This includes the use of industry standard, compliant codes on all claims submissions. Insertion of cervical dilator on same date as delivery (CPT code 59200). 11. The delivery only codes should be reported by the same group physician for a single gestation when: https://www.acog.org/practice-management/coding/coding-library, AMA CPT Content Module: Global OB codes Reporting and Use, 2023 RT Welter All Rights Reserved. 1999;26(3):549-568. UpToDate [online serial]. Alternatively, acoustic stimulation is applied to the maternal abdomen for 1 to 2 seconds and the fetal heart rate is recorded. Increasing evidence suggests that unexplained abnormal maternal serum analyte concentrations (e.g., pregnancy-associated plasma protein A), as well as abnormalities in cell-free DNA levels, in the first and second trimesters are also predictive of adverse pregnancy outcomes, including preeclampsia. 59000 59070 Antepartum and Fetal Invasive Services for. ET), 2023 Annual Clinical & Scientific Meeting, Congressional Leadership Conference (CLC), Coding Question: Non-Stress Test during Labor Management, Alliance for Innovation on Maternal Health, Postpartum Contraceptive Access Initiative. How should [], Copyright 2023. "The patient reports fetal movement as an external monitor records fetal heart rate changes. Madazli R, Kucur M, Gezer A, et al. Efficacy and safety of intrapartum electronic fetal monitoring: an update. 2008;(1):CD000038. Prenatal stress and hemodynamics in pregnancy: A systematic review. UpToDate [online serial]. Alfirevic Z, Stampalija T, Gyte GM. The PSV ratio also improved the prediction of PE with delivery at less than 3 weeks from assessment provided by maternal factors alone (from 31.0 % to 69.4% ), maternal factors plus MAP (74.1 % to 83.4 %), maternal factors, MAP plus UtA-PI (77.1 % to 85.0 %) and maternal factors, MAP plus PlGF (88.6 % to 90.7 %). Br J Obstet Gynaecol. -You should make sure you have a specific diagnosis and not just a pregnancy code (V22.x). Cancer Epidemiol Biomarkers Prev. When billing for the global obstetrical package code, all services must be provided by one obstetrician, one midwife, or the same physician group practice provides all of the patient's routine obstetric care, which includes the antepartum care, delivery, and postpartum care. The LHD can bill 59430, S0281 and codes for the contraceptive device and insertion. This trial included women attending for a routine hospital visit at 19+1 to 23+3 weeks' gestation. Heart rate reactivity is thought to be a good indicator of normal fetal autonomic function. A total of 145 women were left for analysis after exclusions; 14 developed PE, 23 pregnancy-induced hypertension (PIH), 64 SGA of less than fifth centile, 118 SGA of less than 10th centile and 3 stillbirth. Primary care physicians providing only prenatal care should bill for the prenatal visits they have provided using CPT Code 59425 (antepartum care only; 4 to 6 visits) or CPT Code 59426 (antepartum care only; 7 or more visits), and will be reimbursed according to Aetna's fee schedule. Management of fetal distress. The review concluded that, "[u]ntil such time as these are available, routine uterine artery Doppler screening of women considered at low risk is not recommended.". A bi-variate random-effects model was used for the quantitative synthesis of data. } The ACOG guidelines on intrauterine growth restriction (2000) state that umbilical artery ultrasounds may be useful in the evaluation of the growth restricted fetus; however, these guidelines indicate no particular role for uterine artery Doppler ultrasound in the evaluation and management of intrauterine growth restriction pregnancies. Non-global OB care. Close clinical monitoring for preeclampsia is already a major component of prenatal care; improved identification of women at increased or decreased risk of a disease that cannot be prevented and has no treatment other than delivery is unlikely to improve maternal or fetal outcome. Overall, the test lasts 30-40 minutes, during which the ob-gyn monitors the fetal heart rate using external transducers. In a meta-analysis of studies examining the performance of sFlT-1, PlGF, or the sFlT-1/PlGF ratio in predicting adverse outcomes in patients with suspected