Coding

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

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

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