Wiki same day admit/discharge for NST code for MA patients

[jennak73@gmail.com]

We have quite a few Medicaid patients that we send over to Maternity at our local hospital to have NSTs. We charge for the reading of the NST
(59025,26) and also an admit/discharge (99234,25). But Medicaid does not pay for 99234,25. And we also tried H1002,HD but they do not pay for H1002,HD in place of service 21. Any suggestions on a code to use? We are all pretty new at coding this specialty and are learning new things every day case by case. Any help is much appreciated. Thanks!

 

[alayna.wallace@yahoo.com]

Suggestion

Is the 99234 being filed with the same diagnosis as what is being filed with 59025? If so, this will be deemed as inclusive to most insurances. There needs to be additional/separate reasons (diagnoses) for the 99234 to be considered separate from the 59025. I would also suggest that whatever dx is on 59025, exclude it from 99234.

 

[sknapp56]

same day admit/discharge

Is the patient actually admitted to observation or inpatient status? If your provider does an admit/discharge summary you can bill the 99234 with the 25 modifier. If you are just sending them over for the nst as an outpatient and the physician does not see the patient the patient just reads the nst you should bill only the nst. It doesn't appear from your question that you have enough to bill a separate E & M code.

 

[queeneldo]

Medicaid, at least in WA state does not cover 99234-99236 at all. We bill 99232-25 and 59025-26 if seen by physician and 59025-26 if NST only. Use the complication Dx--(e.g 648.03, 250.00 (DM))on both. Do not bill using the
V22-V23 or claim will bundle into global because of supervision of pregnancy description.