or confirmed preeclampsia, both PlGF and the sFlt-1/PlGF ratio demonstrated pooled area under the summary receiver operating characteristic curve values from 0.68 to 0.87 for predicting composite adverse maternal and perinatal outcomes, preterm birth, and fetal growth restriction, but very high heterogeneity of the population sampled coupled with differences in study methodology, study quality, and the outcomes measured limited conclusions regarding the prognostic value of these biomarkers in clinical practice [citing Lim, et al., 2021]". The results of 1 RCT showed significantly lower rates of obstetric interventions in patients assigned to Doppler, such as antepartum admission and labor induction. According to ACOG guidelines, " [n]o benefit has been demonstrated for umbilical artery velocimetry for conditions other than suspected intrauterine growth restriction, such as post term gestation, diabetes mellitus, systemic lupus erythematosus, or anti-phospholipid syndrome. Washington, DC: ACOG; January 2000. Samples of maternal peripheral blood and umbilical venous blood were collected from 28 pre-eclamptic and 24 normotensive pregnant women and their newborns. For most pregnancies at increased risk of stillbirth due to utero-placental insufficiency, testing is considered appropriate beginning at 32 to 34 weeks of gestation. Combining these first trimester parameters did not improve the predictive efficiency of the models. The appropriate diagnosis showing multiple gestation should also be used. Chitotriosidase and YKL-40 in normal and pre-eclamptic pregnancies. Nienhuis SJ, Vles JS, Gerver WJ, Hoogland HJ. Serum IMA, complete blood count (CBC), liver function tests (LFT), renal function tests (RFT), albumin, and C-reactive protein (CRP) were measured in the mothers immediately before birth, and in the cord blood and serum of the newborns at 6 and 24 hours after birth. } 86003. Duan and colleagues (2017) noted that identifying women at risk of PE by maternal serum screening is conducive to prompt gestational management and thereby improve both maternal and perinatal outcomes. The authors concluded that there is limited evidence that prenatal stress is associated with changes in circulation. Pregnancy related E/M office visits must not be billed in conjunction with code, 59425 or 59426 by the same provider for the same beneficiary, during the same. The authors concluded that first trimester ADAM12, PAPP-A, and Ut-A Doppler characteristics are not sufficiently predictive of PE. Non-global OB care, or partial services, refers to maternity care not managed by a single provider or group practice. J Med Assoc Thai. CPT 59400 59510 59409 obstetrical policy Medicare. 2018;60(6):553-559. The acoustic stimulation or vibration is for waking the baby or to cause it to react to the stimulus. 2006;13 (8):33-34. The ob-gyn may perform the labor check, but as long as the patient does not deliver within 24 hours of admittance, you can include the reimbursement for the labor check in your codes for initial hospital care (99221-99223, Initial hospital care, per day, for the evaluation and management of a patient ). Chang YL, Chmait RH, Bornick PW, et al. 2021;137(1):72-81. Br J Obstet Gynaecol. The ob-gyn might repeat this stimulation every five minutes for a maximum of two to three times. UA had sensitivity and specificity 70 % and 47.8 %, respectively, for most suitable cut-off value delta UA 16.7 %. Acta Obstet Gynecol Scand. Most likely you-ll include this fetal monitor use as part of labor management or the global ob package (such as 59400, Routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy, and/or forceps] and postpartum care).Example: A patient at 38 weeks gestation presents to the ob-gyn saying her water has broken but she doesn't feel any contractions. The overall estimates of IMA in detecting PE were pooled sensitivity; 0.80 (95 % CI: 0.73 to 0.86), pooled specificity; 0.76 (95 % CI: 0.70 to 0.81), DOR; 14.32 (95 % CI: 5.06 to 40.57), and area under curve (AUC); 0.860. A -reactive- NST will show the fetal heart rate accelerate from the baseline 15 beats per minute for a minimum of 15 seconds at least twice during a 10-minute window. Before admitting her to the hospital, the ob-gyn evaluates the situation