Annie Posted Wed 13th of July, 2016 09:55:30 AM
Patient comes in through the ER and admit for observation patient doesn't really have any major issues so provider gives a charge entry card for NST. What has to be documented for me to charge for NST only?
SuperCoder Answered Thu 14th of July, 2016 03:03:03 AM
The CPT code for NST would be 59025, Fetal non-stress test, along with modifier 26, Professional Component, because the hospital owns the equipment and will report for that portion of the service. However, When you're reporting 59025, you must have supporting documentation and diagnosis to justify this code. You should make sure you have a specific diagnosis and not just a pregnancy code. Most payers do not cover the NST unless your ob-gyn documented a specific reason. Thus, there should be a medical necessity to support the code.
Hope this helps!
Annie Posted Thu 14th of July, 2016 09:28:25 AM
I know the code for the NST. My question still has not been answered. Providers are seeing patients in the hospital for observations but they want me to only charge for the NST but the only thing they have documented is no changes and the patient is discharged.
SuperCoder Answered Fri 15th of July, 2016 07:26:07 AM
Arbitrarily coding or billing CPT code 59025 for NST for all pregnant patients who are attached to the fetal monitoring device should not occur as this may be considered routine fetal monitoring. Since the patient is transferred from the ER to observation care, you may report the observation codes along with 59205. When a patient is admitted for observation care for less than 8 hours on the same calendar date, the Initial Observation Care, from CPT code range 99218 – 99220, shall be reported by the physician. The Observation Care Discharge Service, CPT code 99217, shall not be reported for this scenario. When a patient is admitted for observation care and then discharged on a different calendar date, the physician shall report Initial Observation Care, from CPT code range 99218 – 99220 and CPT observation care discharge CPT code 99217. When a patient has been admitted for observation care for a minimum of 8 hours, but less than 24 hours and discharged on the same calendar date, Observation or Inpatient Care Services (Including Admission and Discharge Services) from CPT code range 99234 – 99236, shall be reported. The observation discharge, CPT code 99217, cannot also be reported for this scenario. Hence, you may report codes 59025-26 and the appropriate observation code as per level of service with modifier 25 in this scenario.
Hope this helps!