Ob-Gyn Coding Alert

Decide whether to include this in routine ob care.

Take the following coding quiz to cement your skills for telling the difference between a fetal non-stress test (NST) and a labor check. Make sure you know what codes to report in each situation.

Scenario 1: A patient presents whose water has broken, but she doesn’t feel any contractions. She’s in week 38 of gestation and has dilated 3 cm. Prior to admission, the ob-gyn evaluates the baby with a fetal monitor to be reassured that the baby is OK and the mother is not having contractions.

Coding Solution 1: In this case, the physician uses the external transducer to determine the mother’s condition. He did not use it to assess the fetus. Therefore, you should include the labor check as part of the global ob package (for example, 59610, Routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy, and/or forceps] and postpartum care, after previous cesarean delivery).

Scenario 2: A patient at 30 weeks of gestation comes to the doctor’s office complaining that her fetus has not been moving much in the past few weeks. The ob-gyn places the external transducer and performs an NST, using an electronic larynx to stimulate the fetus with noise through the patient’s abdomen when there are no fetal heart rate accelerations during the first 20 minutes of monitoring.

Coding Solution 2: You would report this service with 59025 (Fetal non-stress test). The ob-gyn uses the NST to determine the status of the fetus. The procedure takes longer than a labor check and requires repeated stimulations to assess the specific fetal reaction or lack thereof.

Scenario 3: A patient at 32 weeks’ gestation presents in labor. The ob-gyn admits her to the hospital and places the external transducer on the woman’s abdomen, giving her medication to halt the labor. Based on the readings from the transducer, the labor stops.

Coding Solution 3: Here, you should include the labor check in the hospital admit (99221-99223). As in the first scenario, the ob-gyn did not use the external transducer to examine the fetus’ condition, but to monitor the patient’s contractions. Therefore, you would not report a separate NST.