Billing and Coding: B-Type Natriuretic Peptide (BNP)

This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L33267, B-Type Natriuretic Peptide (BNP). Please refer to the LCD for reasonable and necessary requirements. Coding Guidance Notice : It is not appropriate to bill Medicare for services that are not covered (as described by the entire LCD) as if they are covered. When billing for non-covered services, use the appropriate modifier. BNP is allowed when performed in an office (11), inpatient hospital (21), outpatient hospital (22), emergency room – hospital (23), independent laboratory (81), or in an urgent care facility (20) setting given that results are immediately available (e.g., Documentation Requirements All documentation must be maintained in the patient's medical record and made available to the contractor upon request. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient. The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed. If the provider of the service is other than the ordering/referring physician, that provider must maintain hard copy documentation of test results and interpretation, along with copies of the ordering/referring physician’s order for the studies. The physician must state the clinical indication/medical necessity for the study in his order for the test. An order from the treating physician/nonphysician practitioner as required by CFR, Title 42, Volume 2, Chapter IV, Part 410.32(a) Ordering diagnostic tests.