Ob-Gyn Coding Alert

Question: We have a group practice: maternal fetal medicine (MFM) and ob-gyn. The MFM specialist at the ultrasound location has a unique tax ID. The office ob-gyn is billing at another location with a unique tax ID.

1ST ULTRASOUND SITE MFM specialist interprets BPP BPP score 6/8 -2 for no breathing Recommends NST

2ND OFFICE FOR NST obgyn Performs NST NST documented format on progress note: time documented as 40 mins for E/M (I am being convinced to code both the NST and the E/M service. Rationale being it is a problem visit. However, I feel it is an ob related visit and not billable separately. Also with the new outpatient guidelines “The AMA/ CPT^® guidelines are very clear that any time spent on a separately billable service (ultrasound, procedure, etc.), cannot be included in the time used to assign an E/M service level based on time.)

3RD OFFICE VISIT ROUTINE OB Same OBgyn who performs NST documents a 2nd progress note for routine OB visit E/M time as 20 mins

In this scenario that occurs on the same date of service:

Given that the BPP is interpreted and patient is sent for the NST, is it correct to bill (CPT^® 99215) 40 minutes E/M with the (CPT^® 59025) NST service. The note does not specify that x minutes were for the NST and y minutes were for E/M. It is just total time. What should I do?

In addition, the routine ob visit gets a 20 minutes time which is not billed because it is of the global package. What should I report?

Tennessee Subscriber

Answer: This below is the general antepartum guidelines:

The following services usually occur during antepartum care, but are not inclusive to the global ob package, and may be reported separately:

• Complications of the pregnancy
• Evaluation and management (E/M) services for problems unrelated to the pregnancy
• Lab tests performed outside of routine chemical urinalysis, including venipuncture
• Surgical complications or other problems related to the pregnancy
• Amniocentesis
• Chronic villous sampling
• Cordocentesis
• Fetal stress testing
• Fetal non-stress testing
• OB ultrasounds (limited or complete)
• Fetal biophysical profile
• Fetal electrocardiography
• RH immune globulin administration

You are correct that you may not bill for the routine ob visit on the same date of service. The MFM is going to only report the BPP interpretation as I assume you do not own the equipment? If you don’t, you will add a modifier 26 (Professional Component) to the BPP code (76818, Fetal biophysical profile; with non-stress testing).

As to the NST (59025, Fetal non-stress test), it is a 30-40 minute procedure and includes the interpretation and report as well as discussing the result with the patient. The 40 minutes he is assigning would be the time of the test and probably does not represent a separate significant E/M service. You can confirm this by looking at the start and stop times for the NST which should be on the report or documented in the record. Therefore, you shouldn’t bill a separate E/M as the purpose of the encounter was the NST.