NST without an order--OB check only??

AR2728

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Anytime an OB patient presents to the hospital for an OB check--as in they are concerned, complaints, unsure if in labor....the hospital routinely performs an NST. The NST is not ordered by the physician, however, the NST reading is sent to my OBGYN for interpret and sign off on. He may be called by the hospital for recommendations, but does not see the patient. The NST is signed off at a later date. Is this billable with 59025-26 since my physician is still signing off and reviewing these NSTs even though he has not ordered the NST nor seen the patient the day the NST was performed?

If he is unable to bill for this service as 59025-26 would you please provide rationale as I know he will request additional information. He billed for these at his previous location.
 

AR2728

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Another question on the NST

I spoke with the OB director at our hospital. She stated NSTs are always done on OB patients who present for "checks" to the hospital. They want to ensure all is good, there is not necessarily an "indication" for the test being done it is simply routine protocal for the hospital on their OBs. She stated on occasion they may find an issue during the NST, but still the NST has been done as routine. Are these still billable by the phsyician for reading?
Do I need to ensure that there was a clear indication warranting the NST prior to use billing for the physician reading and interpretation?
 

AR2728

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Does anyone have a similar situation? My OBGYN previous office billed for every NST he read. Does there need to be a specific indication warranting the NST other than it just being protocol because they are pregnant and presented to the hospital with concerns? He believes he should bill for reading each and everyone regardless of why it was performed.
 

Bready

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your OB director is correct. the NST is done whenever a pregnant woman presents to hospital to both check that all is good and as a hospital liability issue. And there may be no clear indication that the NST was warranted ( hosp. liability again). There are some insurance carriers (Aetna, BCBS) that will post what they consider acceptable diagnoses for the NST under their medical policies and guidelines and you can look those up. Your doctor can continue to bill for each and every one but he should he realize that he may not be paid if the NST performed does not meet the insurance carriers guidelines for reimbursement. I would also check with your OB director as to the hospital's policy regarding billing the patient for NSTs not covered (do they write it off?). IF they routinely write off noncovered NSTs, I would think your physician should do the same.
I hope this helps. Unfortunately, physicians are not paid for everything they do--its just good medical practice.
 
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