by placing an external transducer to determine if the mother is experiencing contractions. No mothers or neonates died. 7. These researchers also assessed the association between uterine artery pulsatility index, notching and serum YKL-40 levels. Evidence Report/Technology Assessment No. -You should make sure you have a specific diagnosis and not just a pregnancy code (V22.x). Obstet Gynecol Clin N Am. Aetna considers measurement of serum YKL-40 for evaluation of pre-eclampsia or small-for-gestational age fetuses experimental and investigational becauseits effectiveness for these indications has not been established. This Clinical Policy Bulletin may be updated and therefore is subject to change. The postpartum care only should be reported by the same physician that provides the patient with services of postpartum care only. When you report 59025 (Fetal non-stress test) for NST procedures, make sure you-re reporting them in the appropriate situations. A Cochrane review on BPP for fetal assessment in high-risk pregnancies (Lalor et al, 2008) concluded that there is currently insufficient evidence from randomized trials to support the use of BPP as a test of fetal wellbeing in high-risk pregnancies. ins.dataset.adChannel = cid; window.ezoSTPixelAdd(slotId, 'adsensetype', 1); However, the heterogeneity was particularly high in the high-risk group rendering it impossible to draw firm conclusions. MEDICARE E CODES cpt 99396 medicare. When you-re reporting 59025, you-d better be sure you-ve got supporting documentation--and the supporting diagnosis to justify this code. If the clinical condition that has prompted testing persists, repeat testing (either weekly or twice-weekly, depending on the test used and the presence of certain high-risk conditions) is considered medically necessary until delivery. The authors concluded that this study may be the first to demonstrate maternal and fetal macrophage activation in pre-eclampsia. top: 0px; Baltimore, MD: Williams & Wilkins; 1996:433-442. van Asselt K, Gudmundsson S, Lindqvist P, et al. The effect of introduction of umbilical Doppler recordings to obstetric practice. The mean gestational age at delivery was 35.9 +/- 1.7 weeks. The following CPT codes are for delivery services only: Vaginal delivery only (with or without episiotomy and/or, Vaginal delivery only, after previous cesarean delivery (with or without episiotomy and/or forceps), Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery, Based on CPT and ACOG guidelines, the following items are included in the delivery service codes and should not be reported separately, The admission history and physical examination, Management of uncomplicated labor, vaginal delivery (with or without, episiotomy, with or without forceps), or cesarean delivery, external and internal, fetal monitoring provided by the attending physician, Intravenous induction of labor via oxytocin (CPT code 96365-96367), Repair of first or second degree lacerations*, Insertion of cervical dilator (CPT 59200) to be included if performed on the same, If the physician or group physician provide the delivery and postpartum care only, there are CPT codes that encompass both of these services. The sensitivity, specificity, and area under the receiver operating characteristic curves were used to compare the screening efficiency of the models using nonparametric U statistics. /*margin-bottom: 43px;*/ The modelled performance of screening for PE was also estimated. You would report this service with 59025 because the ob-gyn is using the NST to determine fetal status. The rate of PE was 2.5 % (13/528); 4 (0.8 %) had severe PE. Performance of first trimester biochemical markers and mean arterial pressure in prediction of early-onset pre-eclampsia. Warning: Don't Use 59025 for Labor Checks Obstet Gynecol Surv. Moreover, these researchers stated that further studies on a new and independent series of data could confirm the presented results. Uterine artery Doppler was assessed and outcome was registered from medical records. Provider Search Results in. Models combining markers showed promise, but none had undergone external validation. Last Review10/26/2022. No single marker had a test performance suitable for routine clinical use. Br J Obstet