Ob-Gyn Coding Alert

Question: A patient is admitted to a hospital at 37 weeks for preterm labor and stays for 15 days but does not deliver. Can the attending physician charge outside the global for the interpretation of the non-stress tests (NST), such as 59025 with a modifier? And up to how many readings per day would it be appropriate to charge?


New Jersey Subscriber


Answer: First, at 37 weeks, the condition technically is not premature labor (644.0x), but rather "other threatened labor" - such as 644.1x (False labor) if she does not go on to deliver during this hospitalization.

The physician can report the admission and rounding on the patient each day, but billing for the NST will depend on whether the ob-gyn actually performed an NST. In other words, in order for you to bill for 59025 (Fetal non-stress test), the patient must mark the strip to indicate the fetal movements throughout the 30-40 minutes of the test.

It would be necessary to perform this only if the physician suspected a fetal problem. If the physician uses external fetal monitors to count contractions or monitor fetal heart rate, that would not be a separately reportable service but part of the exam.
 
If the physician performed a true NST, documented it, and provided an interpretation of the results, then the ob-gyn should report 59025 with modifier -26 (Professional component). There are no protocols that stipulate the number of NSTs that physicians can perform per day, but the payer will likely ask for medical-necessity information if they are done more than once a day - especially if the results are all OK and the patient is close to term.