Coding Information

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 policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims. 12 Hospital Inpatient (Medicare Part B only) 13 Hospital Outpatient 14 Hospital - Laboratory Services Provided to Non-patients 21 Skilled Nursing - Inpatient (Including Medicare Part A) 22 Skilled Nursing - Inpatient (Medicare Part B only) 23 Skilled Nursing - Outpatient 71 Clinic - Rural Health 72 Clinic - Hospital Based or Independent Renal Dialysis Center 77 Clinic - Federally Qualified Health Center (FQHC) 85 Critical Access Hospital 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 policy 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 policy should be assumed to apply equally to all Revenue Codes. 0300 Laboratory - General Classification 0301 Laboratory - Chemistry 0520 Freestanding Clinic - General Classification 0521 Freestanding Clinic - Clinic Visit by Member to RHC/FQHC 0523 Freestanding Clinic - Family Practice Clinic 0525 Freestanding Clinic - Visit by RHC/FQHC Practitioner to a Member in a SNF (not in a Covered Part A Stay) or NF or ICF MR or Other Residential Facility CPT/HCPCS Codes: Group 1 Paragraph: N/A Group 1 CPT Codes: 83880 NATRIURETIC PEPTIDE ICD-10 Codes That Are Covered It is the responsibility of the provider to code to the highest level specified in the ICD-10-CM (e.g., to the third to seventh character). The correct use of an ICD-10-CM code listed below does not assure coverage of a service. The service must be reasonable and necessary in the specific case and must meet the criteria specified in this determination. 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 I20.0 Unstable angina I20.2 Refractory 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.A1 Myocardial infarction type 2 I21.A9 Other myocardial infarction type I22.0 Subsequent ST elevation (STEMI) myocardial infarction of anterior 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 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 I42.0 Dilated cardiomyopathy I42.5 Other restrictive cardiomyopathy I42.8 Other cardiomyopathies I50.1 Left ventricular failure, unspecified I50.21 Acute systolic (congestive) heart failure I50.22 Chronic systolic (congestive) heart failure I50.23 Acute on chronic systolic (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 I50.41 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 I5A Non-ischemic myocardial injury (non-traumatic) J44.0 Chronic obstructive pulmonary disease with (acute) lower respiratory infection J44.1 Chronic obstructive pulmonary disease with (acute) exacerbation J45.901 Unspecified asthma with (acute) exacerbation J98.01 Acute bronchospasm 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 R06.82 Tachypnea, not elsewhere classified R06.89 Other abnormalities of breathing R60.1 Generalized edema ICD-10 Codes That Are Not Covered N/A

Revision History Information

Revision History Date Revision History Number Revision History Explanation 10/01/2022 R3 Updated to indicate this article is an LCD Reference Article 10/01/2022 R2 The following ICD-10 codes were added to Group 1: I20.2; I25.112, I25.702, I25.712, I25.722, I25.732, I25.752, I25.762, I25.792. This revision is due to the annual ICD-10-CM updates effective 10/1/2022.  10/01/2021 R1 Per the 2022 ICD-10 CM annual updates, code I5A was added to Group 1 effective 10/1/2021.