Way Revenue Code For 59025 - Mar 2023 ACOG Practice Bulletin No. The ob-gyn interprets the strip and writes (or dictates) a report that he must include in the patient's record. The ob-gyn checks her and sees that she's dilated 3 cm. However, the authors stated that large scale prospective studies areneeded to evaluate the power of this integrated approach in clinical practice. The methodological quality of included studies was assessed using well-accepted quality appraisal guidelines. Semin Perinatol. } A variety of fetal and maternal blood vessels have been evaluated by Doppler wave form analysis to assess the risk of adverse perinatal outcome. In a prospective, case-control study, Madazli et al (2008) compared macrophage activation in normal and pre-eclamptic pregnancies by determining YKL-40 concentration and chitotriosidase activity in maternal and cord serum. The payment for the TC portion of a test includes the practice expense and the malpractice expense. OL LI { Services Excluded from the Global Obstetrical Package, The following services are excluded from the global OB package (CPT codes 59400, 59510, 59610, and 59618). Prediction of pre-eclampsia, low birthweight for gestation and prematurity by uterine artery blood flow velocity waveform analysis in low risk nulliparous women. Ultrasound scanning during pregnancy. The authors concluded that serum PLGF level was lower in women who subsequently developed severe PE early in the second trimester, suggesting its role in prediction of PE. Uterine artery Doppler was assessed and outcome was registered from medical records. 1998;178:1346-1353. When you-re reporting 59025, you-d better be sure you-ve got supporting documentation--and the supporting diagnosis to justify this code. The CST measures the response of the fetal heart rate to uterine contractions. They carried out a systematic search of major databases to identify all published diagnostic accuracy studies on IMA. The authors concluded that abnormal UAD in the third trimester appeared to be moderately useful in predicting perinatal death in pregnancies with suspected SGA. The ob-gyn checks her and sees that she's dilated 3 cm. Amniotic fluid index vs single deepest pocket technique during modified biophysical profile: A randomized clinical trial. 2014;14:35. Home; About Us. Omtzigt AM, Reuwer PJ, Bruinse HW. 11. MEDICARE E CODES cpt 99396 medicare. } Aetna considers Doppler studies of ductus venosus and vessels other than the middle cerebral artery andumbilical arteryfor fetal surveillance of impaired fetal growth experimental and investigational because their effectiveness for these indications has not been established. Ophthalmic artery Doppler in combination with other biomarkers in the prediction of pre-eclampsia at 35-37 weeks' gestation. Billing for Incomplete Antepartum Care 59425 When billing for four to six prenatal visits 59426 When billing for seven or more prenatal visits with or without an initial visit Billing for Multiple Deliveries For additional babies: 59409, 59514, 59612, or 59620 Modifier - 51 and 59 Oral and Maxillofacial Surgery 1985;92:605-610. Ozcan T, Thornburg L, Mingione M, Pressman E. Use of middle cerebral artery peak systolic velocity and intrauterine transfusion for management of twin-twin transfusion and single fetal intrauterine demise. Fetal Non-Stress Test (NST) 59025 - Medical Billing Group 12. The primary outcome was delivery related to PE within 1 and 2 weeks. Clinical Information Cpt 26260 is a surgical, Read More CPT Code 26260 | Description & Clinical InformationContinue, CPT 78191 describes the re-transfusion of a patients tagged platelets, which have been studied for their lifespan after a blood sample is taken. list-style-type: upper-alpha; Indiana Medicaid: Providers: Code Sets The following CPT codes is used to report postpartum care only: Postpartum care only (separate procedure), https://www.acog.org/practice-management/coding/coding-library. Are reading NSTs for pregnant mothers who are inpatients a separately billable service? Am J Obstet Gynecol. Fetal arterial Doppler studies in twin-twin transfusion syndrome. American College of Obstetricians and Gynecologists (ACOG), Committee on Practice Bulletins -- Obstetrics. Ophthalmic artery Doppler in combination with other biomarkers in the prediction of pre-eclampsia at 19-23 weeks' gestation. This includes the use of industry standard, compliant codes on all claims submissions. list-style-type: upper-roman; Otherwise, count the fetal monitoring as routine. MedConverge Home Maternal - Fetal Medicine Billing and CPT Codes Tremendous advances have been made in healthcare during pregnancy and child birth. Although Doppler studies of the ductus venous, middle cerebral artery, and other vessels have some prognostic value for IUGR fetuses, currently there is a lack of randomized trials showing benefit. 