Coding

  • 1.  Billing for NST and required time

    Posted 11-03-2022 19:52
    If a patient is getting NST for antepartum surveillance and meets the criteria for a reactive NST:

    -does the patient need to be kept on for full 20 minutes for the NST be billed?

    ------------------------------
    Megan Thomas
    ------------------------------


  • 2.  RE: Billing for NST and required time

    Posted 11-05-2022 12:04
    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.

    This is from ACOG



    ------------------------------
    Vanita Jain, MD
    Chair, SMFM Coding Committee
    ------------------------------



  • 3.  RE: Billing for NST and required time

    Posted 11-05-2022 20:05
    Megan
    I will mention that ACOG has contradictory guidance:

    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.


    but if you look at the PB it says 'at least 20'
    https://www.acog.org/en/clinical/clinical-guidance/practice-bulletin/articles/2021/06/antepartum-fetal-surveillance

    Nonstress Test

    The NST is based on the premise that the heart rate of a fetus that is not acidotic or neurologically depressed will temporarily accelerate with fetal movement. Heart rate reactivity is thought to be a good indicator of normal fetal autonomic function. Loss of reactivity is most commonly associated with a fetal sleep cycle but may result from any cause of central nervous system depression, including fetal acidemia.

    The patient may be positioned in either the semi-Fowler position (sitting with the head elevated 30 degrees) or lateral recumbent position. In one small randomized study, it took less time to obtain a reactive NST when patients were placed in the semi-Fowler position 20. The FHR is monitored with an external transducer. The tracing is observed for FHR accelerations that peak (but do not necessarily remain) at least 15 beats per minute above the baseline and last 15 seconds from baseline to baseline. The NST should be conducted for at least 20 minutes, but it may be necessary to monitor the tracing for 40 minutes or longer to take into account the variations of the fetal sleep–wake cycle. Vibroacoustic stimulation may elicit FHR accelerations that are valid in the prediction of fetal well-being. Such stimulation offers the advantage of safely reducing the frequency of nonreactive NSTs by 40% and the overall testing time by almost 7 minutes without compromising detection of the acidotic fetus 21 22 23 24. To perform vibroacoustic stimulation, the device is positioned on the maternal abdomen and a stimulus is applied for 1–2 seconds. If vibroacoustic stimulation fails to elicit a response, it may be repeated up to three times for progressively longer durations of up to 3 seconds.

    Nonstress test results are categorized as reactive or nonreactive. Various definitions of reactivity have been used. The most common definition of a reactive, or normal, NST is if there are two or more FHR accelerations (as previously defined) within a 20-minute period 25. A nonreactive NST is one that lacks sufficient FHR accelerations over a 40-minute period. The NST of the normal preterm fetus is frequently nonreactive: from 24 weeks to 28 weeks of gestation, up to 50% of NSTs may not be reactive 26, and from 28 weeks to 32 weeks of gestation, 15% of NSTs are not reactive 17 27 28. Thus, the predictive value of NSTs based on a lower threshold for accelerations (at least 10 beats per minute above the baseline and at least 10 seconds from baseline to baseline) has been evaluated in pregnancies at less than 32 weeks of gestation and has been found to sufficiently predict fetal well-being 29 30. Variable decelerations may be observed in up to 50% of NSTs 31. Variable decelerations that are nonrepetitive and brief (less than 30 seconds) are not associated with fetal compromise or the need for obstetric intervention 31. Repetitive variable decelerations (at least three in 20 minutes), even if mild, have been associated with an increased risk of cesarean delivery for a nonreassuring intrapartum FHR pattern 32 33. Fetal heart rate decelerations during an NST that persist for 1 minute or longer are associated with a markedly increased risk of both cesarean delivery for a nonreassuring FHR pattern and fetal demise 34 35 36. In this setting, the decision to deliver should be made with consideration of whether the benefits outweigh the potential risks of

    I'll have to check the CPT book to get an actual code description for you.  



    ------------------------------
    Vanita Jain, MD
    Chair, SMFM Coding Committee
    ------------------------------



  • 4.  RE: Billing for NST and required time

    Posted 11-07-2022 10:20
    Megan
    I looked in the CPT book, which does not specify a length of time for the NST.
    It does say however that one should check CPT Assistant - which I do NOT have a subscription too, though looks like perhaps last update in CPT assistant for this was 1998.   My general sense is that there is no 'requirement' for a full 20 minutes in order to 'bill' the 59025, but one could consider that if you don't keep them on for the 'traditional' 20 minutes, would that be best practices (i.e. risk/would you miss a decel?).
    Since I am NOT a coder, likely best you post this question to the ACOG coding site directly.  Their coders likely do subscribe to CPT assistance and can check this for you.  I assume you are an ACOG member? Link here:  https://www.acog.org/practice-management/coding/ask-a-coding-question
    Best to get the 'official' response from the society that puts out clinical guidance on this topic.
    My personal practice is to leave patients on for the full 20 minutes before I will read it.
    Best,
    Vanita



    ------------------------------
    Vanita Jain, MD
    Chair, SMFM Coding Committee
    ------------------------------