text

The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Brain Natriuretic Peptide (BNP) Level L33422.

Response To Comments

Number Comment Response
1
N/A

Coding Information

Bill Type Codes

Code Description
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Revenue Codes

Code Description
N/A

CPT/HCPCS Codes

Group 1

(1 Code)
Group 1 Paragraph

CPT® code 83880 may be reasonable once a month for an individual patient. There must be supportive documentation in the medical record to demonstrate the medical necessity of more frequent testing.

Group 1 Codes
Code Description
83880 Assay of natriuretic peptide
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CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

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Group 1 Codes

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ICD-10-CM Codes that Support Medical Necessity

Group 1

(112 Codes)
Group 1 Paragraph

Use of these codes does not guarantee reimbursement. The patient's medical record must document that the coverage criteria in the related LCD have been met.

Group 1 Codes
Code Description
E85.81 Light chain (AL) amyloidosis
E85.82 Wild-type transthyretin-related (ATTR) amyloidosis
E85.89 Other amyloidosis
I11.0 Hypertensive heart disease with heart failure
I13.0 Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
I13.2 Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease
I16.0 Hypertensive urgency
I16.1 Hypertensive emergency
I16.9 Hypertensive crisis, unspecified
I1A.0 Resistant hypertension
I20.0 Unstable angina
I20.81 Angina pectoris with coronary microvascular dysfunction
I20.89 Other forms of angina pectoris
I21.01 ST elevation (STEMI) myocardial infarction involving left main coronary artery
I21.02 ST elevation (STEMI) myocardial infarction involving left anterior descending coronary artery
I21.09 ST elevation (STEMI) myocardial infarction involving other coronary artery of anterior wall
I21.11 ST elevation (STEMI) myocardial infarction involving right coronary artery
I21.19 ST elevation (STEMI) myocardial infarction involving other coronary artery of inferior wall
I21.21 ST elevation (STEMI) myocardial infarction involving left circumflex coronary artery
I21.29 ST elevation (STEMI) myocardial infarction involving other sites
I21.3 ST elevation (STEMI) myocardial infarction of unspecified site
I21.4 Non-ST elevation (NSTEMI) myocardial infarction
I21.9 Acute myocardial infarction, unspecified
I21.A1 Myocardial infarction type 2
I21.A9 Other myocardial infarction type
I21.B Myocardial infarction with coronary microvascular dysfunction
I22.0 Subsequent ST elevation (STEMI) myocardial infarction of anterior wall
I22.1 Subsequent ST elevation (STEMI) myocardial infarction of inferior wall
I22.2 Subsequent non-ST elevation (NSTEMI) myocardial infarction
I22.8 Subsequent ST elevation (STEMI) myocardial infarction of other sites
I22.9 Subsequent ST elevation (STEMI) myocardial infarction of unspecified site
I24.81 Acute coronary microvascular dysfunction
I24.89 Other forms of acute ischemic heart disease
I25.110 Atherosclerotic heart disease of native coronary artery with unstable angina pectoris
I25.112 Atherosclerotic heart disease of native coronary artery with refractory angina pectoris
I25.700 Atherosclerosis of coronary artery bypass graft(s), unspecified, with unstable angina pectoris
I25.702 Atherosclerosis of coronary artery bypass graft(s), unspecified, with refractory angina pectoris
I25.710 Atherosclerosis of autologous vein coronary artery bypass graft(s) with unstable angina pectoris
I25.712 Atherosclerosis of autologous vein coronary artery bypass graft(s) with refractory angina pectoris
I25.720 Atherosclerosis of autologous artery coronary artery bypass graft(s) with unstable angina pectoris
I25.722 Atherosclerosis of autologous artery coronary artery bypass graft(s) with refractory angina pectoris
I25.730 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with unstable angina pectoris
I25.732 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with refractory angina pectoris
I25.750 Atherosclerosis of native coronary artery of transplanted heart with unstable angina
I25.752 Atherosclerosis of native coronary artery of transplanted heart with refractory angina pectoris
I25.760 Atherosclerosis of bypass graft of coronary artery of transplanted heart with unstable angina
I25.762 Atherosclerosis of bypass graft of coronary artery of transplanted heart with refractory angina pectoris
I25.790 Atherosclerosis of other coronary artery bypass graft(s) with unstable angina pectoris
I25.792 Atherosclerosis of other coronary artery bypass graft(s) with refractory angina pectoris
I31.1 Chronic constrictive pericarditis
I31.31 Malignant pericardial effusion in diseases classified elsewhere
I31.39 Other pericardial effusion (noninflammatory)
I42.0 Dilated cardiomyopathy
I42.1 Obstructive hypertrophic cardiomyopathy
I42.2 Other hypertrophic cardiomyopathy
I42.5 Other restrictive cardiomyopathy
I42.8 Other cardiomyopathies
I42.9 Cardiomyopathy, unspecified
I50.1 Left ventricular failure, unspecified
I50.20 Unspecified systolic (congestive) heart failure
I50.21 Acute systolic (congestive) heart failure
I50.22 Chronic systolic (congestive) heart failure
I50.23 Acute on chronic systolic (congestive) heart failure
I50.30 Unspecified diastolic (congestive) heart failure
I50.31 Acute diastolic (congestive) heart failure
I50.32 Chronic diastolic (congestive) heart failure
I50.33 Acute on chronic diastolic (congestive) heart failure
I50.40 Unspecified combined systolic (congestive) and diastolic (congestive) heart failure
I50.41 Acute combined systolic (congestive) and diastolic (congestive) heart failure
I50.42 Chronic combined systolic (congestive) and diastolic (congestive) heart failure
I50.43 Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure
I50.810 Right heart failure, unspecified
I50.811 Acute right heart failure
I50.812 Chronic right heart failure
I50.813 Acute on chronic right heart failure
I50.814 Right heart failure due to left heart failure
I50.82 Biventricular heart failure
I50.83 High output heart failure
I50.84 End stage heart failure
I50.89 Other heart failure
I50.9 Heart failure, unspecified
I60.2 Nontraumatic subarachnoid hemorrhage from anterior communicating artery
I63.013 Cerebral infarction due to thrombosis of bilateral vertebral arteries
I63.033 Cerebral infarction due to thrombosis of bilateral carotid arteries
I63.113 Cerebral infarction due to embolism of bilateral vertebral arteries
I63.133 Cerebral infarction due to embolism of bilateral carotid arteries
I63.213 Cerebral infarction due to unspecified occlusion or stenosis of bilateral vertebral arteries
I63.233 Cerebral infarction due to unspecified occlusion or stenosis of bilateral carotid arteries
I63.313 Cerebral infarction due to thrombosis of bilateral middle cerebral arteries
I63.323 Cerebral infarction due to thrombosis of bilateral anterior cerebral arteries
I63.333 Cerebral infarction due to thrombosis of bilateral posterior cerebral arteries
I63.343 Cerebral infarction due to thrombosis of bilateral cerebellar arteries
I63.413 Cerebral infarction due to embolism of bilateral middle cerebral arteries
I63.423 Cerebral infarction due to embolism of bilateral anterior cerebral arteries
I63.433 Cerebral infarction due to embolism of bilateral posterior cerebral arteries
I63.443 Cerebral infarction due to embolism of bilateral cerebellar arteries
I63.513 Cerebral infarction due to unspecified occlusion or stenosis of bilateral middle cerebral arteries
I63.523 Cerebral infarction due to unspecified occlusion or stenosis of bilateral anterior cerebral arteries
I63.533 Cerebral infarction due to unspecified occlusion or stenosis of bilateral posterior cerebral arteries
I63.543 Cerebral infarction due to unspecified occlusion or stenosis of bilateral cerebellar arteries
R06.00 Dyspnea, unspecified
R06.01 Orthopnea
R06.02 Shortness of breath
R06.03 Acute respiratory distress
R06.09 Other forms of dyspnea
R06.2 Wheezing
R06.3 Periodic breathing
R06.82 Tachypnea, not elsewhere classified
R06.83 Snoring
R06.89 Other abnormalities of breathing
R60.0 Localized edema
R60.1 Generalized edema
N/A

