Ob-Gyn Coding Alert

Tip:  Make sure you include labor checks in the global ob code

Do you want to code fetal non-stress test (NST) using 59025? Better make sure the patient recorded when she feels the baby moving. Otherwise, count the fetal monitoring as routine. Find Out What Makes a True NST 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 Denell Engstrom, CPC, coding manager and billing specialist at the Woman's Clinic in Boise, Idaho. 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 to induce 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  ob-gyn will determine this to be a -nonreactive- NST.

Key concept: 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.

Heads up: If the ob-gyn performs this test in the hospital setting, you should add modifier 26 (Professional component) to 59025. You should add modifier 26 to 59025 because the hospital owns the equipment and will report for that portion of the service. Don't Overlook ICD-9 When you-re reporting 59025, you-d better be sure you-ve got supporting documentation--and the supporting diagnosis to justify this code. -You should make [...]