Wiki Required NST Documentation - 59025

[tloeb]

Can anyone way in on whether a NST 59025 is billable when the documented components of the NST are comingled within the E/M documentation? Or does the NST need to be documented separately either as a procedure note or within the E/M notes as a separtely titled procedure with detail/results? Example of comingled within the E/M that ACOG is stating not billable is below NST in bold:
Objective

Vitals:
	09/09/23 1839	09/09/23 1850	09/09/23 1859	09/09/23 1909
BP:	144/82	136/70	131/72	136/72
Pulse:	111	103	102	100
Resp:
Temp:

Gen: AO x 3, NAD
CV: RRR
Resp: CTAB
Skin: warm and dry to touch, no rashes
Abdomen: Gravid, soft, NT to palpation
Back: neg CVAT
Extremities: warm and well perfused, 1+ pitting edema in upper extremities, 2+ pitting edema in lower extremities, DTRs 1+ bilateral LE
SVE: deferred
FHTs: Baseline 150, moderate variability, + accelerations, no decels.
UCs: q 5-10min, mild to palpation
Labs: PIH pannel sent.
GBS/GBS rapid sent

Assessment
XXXXXXXX is a _29 y.o._ G1P0 at 35w3d
Does not meet gestational HTN diagnosis because we do not have recorded HTN BPs greater than 4 hours apart.
VSS
Reactive NST
Vertex confirmed via BS US.
GBS Pending

Thank you!

 

[Cmama12]

I don't have any resources to direct you to but I can tell you that we often see them embedded and we do bill them out separately. Here's one I just came across

Physical Exam:
General appearance: alert, appears stated age, cooperative and in no apparent distress
Head: Normocephalic, without obvious abnormality, atraumatic
Skin: No lesions, bruising or abnormal skin discoloration apparent
Lungs: normal effort
Heart: normal rate
Abdomen: Soft, non tender, gravid, pain with palpation of paraspinal muscles on the left consistent with musculoskeletal origin, no CVA tenderness. No RUQ pain.
Extremities: no clubbing, no cyanosis, trace non pitting edema, redness or tenderness in the calves
Psych: Appropriate mood and affect
GU: deferred

Reactive NST with Baby A baseline at 135, moderate variability, with accels and Baby B baseline at 135, moderate variability, accels. Irregular contractions on toco.

 

[rtrudel35]

As long as the documentation was done by a doctor or CNM then we would bill for a NST with that documentation. Alot of the time the NST is done by a RN but we need a provider to write an attestation or their own interpretation.

 

[Jenetteis]

Hi, is this acceptable to bill as an NST? TIA

FHR reactive
Uterine activity is being monitored by TOCO with contractions occurring Irregular minimal

 

[nyckimmie]

Hello, I'm looking for the same advice as the original poster. Coding for facility observation type accounts, sometimes all the documentation we get is results embedded on a am h&p, there is an order, its not from a previous visit, there is medical necessity. a managerthis advice from hcpro and is questioning #3. If no time is noted, can we still bill it? Thank you for any response.

 

[nielynco]

Per the ACOG Coding Committee, the following is a brief description of CPT code 59025, Fetal NST:

"The patient reports fetal movement as an external monitor records fetal heart rate changes. The procedure is noninvasive and typically takes 20 to 40 minutes to perform. However, if a reassuring test is achieved within the first 10 minutes or less, the patient does not have to be monitored for the additional time.

CPT code 59025 can be conducted as many times as medically necessary. For patients with conditions complicating pregnancy, 59025 is typically performed weekly beginning in the mid to latter part of the third trimester and continuing until delivery. The non-stress test may be the primary means of fetal surveillance for many high risk pregnancies. Proper diagnostic reporting to justify the medical necessity and documentation is important to ensure appropriate reimbursement.

However, if routinely performed on all patients without distinct medical necessity, this code is not separately reported."

ACOG does not specify what the documentation needs to look like, but you MUST have a copy of a strip somewhere that shows the length of the testing and indicates the fetal movement. In years past a practice/hospital department would have a form to record the BP, movements, FHR, etc which also included the reason for the test, and the interpretive result - similar to an ultrasound report. Now with EMR records, shortcuts as being taken that do not always make it clear that the requirements have been met.

 

[dc08121]

Per the ACOG Coding Committee, the following is a brief description of CPT code 59025, Fetal NST:

"The patient reports fetal movement as an external monitor records fetal heart rate changes. The procedure is noninvasive and typically takes 20 to 40 minutes to perform. However, if a reassuring test is achieved within the first 10 minutes or less, the patient does not have to be monitored for the additional time.

CPT code 59025 can be conducted as many times as medically necessary. For patients with conditions complicating pregnancy, 59025 is typically performed weekly beginning in the mid to latter part of the third trimester and continuing until delivery. The non-stress test may be the primary means of fetal surveillance for many high risk pregnancies. Proper diagnostic reporting to justify the medical necessity and documentation is important to ensure appropriate reimbursement.

However, if routinely performed on all patients without distinct medical necessity, this code is not separately reported."

ACOG does not specify what the documentation needs to look like, but you MUST have a copy of a strip somewhere that shows the length of the testing and indicates the fetal movement. In years past a practice/hospital department would have a form to record the BP, movements, FHR, etc which also included the reason for the test, and the interpretive result - similar to an ultrasound report. Now with EMR records, shortcuts as being taken that do not always make it clear that the requirements have been met.

When billing NST for twin gestation, does the provider have to have 2 orders for NST in chart to distinguish Baby A and Baby B in order for me to bill for 2?

 

[nielynco]

When billing NST for twin gestation, does the provider have to have 2 orders for NST in chart to distinguish Baby A and Baby B in order for me to bill for 2?

Not 2 orders as the NST when done on twins will be done on both (unless one is deceased), but the report must clearly indicate that both were tested and the result for each.

 

[pclaybaugh]

Uh, thanks for all the advice on this subject. This facility maintains the strip is enough, with a illegible signature and a handwritten diagnosis on the strip, sometimes also not legible, no further documentation to be found anywhere. I can't find the providers interpretation of the result other than the "diagnosis" on the strip. This is a facility that has recently adopted a new EMR system and is struggling. The patient population is heavily Medicaid.
Any further recommendations as to how to convince the staff that a bit more information is required.

 

[nielynco]

Uh, thanks for all the advice on this subject. This facility maintains the strip is enough, with a illegible signature and a handwritten diagnosis on the strip, sometimes also not legible, no further documentation to be found anywhere. I can't find the providers interpretation of the result other than the "diagnosis" on the strip. This is a facility that has recently adopted a new EMR system and is struggling. The patient population is heavily Medicaid.
Any further recommendations as to how to convince the staff that a bit more information is required.

Please note that I am not trying to be political, but be aware that if the federal government reduces or eliminates dollars for Medicaid, your good documentation may make the difference between payment or no payment. If the State Medcaid program has fewer resources, they will begin to more stringently demand accountability for the services they can pay for. Just saying.

 

[pclaybaugh]

Please note that I am not trying to be political, but be aware that if the federal government reduces or eliminates dollars for Medicaid, your good documentation may make the difference between payment or no payment. If the State Medcaid program has fewer resources, they will begin to more stringently demand accountability for the services they can pay for. Just saying.

Yes, ma'am, I have uttered these words and hope that these folks take heed. As I am that last one to review the documentation, prior to billing, I am also protecting my credentials. The last thing I want is for this facility to be audited and documentation that I reviewed be scrutinized and not meeting compliance.
I think all coders need to take a hard look at what is being documented to remain compliant.