207. Evidence for the outcome of stillbirth was graded according to regimen subgroups -- with a moderate quality rating for stillbirth (fetal/umbilical vessels only) and a low quality rating for stillbirth (fetal/umbilical vessels + uterine artery vessels). An UpToDate review on "Prediction of preeclampsia" (Norwitz, 2014) states that "Studies of uterine artery Doppler velocimetry for prediction of preeclampsia are difficult to compare because investigators have used different Doppler sampling techniques, definitions of abnormal flow velocity waveform, populations, gestational age at examination, and criteria for the diagnosis of preeclampsia . The positive likelihood ratio was 3.5 (95 % CI: 2.3 to 5.5) and negative likelihood ratio 0.43 (95 % CI: 0.22 to 0.85); the diagnostic OR was 8.3 (95 % CI: 3 to 22.4). 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). NST Procedure Code 59025 Components of a NST - V i biliVariability Short term variability (STV) . Fretts RC, Elkin EB, Myers ER, Heffner LJ. 27. The authors concluded that existing evidence does not provide conclusive evidence that the use of routine UAD ultrasound, or combination of umbilical and UAD ultrasound in low-risk or unselected populations benefits either mother or baby. The competing risks model was used to estimate the individual patient-specific risks of delivery with PE at less than 37 and greater than or equal to 37 weeks' gestation and determine the AUC and DR, at 10 % FPR, in screening by a combination of maternal demographic characteristics and medical history with biomarkers. Moreover, the pattern of its expression in certain tissues (e.g., human liver or cartilage) suggested that YKL-40 may also serve as an inflammatory marker involved in inflammatory states and vascular processes (Johansen et al, 2006). Billing for non-global OB or Partial care may occur under the following circumstances. These researchers did not adjust for smoking, maternal age, or ethnicity while calculating the MoM values due to small number of smokers in the reference population (smoking) and insignificant differences in maternal age or ethnicity between the cases and controls. Combinations of these parameters do not further improve their screening efficiency. The average salary for a Medical Billing Specialist is $39,188 per year in Koppel (United States). Norwitz ER. 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. The AUC and DR of delivery with PE, at 10 % FPR, after screening by maternal factors, ophthalmic artery second to first PSV ratio and combinations with MAP, UtA-PI, serum PlGF and serum sFlt-1 were determined. Ultrasound Obstet Gynecol. Saade GR. Repeat Procedures modifiers 76 & 77 - Medical billing cpt modifiers and The clinical findings of other studies that the association of UAD with adverse outcome was independent of brain Doppler made a strong correlation between these parameters unlikely. This trial included women attending for a routine hospital visit at 19+1 to 23+3 weeks' gestation. Billing and Coding Guidelines for Wound Care. 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. Overall, the test lasts 30-40 minutes, during which the ob-gyn monitors the fetal heart rate using external transducers. BMC Pregnancy Childbirth. Colorado Hospital System Centura Health Breaking Up, 59400 Routine obstetric care including antepartum care, vaginal delivery (with or. Predictive sensitivity was low; receiver operating characteristic curve analysis yields areas under the curve of 0.592 (95 % confidence interval [CI]: 0.548 to 0.635) for the combination of Ut-A Doppler and UA PI z-scores. Seshadri and colleagues (2019) noted that IMA has been widely accepted as a serological biomarker; and it has been proposed as a simple and novel marker of oxidative stress in PE. 2002;99(4):589-593. Most payers do not cover the NST unless your ob-gyn documented a specific reason,- Engstrom says. These recommendations are based upon current evidence and should be used to guide patient management with individualization of care as dictated by the specific clinical circumstance (algorithm 1). technical analyst jobs in Vasant Kunj, Delhi - in.indeed.com Preeclampsia: Clinical features and diagnosis. Keep in mind: If the ob-gyn performed this service in the hospital using hospital equipment, you can bill only the professional component of the test (59025-26, Professional component). 2014;44(4):411-418. 