Reimbursement Advisor

Document the reason for a nonstress test

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Q I billed a nonstress test (NST) that was rejected. The note in the chart says the test was nonreactive. What should I do? Should we not have billed the NST at all, or can I just submit a diagnosis of no fetal movement?

A A nonreactive fetal NST is the finding of the exam—not the reason it was conducted. To justify performing the NST, you need to consider why it was ordered in the first place. Since this exam is done to measure fetal well-being, there are several possibilities.

To name just a few:

  • complaints of decreased fetal movement (655.73)
  • fetal size that is small or large for dates (656.53 or 656.63)
  • previous intrauterine fetal demise (V23.49)
  • abnormal fetal heart rate (659.73)
  • maternal abdominal trauma (659.83, along with a diagnosis indicating the injury)

Whatever the reason for the test, make sure it is documented; if it is not and the records are audited, returning money to the payer would be your best-case scenario. The worst-case scenario? Accusations of fraud for billing a service not documented (meaning, to the payer, that it never happened).

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

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