Coding Question of the Month: August 2019

Non-Stress Test during Labor Management 

QUESTION: Would NST monitoring during labor be included in the global? The ACOG Coding Manual states “included intrapartum services”: management of uncomplicated labor including fetal monitoring, placement of internal fetal and/or uterine monitors. Is this statement referring to NSTs (59025) and fetal contraction stress test (59020)?

ANSWER:
Routine and continuous fetal monitoring is considered to be included in the global.  These services are not generally reported with codes 59025 or 59020. However if the services are reported to evaluate and manage a problem these codes would be reported.  They are distinct tests with a start, middle, and end.  

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. 

However, if routinely performed on all patients without distinct medical necessity, this code is not separately reported."

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