Ob-Gyn Coding Alert

Question: When a patient comes in for a non-stress test (NST) or an ultrasound, can I include an evaluation and management (E/M) code with the NST or ultrasound?

Montana Subscriber

Answer: The answer depends on several factors. If you are billing global ob care, the visits are part of the package until after the 13th antepartum visit. If the E/M service is for the management of a complication of pregnancy, some payers may reimburse for these additional visits and some may not. At the very least, you would have to show that the E/M service was significant and separately identifiable from the NST or ultrasound exam (76815, echography, pregnant uterus, B-scan and/or real time with image documentation; limited [fetal size, heart beat, placental location, fetal position, or emergency in the delivery room]), therefore physician documentation will be crucial.

If you are a maternal fetal specialist who sees the patient only infrequently and is performing the NST or ultrasound that is, you are not billing for the global service you can itemize your E/M services, but the same rule holds in this case. Has the physician documented a significant and separately identifiable E/M service at the time of the NST or ultrasound exam? If the answer is yes, bill both remembering to add modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M service. If not, bill only for the study performed.