Gynaecol. Prediction of preeclampsia with maternal mid-trimester placental growth factor, activin A, fibronectin and uterine artery Doppler velocimetry. The authors concluded that serum IMA in addition to the prevalence of SGA were significantly increased in the PE group; thus, cord blood IMA might be a predictive biomarker for SGA in PE pregnancies. The ophthalmic artery second to first PSV ratio was significantly increased in PE pregnancies and the PE effect depended on gestational age at delivery; the deviation from normal was greater for early than late PE. 200. Ultrasound Obstet Gynecol. Washington, DC: ACOG; December 1994. Such documentation should be maintained and available upon request. Services should be billed using Current Procedure Terminology (CPT) codes, Healthcare Common Procedure Coding System (HCPCS) codes and/or revenue codes. Washington, DC: ACOG; October 1999. window.ezoSTPixelAdd(slotId, 'stat_source_id', 44); Based on the lack of evidence on the clinical utility of uterine artery blood flow measurements, the Cochrane reviewers concluded: "It is not clear if the study of utero-placental arteries makes any real contribution or not. No association was found between pre-eclampsia and serum YKL-40. Prediction of preeclampsia or intrauterine growth restriction by second trimester serum screening and uterine Doppler velocimetry. Obstet Gynecol. 32 CFR 199 (DHA Version), December 2016 (for use with 2015 (T-2017) Manuals) DoD Women, Infants, and Children (WIC) Overseas Program Policy Manual, July 2017 Of 2,532 studies reviewed, 12 met the criteria for inclusion; 6 reported that prenatal stress significantly affected maternal or fetal hemodynamics; 6 found no significant association between maternal stress and circulation. Studied parameters were evaluated using ROC analysis. Cochrane DatabaseSyst Rev. 1987;1(8526):188-190. Lacin S, Demir N, Koyuncu F, et al. Don't Overlook ICD-9 Cindy Hughes is the coding and compliance specialist for the AAFP and is a contributing editor to Family Practice Management. cord serum concentration of YKL-40 (r = 0.61, r = 0.84, and r = 0.58, respectively). As per ACOG and AMA guidelines, The antepartum care only codes 59425 or 59426 should be reported as described below, A single claim submission of CPT code 59425 or 59426 for the antepartum care only, excluding the confirmatory visit that may be reported and separately reimbursed when the antepartum record has not been initiated. The above services are not separately reimbursed when submitted separately from the global OB code. Second, most of the included studies were hampered by lack of blinding of the UAD measurements. Billing guidelines . Included studies were those that assessed the association of abnormal UAD parameters and stillbirth. Second, these investigators only had a small number of pregnancies complicated by chronic hypertension in the study cohort; thus, they could not derive strong conclusions in this subgroup. 93015. Author . 1997;9(2):101-106. The mother marks the strip when she feels movement throughout the 30-40 minutes of the test. Furthermore, UpToDate reviews on "Preeclampsia: Clinical features and diagnosis" (August and Sibai, 2015), "Prediction of preeclampsia" (Norwitz), and "Fetal growth restriction: Evaluation and management " (Resnik, 2015) do not mention the use of YKL-40 as a biomarker. Ott WJ, Mora G, Arias F, et al. Still snag [], Bust 3 Myths to Increase Pay Without Raising a Red Flag, Youre most likely to use modifier 22 in these situations. 2008;100(3):239-243. In a systematic review, Kuc et al (2011) examined the literature on the predictive potential of first-trimester serum markers and of UAD velocity waveform assessment (uterine artery [Ut-A] Doppler). Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Allen RE, Morlando M, Thilaganathan B, et al. 99214 - Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and . Abnormal uterine artery Doppler studies in the first and second trimester have been associated with subsequent adverse pregnancy outcomes including preeclampsia, fetal growth restriction, and perinatal mortality. The authors concluded that ophthalmic artery Doppler is a simple, accurate and objective technique with a standalone predictive value for the development of early-onset PE equivalent to that of uterine artery Doppler evaluation. Modifier 25 indicates that on the day of a procedure, the patient's condition required a significant, separately identifiable E/M service, above and beyond the usual pre-and post-operative care associated with the procedure or service performed. (adsbygoogle = window.adsbygoogle || []).push({}); Serum PAPPA, -hCG, and AFP levels were not significantly different between the PE and control groups. The rate of perinatal death is reduced by as much as 29 % when umbilical artery Doppler velocimetry is added to standard antepartum testing in the setting of fetal growth restriction". Examples of such high-risk conditions include bleeding, chronic or pregnancy-induced hypertension, collagen vascular disease (including anti-phospholipid syndrome), fetal growth restriction, gestational diabetes, impaired renal function, maternal heart disease (New York Heart Association Class III or IV), oligohydramnios, significant isoimmunization, steroid-dependent or poorly controlled asthma (not an all-inclusive list). Prediction of preeclampsia. Predictive value of ophthalmic artery Doppler velocimetry in relation to development of pre-eclampsia. For the comparison of a single Doppler assessment versus no Doppler, evidence for group differences in perinatal death was detected (RR 0.36, 95 % CI: 0.13 to 0.99; 1 study, 3,891 participants). The most promising of these methods appears to be MCA PSV. When you-re reporting 59025, you-d better be sure you-ve got supporting documentation--and the supporting diagnosis to justify this code. 12. Main outcome measures were pre-eclampsia, hypertension, and small-for-gestational age. These investigatorssearched the Cochrane Pregnancy and Childbirth Group Trials Register (May 2010). Areview of the evidenceforuterine artery Doppler studies prepared for the Society for Maternal Fetal Medicine (Scicioneand Hayes,2009)found that the predictive value of Doppler testing in a low-risk population of women appears to be low, and currently there are no available interventions to prevent adverse outcomes based on an abnormal result. The authorspresented encouraging results for the prediction of early PE, even in the first trimester of pregnancy. National Correct Coding Initiative (NCCI) Medically Unlikely Edits (MUEs) are used by the Medicare Administrative Contractors (MACs), to reduce improper payments for Part B claims. Otherwise, count the fetal monitoring as routine. The study population of 2,853 pregnancies contained 76 (2.7 %) that developed PE, including 18 (0.6 %) that delivered with PE at less than 37 weeks' gestation. Intrauterine death of one twin, with rescue of the other, in twin-twin transfusion syndrome. Epidemiology of antepartum fetal testing. The authors stated that this study had several drawbacks. Senat MV, Loizeau S, Couderc S, et al. Mean arterial pressure (MAP) and maternal weight (p=0.001) were significantly associated with PIH (DR 48 %, AUC 0.76, 95 % CI: 0.65 to 0.86). Ultrasound Obstet Gynecol. Int J Gynaecol Obstet. The physician and/or other health care professional should report CPT code 59426 when 7 or more visits are provided, CPT code 59425 when 4-6 visits are provided, or an E/M visit when only providing 1-3 visits. Modified BPP combines the NST (with the option of acoustic stimulation), as a short-term indicator of fetal acid-base status, with the amniotic fluid index as an indicator of long-term placental function. Prediction and differential diagnosis. Screening for pre-eclampsia: A systematic review of tests combining uterine artery Doppler with other markers. Ultrasound Obstet Gynecol. Notice how this procedure takes longer than a labor check and requires repeated stimulations to assess the specific fetal reaction or lack thereof.Heads up: If the ob-gyn performs this test in the hospital setting, you should add modifier 26 (Professional component) to 59025. OL OL OL LI { Eur J Obstet Gynecol Reprod Biol. You can use modifier 26 with CPT code 59025 if the fetal non-stress test is performed in a hospital because they already bill the technical component. The correlation is greatest in high-risk pregnancies, but insufficiently predictive in general, low-risk populations to be useful