Wiki 59025

[Korbc]

hey guys
had nst done for 20 min length of time, but my provider wasn't sure if she could still charge if patient was only 23 weeks. I don't see in cpt or any resources that there's any restriction regarding weeks gestation......was just wondering if anyone knew otherwise?
thanks!

 

[mmckibbin]

We only bill an NST if the patient is 23 completed weeks or more.

 

[rstroup]

It will depend on the payer but it is typically done within the last 6 weeks of gestation.

 

[nielynco]

hey guys
had nst done for 20 min length of time, but my provider wasn't sure if she could still charge if patient was only 23 weeks. I don't see in cpt or any resources that there's any restriction regarding weeks gestation......was just wondering if anyone knew otherwise?
thanks!

ACOG has guidelines for an NST, and in general, you would not begin testing until 32 weeks gestation. The diagnostic value of NSTs before 32 weeks varies and has high false-positive rates due to the immaturity of the fetal heart. This means that the there are insufficient fetal heart rate accelerations over 40 minutes. The NST of most preterm fetuses are frequently nonreactive: From 24 weeks, up to 50 percent of NSTs may be nonreactive, and from 28 to 32 weeks of gestation, 15 percent of NSTs are not reactive. There is no recommendations that support performing one at 23 weeks gestation. Most payers will follow ACOG guidelines on this issue so I would expect a denial if you do bill for this. You can access the ACOG guidelines summary at: https://www.aafp.org/pubs/afp/issues/2000/0901/p1184.html

 

[nielynco]

It will depend on the payer but it is typically done within the last 6 weeks of gestation.

This answer is not wrong, but an NST can begin at 32 weeks if there is a medical indication.

 

[Korbc]

We only bill an NST if the patient is 23 completed weeks or more.

thanks! do you have any reference material for this by any chance?

 

[Korbc]

ACOG has guidelines for an NST, and in general, you would not begin testing until 32 weeks gestation. The diagnostic value of NSTs before 32 weeks varies and has high false-positive rates due to the immaturity of the fetal heart. This means that the there are insufficient fetal heart rate accelerations over 40 minutes. The NST of most preterm fetuses are frequently nonreactive: From 24 weeks, up to 50 percent of NSTs may be nonreactive, and from 28 to 32 weeks of gestation, 15 percent of NSTs are not reactive. There is no recommendations that support performing one at 23 weeks gestation. Most payers will follow ACOG guidelines on this issue so I would expect a denial if you do bill for this. You can access the ACOG guidelines summary at: https://www.aafp.org/pubs/afp/issues/2000/0901/p1184.html

thanks so much for the great resource!