How To Use CPT Code 59025

CPT 59025 is a code used for fetal non-stress tests, which measure the fetal heart rate in response to its own movements. This article will cover the description, procedure, qualifying circumstances, when to use the code, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 59025 procedures.

1. What is CPT 59025?

CPT 59025 is a medical billing code used for fetal non-stress tests (NST). These tests are performed to measure the fetal heart rate in response to its own movements, providing valuable information about the well-being of the fetus. The code is used by medical coders and billers to document and bill for this specific procedure.

2. 59025 CPT code description

The official description of CPT code 59025 is: “Fetal non-stress test.”

3. Procedure

1. The patient lies down on a bed with her back raised.
2. One belt is attached to the mother’s abdomen to measure fetal heart rate, and another belt is used to measure fetal movements and contractions.
3. An external monitor records the heart rate and reactivity of the heart rate to fetal heart movement.
4. In some cases, the mother is given a buzzer and instructed to push it each time she feels the baby move.
5. The provider may use sound to induce acceleration in the heart rate.
6. The procedure usually takes 20 to 40 minutes to complete.
7. The provider interprets the results in a written report.

4. Qualifying circumstances

CPT 59025 services are typically provided to pregnant women who are at or beyond 28 weeks of gestation, or earlier if there is a concern for fetal well-being. The test may be performed for various reasons, such as monitoring high-risk pregnancies, assessing fetal well-being in cases of decreased fetal movement, or evaluating the fetus in the presence of maternal medical conditions that may affect fetal health.

5. When to use CPT code 59025

It is appropriate to bill CPT 59025 when a fetal non-stress test is performed to assess the well-being of the fetus. This code should be used for each individual NST performed, regardless of the number of fetuses being monitored. The code should not be used for monitoring contractions during labor, as this type of monitoring is considered integral to labor management.

6. Documentation requirements

To support a claim for CPT 59025, the following information should be documented in the patient’s medical record:

• Indication for the test (e.g., high-risk pregnancy, decreased fetal movement, maternal medical condition)
• Date and time of the test
• Duration of the test
• Results of the test, including fetal heart rate accelerations and any other relevant findings
• Provider’s interpretation of the results and any recommendations for further testing or management

7. Billing guidelines

When billing for CPT 59025, it is important to follow the appropriate guidelines and rules. If the test is performed in a hospital setting, modifier 26 (Professional component) should be added to the code, as the hospital will be billing for the technical component. Additionally, it is essential to ensure that the documentation requirements listed above are met to support the claim for the service.

8. Historical information

CPT 59025 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Similar codes to CPT 59025

There are several codes related to CPT 59025, which differ based on the specific type of fetal monitoring or testing being performed. These include:

• CPT 59020: Fetal contraction stress test, which evaluates the fetal heart rate response to induced contractions
• CPT 59050: Fetal acoustic stimulation test, which assesses the fetal heart rate response to sound stimulation
• CPT 59051: Fetal biophysical profile, which includes a combination of tests to evaluate fetal well-being
• CPT 76805: Ultrasound, pregnant uterus, real-time with image documentation, which provides a visual assessment of the fetus and its environment
• CPT 76815: Ultrasound, pregnant uterus, limited (e.g., fetal heart beat, placental location, fetal position and/or qualitative amniotic fluid volume), which is a focused examination of specific aspects of the fetus and its environment

10. Examples

Here are 10 detailed examples of CPT code 59025 procedures:

1. A 32-week pregnant woman with gestational diabetes undergoes a fetal non-stress test to monitor the well-being of her baby.
2. A 35-week pregnant woman with a history of preeclampsia has a fetal non-stress test to assess her baby’s well-being.
3. A 28-week pregnant woman reports decreased fetal movement and undergoes a fetal non-stress test to evaluate her baby’s health.
4. A 30-week pregnant woman with a high-risk pregnancy due to advanced maternal age has a fetal non-stress test to monitor her baby’s well-being.
5. A 34-week pregnant woman with a history of stillbirth undergoes a fetal non-stress test to assess her baby’s well-being.
6. A 36-week pregnant woman with a twin pregnancy has a fetal non-stress test to monitor the well-being of both babies.
7. A 29-week pregnant woman with a history of preterm labor undergoes a fetal non-stress test to evaluate her baby’s health.
8. A 31-week pregnant woman with a history of intrauterine growth restriction has a fetal non-stress test to monitor her baby’s well-being.
9. A 33-week pregnant woman with a history of placental abruption undergoes a fetal non-stress test to assess her baby’s well-being.
10. A 37-week pregnant woman with a history of hypertension has a fetal non-stress test to monitor her baby’s well-being.