as a primary screening test. Washington, DC: ACOG; 2007. Prospective observational study to determine the accuracy of first-trimester serum biomarkers and uterine artery Dopplers in combination with maternal characteristics and arteriography for the prediction of women at risk of preeclampsia and other adverse pregnancy outcomes. Furthermore, the false positive rate of this test is quite high, leading to excessive patient anxiety and health care costs. The authors concluded that the combination of the PAPP-A level and the 2nd trimester sFlt-1/PlGF ratio, and the combination of the 2nd trimester sFlt-1 level with BMI, were better predictors of late-onset PE than any individual marker. reimbursed when the antepartum record has not been initiated. Chapter 32 - Billing Requirements for Special Services Table of Contents (Rev. Am J Obstet Gynecol. Overall summary of test accuracy was provided by the diagnostic odds ratio (OR). In a multi-parametric model, both UtA-PI and PD1 achieved a 67 % detection rate for early PE, although when combined, the detection rate only increased to 68 %. This is also called a non-stress test (NST). First diastolic peak velocity of ophthalmic artery Doppler at a cut-off of 23.3cm/s showed modest sensitivity (61.0 %; 95 % CI: 44.2 to 76.1%) and specificity (73.2 %; 95 % CI: 66.9 to 78.7 %) for the prediction of early-onset PE (AUC, 0.68; 95 % CI: 0.61 to 0.76). You should add modifier 26 to 59025 because the hospital owns the equipment and will report for that portion of the service. For 1 to 3 visits: Use E/M office visit codes. Sonographic and histopathological results were evaluated. These investigators reviewed published systematic reviews to collate evidence on the ability of available tests to predict PE, to identify high-value avenues for future research and to minimize future research waste in this field. A provider could also bill the procedure with a -22 modifier in which an additional 50% could be Therefore, a combination of multiple markers yields high detection rates and is promising to identify patients at high-risk of developing PE. Third-trimester uterine artery Doppler for prediction of adverse outcome in late small-for-gestational-age fetuses: Systematic review and meta-analysis. Preterm infants are classified as SGA or non-SGA according to the Fenton preterm growth chart. Reuwer PJ, Bruinse HW, Stoutenbeek P, Haspels AA. Ophthalmic artery Doppler in combination with other biomarkers in the prediction of pre-eclampsia at 19-23 weeks' gestation. Banta DH, Thacker SB. Physicians shall report the Healthcare Common Procedure Coding System/Current Procedural Terminology (HCPCS/CPT) code that describes the procedure performed to the greatest specificity The authors concluded that ophthalmic artery Doppler could potentially improve the performance of screening for PE at 35 to 37 weeks, especially imminent PE with delivery within 3 weeks of assessment; however, further studies are needed to validate these findings. 1998;77(5):527-531. Eur J Obstet Gynecol Reprod Biol. The ACOG guidelines on eclampsia and preeclampsia (2002) state that "Doppler velocimetry of the uterine arteries was reported not to be a useful test for screening pregnant women at low risk for preeclampsia." ins.id = slotId + '-asloaded'; Women assigned to antepartum umbilical artery Doppler velocimetry have been shown to require less frequent antenatal monitoring and shorter durations of maternal hospitalization. Are these added codes we should use in [], 2 Babies, 2 Ob-Gyns Doesn't Have to Spell Trouble, Question: We-ve been having trouble with insurance reimbursement for the assistance of a second physician [], 7 Surefire Strategies for Pap Smear Coding Success, Copyright 2023. 28. Matias DS, Costa RF, Matias BS, et al. Maternal serum ADAM12 and PAPP-A levels were measured by an immunoassay, and mean Ut-A Doppler PIs were calculated. All trials had adequate allocation concealment, but none had adequate blinding of participants, staff or outcome assessors. Fam Pract Manag. In: Chesley's hypertensive disorders in pregnancy. Utility of antepartum umbilical artery Doppler velocimetry in intrauterine growth restriction. Copayments; Fee-for-Service.
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