J98.01 — Acute bronchospasm
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- This article provides billing, coding, and guideline information that complements Local Coverage Determination (LCD) L34410 for B-type Natriuretic Peptide (BNP) testing; refer to LCD L34410 for clinical coverage criteria.
- Claims must follow the complementary Local Coverage Determination (LCD L34430) and, when CPT 97000–97799 are used by PT/OT, must include documentation that the services meet the coverage and documentation requirements for physical or occupational therapy.
- Supporting documentation must demonstrate that CPT 31720 was personally performed by the physician or qualified NPP when billing that code.
- For consecutive days of respiratory therapy, the medical record must document why the patient was not transferred to a higher level of care.
Key Coverage Criteria
- Therapeutic procedures whose principal aim is to treat a respiratory impairment must be billed using HCPCS codes G0237, G0238, or G0239.
- CPT 94762 is medically necessary when intermittent arterial blood gas sampling is likely to miss important variations in the patient's respiratory status.
- CPT 94762 is medically necessary when the patient has hypoxemia and there is a need to assess supplemental oxygen requirements and/or a therapeutic oxygen regimen.
- BNP testing is covered when medical necessity is documented in the patient's record in accordance with the related Local Coverage Determination (LCD).
- BNP testing performed as a diagnostic test should have the test result reported on the claim if known; if result is not known, report the symptoms that prompted the test.
- B-type natriuretic peptide (BNP) testing is covered when performed in accordance with the associated Local Coverage Determination (LCD) and the patient's clinical indications documented in the medical record.
20 Active Policies
L33573 — B-type Natriuretic Peptide (BNP) Testing
J06
A56826 — Billing and Coding: B-type Natriuretic Peptide (BNP) Testing
J06
A57205 — Billing and Coding: Oximetry Services
J12
L35434 — Oximetry Services
J12
A56605 — Billing and Coding: B-type Natriuretic Peptide (BNP) Testing
Related Codes
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