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Reimbursement Advisor


Limits to NSTs?

May 2005 · Vol. 17, No. 5

<huc>Q</huc> A patient was admitted to a hospital at 37 weeks’ gestation for preterm labor. She stayed 15 days but did not deliver.

Can the attending physician charge outside the global fee for interpreting non-stress tests (NSTs) during this period? If so, how many readings a day can be billed?

<huc>A</huc> At 37 weeks, the patient does not have premature labor (644.0x), but “other threatened labor,” which is ICD-9 code 644.13 if she does not go on to deliver during this hospitalization. The physician can bill for the admission and daily rounding, but billing for the NST will depend on whether one was performed.

To bill for 59025, the patient is required to mark the strip to indicate fetal movements throughout the 30 to 40 minutes of the test. It would only be necessary to do so if the physician suspected a fetal problem.

However, if external fetal monitors are being used to count contractions or monitor heart rate, the NST would be billed as part of the exam.

No Limit on Number of Tests, If Medically Needed

If a true NST is performed and documented and the physician has interpreted the results, then the obstetrician can bill for it using 59025–59026. No protocols stipulate a limit for NSTs in a single day, but the payer will likely ask about medical necessity if more than 1 per day is performed—especially if the results are all reassuring and the patient is close to term.

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

OBG Management ©2005 Dowden Health Media
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