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Posted By Maria on 03-08-2018, 17:01:38 in Ob-Gyn
Hi Melanie,

Thanks so much for all your help.

I do a lot of billing for afterhours Resident's Clinics.

Often the Dr are wanting to bill an NST (with H&P) with only 1) reactive 2) reactive NST or 3) reassuring as the results given.

In this clinic, they always do a rather lengthy H&P for OB patients. FHT are always given.

Example FHT:
Fetal Heart Rate
Mode: External US
Baseline Rate: 130 bpm
Variability: Moderate
Pattern: Accelerations

With "reactive" stated with the above listed FHT information, is this enough to bill for an NST?

There is no mention of time, or fetal movements, usually it done for the mom's issue such as cold, fell down, n&V, flu, etc....

I feel like those are simple monitoring for labor or just a FHT check. Not a true NST.

Could you please tell me what absolutely has to be documented to bill out a NST.?

Thanks, Maria






Comments (1)
Posted By Melanie Witt on 03-10-2018, 15:20:05
We are in luck that ACOG has weighed in on this very topic. This is what they have published and based on this, what you have indicated above would not pass muster for billing an NST.

NST Documentation
Required Information
-Notes
-Facility Name
-Patient Demographic
 patient name
Information
 starting date of last normal menstrual period (LNMP)
 examination date
 date of dictation/transcription/written report
 name of interpreting ultrasonographer and/or physician
Procedures and Materials
Name or type of examination (Non-Stress Test)
Findings / Code Description Elements Evaluated and Noted
• Total time run (should run for a minimum of twenty minutes even if a
reactive test is obtained in the first ten minutes of monitoring).
• Outcome of NST testing- reactive/non reactive
• If stimulation is used- documentation should include a description of the tracing prior to
stimulation, duration of stimulus and response of fetus
Other:
 “Why “ the procedure was performed/ICD-10-CM codes, if available
 The ultrasonographer and/or physician must always sign interpretation and final reports
Potential limitations
The report should, when appropriate, identify factors that may compromise the sensitivity and specificity
of the examination.
Clinical issues
The report should address or answer any specific clinical questions. If there are factors that prevent
answering of the clinical question, this should be stated explicitly.
Impression (conclusion or diagnosis)
 A precise diagnosis should be given when possible, using ICD-10-CM codes.
 A differential diagnosis should be rendered when appropriate.
 Follow-up or additional diagnostic studies to clarify or confirm the conclusion/diagnosis should be
suggested when appropriate.
 Plan of care and instructions should be documented when appropriate.
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