Pathology/Lab Coding Alert

Question: What is the correct code for BNP, and what conditions show medical necessity for the test?

Florida Subscriber

Answer: You should report the test for B-type natriuretic peptide (BNP) using 83880 (Natriuretic peptide). The blood test is an effective indicator of heart failure and may be useful for early diagnosis, tracking progression and monitoring response to therapy in patients with suspected or known heart failure.

Medicare does not have a National Coverage Determination for BNP, so local carriers and other insurers have their own rules regarding what indicates medical necessity for the test.

First Coast in Florida provides a list of covered diagnoses for BNP that includes many ICD-9 codes indicating known or suspected heart failure, such as 786.05 (Shortness of breath), 428.x (Heart failure) or 404.x (Hypertensive heart disease). You can contact other insurers to learn individual coverage rules.