Ob-Gyn Coding Alert

Although you have one code -- 59025 -- to reflect a fetal non-stress test (NST) service, you must look for certain qualities to differentiate fetal NSTs and labor checks,take into account your place of service, and pinpoint accurate diagnosis codes.

Our experts break down what your fetal NST claims need to pass your payer's muster.

When you report 59025 (Fetal non-stress test) for NST procedures, make sure you-re reporting them in the appropriate situations.What happens: During the NST procedure, the ob-gyn evaluates the patient and assesses fetal well-being without using IV medications, says Lavon E. Carter, CPC,reimbursement analyst at Maternal Fetal Associates of Kansas & PARAGYN Surgical LLC in Wichita.

-A belt is placed on the mother to assess the fetal heart rate and movement,- says Erica D. Schwalm, CPC-GENSG, coding and reimbursement specialist for Hampden County Physicians in Ludlow, Mass. Overall, the test lasts 30-40 minutes, during which 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. If there are no accelerations after 20 minutes, the ob-gyn may attempt toinduce a fetal response with acoustic stimulation through the mother's abdomen or a vibration. The acoustic stimulation or vibration is for waking the baby or to cause it to react to the stimulus. The ob-gyn might repeat this stimulation every five minutes for a maximum of two to three times. If the baby's heart rate still does not accelerate, the obgyn will determine this to be a -nonreactive- NST.

Key: The most important factor is that the patient marks the fetal movements. The ob-gyn interprets the strip and writes (or dictates) a report that he must include in the patient's record.

For example, your ob-gyn sees a patient at 31 weeks gestation who complains that her fetus has not been moving much in the past few weeks. During the first 20 minutes of monitoring, the ob-gyn uses the external transducers and detects no fetal heart rate accelerations. Afterward, he tries an electronic larynx to stimulate the fetus with noise through the patient's abdomen. The mother marks the strip when she feels movement throughout the 30-40 minutes of the test.

You would report this service with 59025 because the ob-gyn is using the NST to determine fetal status. Notice how this procedure takes longer than a labor check and requires repeated stimulations to assess the specific fetal reaction or lack thereof.

You need to be conscientious of your place-of-service(POS), because if your ob-gyn performs a fetal NST in the hospital, you should include modifier 26 (Professional component) with 59025.

Why: You should add modifier 26 to 59025 because the hospital owns the equipment and will report that portion of the service.

With that in mind, try your hand at these scenarios:

Scenario 1: A pregnant patient came into the office and underwent a fetal NST because of decreased fetal movement. Dr. A performed this test, and then sent her to the hospital. Dr. B (of the same practice) did another NST for abnormal fetal heart rate on the same date. What should you do?

You should report:

- 59025

- 59025-26-59 (Distinct procedural service).

Appended to the second NST code, modifier 26 tells the payer the second test took place in the hospital, and modifier 59 alerts the payer to a separate, distinct procedure.

Scenario 2: Your ob-gyn admits a pregnant patient who had a motor vehicle accent (MVA) for observation.She underwent a continuous 12 hours of fetal NST. Whatshould you do?

You know that a fetal NST is a 40-minute test to check on fetal well-being. If the ob-gyn is monitoring the patient continuously for 12 hours, then you should include that monitoring as part of the observation care (99217-99220).

If the ob-gyn is truly doing a 12 hours fetal NST and the patient marks fetal movements during this whole time, then you should report the unlisted code 59899 (Unlisted procedure, maternity care and delivery) with modifier 26 to show the ob-gyn is not using your practice's own equipment.

Don't Overlook ICD-9

When you-re reporting 59025, you should make sure you have a specific diagnosis and not just a pregnancy code (V22.x). Most payers do not cover the NST unless your ob-gyn documented a specific reason, Carter says

-Aetna, for example, will not pay if the NST is -routine- (V22.x),- Schwalm points out. Check out its policy at www.aetna.com/cpb/medical/data/1_99/0088.html.

Example: Refer back to Scenario 1 above. In this two NSTs situation, you would use the decreased fetal movement code (655.73) for the first NST. For the second,you could link abnormal fetal heart rate (659.7,Abnormality in fetal heart rate and rhythm). Two separate diagnoses further delineate two different procedures.