Hi Allan
Payers individually have lists of indications for the NST. Aetna has the most easily accessible one for 59025 with icd-10 codes they traditionally approve (last reviewed 4/2019) -
Antepartum Fetal Surveillance. In short there is no "magic list" - yet!
The Coding Committee has put together a task force to create our own list of ICD-10 indications for major imaging studies.
We are awaiting for an antenatal surveillance updated document - which we are told is in progress/anticipated for this year.
In the interim we are planning to review what we consider (based on published practice parameters) appropriate IcD-10 indications for the 76811, 76805 (as these are already published), and likely 76825.
This particular issue had to do with when you see a patient for a "labor" issue - is the evaluation of the fetal monitoring considered part of your "labor evaluation" E/M or is it a separately billable NST service (with separate indication)? The Coding Committee's opinion has been, and remains, that when you are seeing the patient in Ob triage or an Ob ER for an acute medical concern or "labor check" that fetal monitoring you do is part of the overall E/M visit for that day. We do not feel there is a separately billable NST charge.
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Vanita Jain, MD
Chair, SMFM Coding Committee
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Original Message:
Sent: 01-28-2020 20:05
From: Allan Fisher
Subject: NST reimbursement
As with anything, I am assuming now that the insurances are only paying for certain diagnostic codes. Is there now a magic list of such codes for NSTs?
Allan Fisher, MD
--
Allan J Fisher, MD, FACOG, FACMG
"None of us is as dumb as all of us." NASA
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– Morpheus from The Matrix
Original Message------
Good Morning
As Fadi stated, we would NOT recommend utilizing high risk icd-10 codes in a low risk patient in order to obtain reimbursement.
The committee has typically recommended the following (taken from our coding manual):
When performing continuous electronic fetal monitoring, you cannot bill the non-stress test (59025) or contraction stress test (59020) code for these services. Fetal monitoring is considered a labor management service and is included in the primary service (E/M, observation, etc.). The technique is similar to NST or CST since the fetal heart monitor is used for both. The procedures, however, are different with respect to coding. Fetal monitoring is considered a labor management service and is included in the primary charge (E/M, observation, etc.). Therefore, fetal monitoring is not separately billed or coded.
As Fadi noted, the patient is being evaluated in Ob triage, put on cEFM during this evaluation (for FHR/toco) but all of this 'work' is included in your E/M or obs or inpatient charge for that encounter. If the patient is 'ruled out' for labor, you do not then bill the E/M code for that work AND an NST, the cEFM was part of your encounter. Even with NST, and not just monitoring, there is always a question of what the purpose of testing a normal patient would be - whether there is any diagnostic value. Most payers now have diagnosis guidelines for NST, because providers have been billing them routinely for patients without risk. Especially with CMS payers, as Fadi noted, I would be concerned if the institution was audited, that this would be flagged. I think Fadi also provided some good clinical examples of when an NST could be billed in addition to an E/M visit.
Hope that helps!
thanks
vanita
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Vanita Jain, MD
Chair, SMFM Coding Committee
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