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NST CPT 59025

Tracie Posted Mon 25th of February, 2019 15:32:54 PM
If a patient presents to the labor and deliver floor with an order to rule out labor, the patient receives a non stress test. From those results, the patient is admitted or discharged to the facility. Can the facility charge 59025 and the physician charge 59025-26? The pregnancy is not preterm and the mother is healthy. Can you offer guidance of when and when not this should not be charged? Also, if a facility has a policy in place, can a NST be a standard test to evaluate the pregnancy well-being, as long as it is not a rule out labor (not pre-term labor).
SuperCoder Answered Tue 26th of February, 2019 08:38:22 AM


Hi,

Thanks for your question.

If the provider performs this test in the hospital setting, you should add modifier 26 (Professional component) to CPT® code 59025 because the hospital will be billing for the technical component.

Ob-gyns often use fetal monitor to determine if a woman is in labor, but that doesn't mean you should report 59025. Most likely you will include this fetal monitor use as part of labor management or the global ob package (such as 59400, Routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy, and/or forceps] and postpartum care).

Hope this helps.

Thanks.

 

Tracie Posted Tue 26th of February, 2019 09:03:34 AM
Can you give us information in regards to the technical portion for an acute hospital. Can we charge 59025 for rule out labor? Example 1: Patient present to the L&D floor, has an order from a provider, NST to rule out labor. the nursing staff performs the NST, patient is not in labor and discharged. The physician does read the NST and dictates a report. DX remains unchanged Example 2: Patient present to the L&D floor, no order, a protocol in place to do NST if the patient believes they are in labor. Nursing staff performs the NST, patient is not in labor & discharged. The physician does read the NST & dictates a report. Dx R/out labor Example 3: Patient presents to the L&D floor with order, r/o labor, it is noticed the kick count is off and noted. Patient has a UTI, then we have medical necessity, and additional dx codes. Then we can bill as a facility from my understanding. please review from the aspect as an acute facility, not professional.
SuperCoder Answered Wed 27th of February, 2019 11:33:04 AM

Hi,

Our team is working on this and will get back to you soon.

Thanks.

SuperCoder Answered Thu 28th of February, 2019 04:08:38 AM


Hi,

Thanks for our patience.

NST differs from “routine” monitoring in that the patient is asked to mark fetal movements on the monitor strip (or with newer equipment, fetal movement is detected and marked on the strip), which the physician then interprets as generally reactive, and nonreactive. Therefore, when the ob-gyn performs an NST to determine fetal well-being, you should report 59025. The NST is a valuable tool to be reassured that the baby is doing fine.

An ob-gyn can perform an NST for a patient in the early stages of labor if a problem with fetal well-being is suspected. But remember that the test must include an indication of fetal movements and the physician must interpret the strip and write (or dictate) a report, which must be entered into the patient record. In other words, it is not enough to put the patient on the monitor and bill for an NST.

When you're reporting 59025, you'd better be sure you've got supporting documentation--and the supporting diagnosis to justify this code. Most payers do not cover the NST unless your ob-gyn documented a specific reason.

In the first two examples, code 59025 could be added and in the third example since there is a additional diagnosis mentioned then E/M would be added.

Please find below link to Supercoder article on 59025 for labor check that can be helpful with some other examples also.

https://www.supercoder.com/coding-newsletters/my-ob-gyn-coding-alert/think-you-can-use-59025-for-labor-checks-think-again-article

If you are unable to open the link, please let us know so that we can provide you with the article.

Hope this helps.

Thanks.

Tracie Posted Thu 28th of February, 2019 08:21:44 AM
We do not have access to the article, can you please email it to me? Thank you for your response, that is appreciated.
SuperCoder Answered Fri 01st of March, 2019 09:08:29 AM


Hi,

I am pasting the article below, as I won't able to mail it to through this process.

Hope this helps.

Thanks.

NSTs monitor the fetus while labor checks assess the mother

If you are reporting 59025 when the ob-gyn checks to determine if a patient is in labor, you may not be coding accurately, even though the procedures are similar.
 
Ob-gyns often use a fetal monitor to determine if a woman is in labor. They use the same device for a fetal non-stress test (NST, 59025). But there are significant differences between the two procedures that require distinct approaches to coding.

Use 59025 for NST Only

To understand why you can't use 59025 for labor checks, first review what an NST involves. During the procedure, the ob-gyn monitors the fetal heart rate using external transducers. A "reactive" NST will show the fetal heart rate accelerate from the baseline 15 beats per minute for a minimum of 15 seconds at least twice during a 10-minute window, says Philip Eskew, MD, medical director of women and infants' services at St. Vincent's Hospital's Family Life Center in Indianapolis. If there are no accelerations after 20 minutes, the ob-gyn may attempt to induce a fetal response with acoustic stimulation through the mother's abdomen or a vibration that would awaken the baby or cause it to react to the stimulus. This stimulation might be repeated every five minutes for a maximum of two to three times, he notes. "If there are still no accelerations of the fetal heart rate, then it is interpreted as a 'nonreactive' NST."
 
"NST differs from 'routine' monitoring in that the patient is asked to mark fetal movements on the monitor strip, which the physician then interprets as generally reactive, nonreactive, and perhaps 'equivocal,' " according to Jeffrey Itkin, MD, FACOG, a former member of American College of Obstetrics and Gynecology's (ACOG's) Coding and Nomenclature Committee.
 
Therefore, when the ob-gyn performs an NST to determine fetal well-being, you should report 59025, Itkin says. According to Medicare's 2003 Physician Fee Schedule, the procedure carries 1.1 relative value units, meaning it's worth approximately $40.
 
On the other hand, an ob-gyn can perform an NST for a patient in the early stages of labor, Itkin points out. But remember that the patient must mark the fetal movements and the physician must interpret the strip and write (or dictate) a report, which must be entered into the patient record. "It is not enough to put the patient on the monitor and bill for an NST," Itkin adds.
 
"The NST is a valuable tool to be reassured that the baby is doing fine," Eskew says. "Spontaneous accelerations in response to an active baby are not only reassuring to the physician but often are an education to the mother: 'That's the baby moving? I have felt that before but didn't know it was the baby moving.' "

Include Labor Checks in Global

So the question remains: How do you get reimbursed for labor checks if you don't use 59025?
 
If the patient is at term, in labor and the ob-gyn admits her for delivery, the labor check is included as part of the global ob package (for example, 59400, Routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy, and/or forceps] and postpartum care), says Peggy Stilley, CPC, office manager for Women's Healthcare Specialists, an Oklahoma University-based private ob-gyn practice in Tulsa.
 
On the other hand, the physician may perform a labor check and then request an NST to be reassured that the fetus is well before sending the patient home, Eskew notes. "Most NSTs are performed when the patient states that she has not felt the baby move very much or the mother is past 40 weeks 0 days," he adds. As long as the patient does not deliver within 24 hours of admittance, the reimbursement for the labor check would be included in the initial hospital care (99221-99223, Initial hospital care, per day, for the evaluation and management of a patient ...), Stilley says. Because the ob-gyn did not admit the patient for delivery, he or she can report the initial care separately from the ob global period.
 
If the patient delivers less than 24 hours after admittance, however, you should again consider the labor check part of the ob global, Stilley adds. Consequently, you should not bill it separately.

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