Correct Billing of BNP: Again, again and again…

on Tuesday, 12 February 2013. All News Items | Billing

For seemingly the umpteenth time, Cahaba GBA has published a reminder concerning the correct billing of Serum-type B Natriuretic Peptide (BNP) Testing (CPT code 83380). The Part A prepay review of bill type 14x (outpatient laboratory testing) continues to indicate a high error rate. The main reasons for denials are that documentation does not support the clinical urgency for the test and lack of timely submission of requested documentation. Remember that per Cahaba’s LCD, BNP is only indicated when there is an acute event such as:

  • Establishing diagnosis of congestive heart failure (CHF) in acutely ill patients presenting with dyspnea or
  • Predicting long term risk in the first few days after an acute cardiac event (including acute exacerbation of previously diagnosed CHF).

BNP is not covered for monitoring or tailoring treatment for CHF.

Article by Debbie Rubio

Debbie Rubio, BS, MT (ASCP), is the Manager of Regulatory Affairs and Compliance at Medical Management Plus, Inc. Debbie has over twenty-seven years of experience in healthcare including nine years as the Clinical Compliance Coordinator at a large multi-facility health system. In her current position, Debbie monitors, interprets and communicates current and upcoming regulatory and compliance issues as they relate to specific entities concerning Medicare and other payers. You may contact Debbie at This email address is being protected from spambots. You need JavaScript enabled to view it. .

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