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

Group 1 Paragraph

All other ICD-10-CM codes not listed under ICD-10-CM Codes that Support Medical Necessity will be denied as not medically necessary.

Group 1 Codes

N/A

N/A

ICD-10-PCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description
N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Code Description
N/A

Other Coding Information

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A N/A
N/A
Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A

Revision History Information

Revision History Date Revision History Number Revision History Explanation
10/01/2023 R5

Under ICD-10 Codes that Support Medical Necessity Group 1: Codes the description was revised for I25.112 and added I1A.0, I20.81, I20.89, I21.B, I24.81 and I24.89. This revision is due to the Annual ICD-10-CM Update and will become effective on 10/1/23.

10/01/2022 R4

Under ICD-10 Codes that Support Medical Necessity Group 1: Codes added I25.112, I25.702, I25.712, I25.722, I25.732, I25.752, I25.762, I25.792, I31.31 and I31.39. This revision is due to the Annual ICD-10-CM Update and will become effective on 10/1/22.

08/03/2020 R3

Under CMS National Coverage Policy added verbiage to read “Title XVIII of the Social Security Act, §1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.” Under Article Text added verbiage to read “The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Brain Natriuretic Peptide (BNP) Level L33422”. Under CPT/HCPCS Codes Group 1: Paragraph added the registered mark to CPT. Under ICD-10 Codes that Support Medical Necessity Group 1: Paragraph changed verbiage to read “The patient's medical record must document that the coverage criteria in the related LCD have been met”. Under ICD-10 Codes that Support Medical Necessity Group 1: Codes added E85.81, E85.82, E85.89. Formatting, punctuation and typographical errors were corrected throughout the article.

10/10/2019 R2

This article is being revised in order to adhere to CMS requirements per chapter 13, section 13.5.1 of the Program Integrity Manual, to remove all coding from LCDs and incorporate into related Billing and Coding Articles. Regulations regarding billing and coding were removed from the CMS National Coverage Policy section of the related Brain Natriuretic Peptide (BNP) Level L33422 LCD and placed in this article.

 

05/30/2019 R1

All coding located in the Coding Information section has been removed from the related Brain Natriuretic Peptide (BNP) Level L33422 LCD and added to this article.

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L33422 - Brain Natriuretic Peptide (BNP) Level
Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
08/16/2023 10/01/2023 - N/A Currently in Effect You are here
08/10/2022 10/01/2022 - 09/30/2023 Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

  • Brain
  • Natriuretic
  • Peptide
  • BNP