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Posted By Maria on 10-09-2018, 07:54:18 in Ob-Gyn
Good Morning Melanie,

What would be the minimal requirements to bill a CST?

I am not familiar with this procedure at all.

This is the only information I am given. I see no other description given on the test.

1. IUP @ 38w2d GA
-- Reassuring fetal status, negative spontaneous CST
-- Preg c/b: recent triage visit for chest tightness/dizziness (s/p EKG, Echo, cardio consult - NML), anxiety (On Buspar daily), + CF carrier (FOB negative), tobacco use (1-2 cigarettes/day)
 
Is the simple note of negative spontaneous CST sufficient to bill a CST?

Thanks, Maria
Comments (2)
Posted By Maria on 10-15-2018, 07:37:30
Thank so very much, Melanie.

I assume this is for interruption only, but I will confirm that today. I had been unsuccessful in locating much information on this test, from a coding aspect, so your description is a tremendous help.
Posted By Melanie Witt on 10-10-2018, 17:13:02
In my opinion, this statement is insufficient for billing 59020 since that would include both performing the test and also interpreting the result. If this was an interpretation only, then you would report this code with a modifier -26, but it would still be prudent for you to be sure that is was a CST that was actually performed and there is a test strip to back this up showing the contractions, FHR, length of the test at each measured interval, stimulation used (or rate of contractions if based solely on normal contractions), and most important, indication for doing it. While you have given me a list of diagnosis codes, none of these would support doing a CST unless there was an issue with the fetus such as decreased fetal movement as the cardio consult was normal. Note that the CST measures the fetal response to contractions while the NST measures fetal response to fetal movement.

For the CST, either a dilute oxytocin solution is infused or nipple stimulation is performed until three contractions occur within 10 minutes. There is no standard technique for nipple stimulation. The patient gently massages the nipple of one breast through her clothes for two minutes, stopping with onset of contractions; stimulation is resumed if contractions are too infrequent for CST interpretation. Both nipples can be stimulated if no contractions occur. In women who are having spontaneous contractions of adequate frequency, oxytocin or nipple stimulation is unnecessary. Relative contraindications to stimulating contractions for a CST are conditions that are also contraindications to labor and vaginal delivery, such as placenta previa, vasa previa, and previous classical cesarean delivery or extensive uterine surgery. Preterm labor, patients at high risk for preterm delivery, and preterm premature rupture of membranes are also relative contraindications.

So with this being spontaneous contractions where is the strip the shows the contraction with the heart rate tracing over the length of the test? And are you trying to bill just the interpretation or the the professional and technical components.
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