1997;9(4):271-286. This visit included recording of maternal demographic characteristics and medical history, ultrasound (US) examination for fetal anatomy and growth, assessment of flow velocity waveforms from the maternal ophthalmic arteries, and measurement of MAP, UtA-PI, serum PlGF and serum sFlt-1. To separately bill this service with 59025 (Fetal nonstress test), your ob-gyn must document a clear indication for doing the NST (for instance, to measure fetal wellbeing).You must have a report with the findings and a recommendation for further testing or treatment. 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.". Therefore when the facility is billing for observation services, an outpatient claim will be submitted under a 13X or 85X Type of Bill (TOB). 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. Hecher K, Ville Y, Nicolaides KH. If there are no accelerations after 20 minutes, the ob-gyn may attempt to induce a fetal response with acoustic stimulation through the mother's abdomen or a vibration. American College of Obstetricians and Gynecologists (ACOG). -We also don't code for a labor check when the patient goes to the hospital for observation and is then admitted for delivery.-On the other hand, you may find a way to be indirectly reimbursed for the labor check. Antepartum fetal surveillance: ACOG practice bulletin, number 229. Approximately 1/3 (n = 37 (29.4 %)) of all reviews examined solely biochemical markers for predicting PE, 31 (24.6 %) examined genetic associations with PE, 46 (36.5 %) reported on clinical characteristics, 4 (3.2 %) examined only US markers, and 6 (4.8 %) evaluated a combination of tests; 2 (1.6 %) additional reviews examined primary studies investigating any screening test for PE. About NEPRA; The Authority; Sr. Management; Careers; Tenders; Legal; Licences Ciobanu A, Wright A, Syngelaki A, et al. Prediction of preeclampsia or intrauterine growth restriction by second trimester serum screening and uterine Doppler velocimetry. 26. Maternity Reimbursement - Horizon NJ Health Fam Pract Manag. This is also called a non-stress test (NST). 2000;15:205-208. Overall, the test lasts 30-40 minutes, during which the ob-gyn monitors the fetal heart rate using external transducers. Median ADAM12 levels were significantly lower in patients who developed PE compared to those who did not (0.81 versus 1.01 MoM; p = 0.04). PMH Billing Scenario 3 Patient returns to LHD within 60 days of delivery for her postpartum visit.Patient has an IUD inserted at the postpartum visit in the FP Clinic. Endometrial thickness, pulsatility and resistance indices (PI and RI) of the uterine, myometrial and endometrial vasculature, endometrial histopathology were measured by trans-vaginal Doppler sonography. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites. The other 2 ophthalmic artery indices of first PSV and PI were not significantly affected by PE. Clin Exp Obstet Gynecol. AHRQ Publication No. Hierarchical summary ROC curves were constructed using random-effects modeling. These researchers stated that further prospective studies are needed to validate these findings. August P, Sibai BM. Roberts AB, Mitchell JM, Lake Y, et al. SGA of less than fifth centile was significantly associated with low PlGF (p< 0.001 ; DR 57 %, AUC 0.73, 95 % CI: 0.65 to 0.80). The outcome of this procedure can also be nonreassuring (or nonreactive) if there are not enough heart rate accelerations within 40 minutes. If you would like to change your settings or withdraw consent at any time, the link to do so is in our privacy policy accessible from our home page.. The other one is used for measuring the fetal heart rate. Fren JF, Heazell AE, Tveit JV, et al. A randomized controlled trial on the clinical value of umbilical Doppler velocimetry in antenatal care. Better make sure the patient recorded when she feels the baby moving. ", American College of Obstetricians and Gynecologists . Yes. This was probably due to the low number of patients with PE, and the fact that PE results from various pathophysiologic mechanisms that may alter the markers in different ways. Ob/Gyn Coding Guidelines 2022 Fetal movement assessment. Dildy GA. 2008;(3):CD006593. Prenatal stress and hemodynamics in pregnancy: A systematic review. 2009;201(2):121-126. In the selected literature, a combination of these markers was analyzed, and where relevant, the value of maternal characteristics was added. Umbilical artery Doppler velocimetry is considered medically necessary only in pregnancies complicated by intra-uterine growth restriction, oligohydramnios, twin-twin transfusion syndrome and/or discordant fetuses. 90791 90792 . Hemoglobinopathies (hemoglobin SS, SC, or S-thalassemia), Multiple gestation (with significant growth discrepancy), Post-term pregnancy (greater than 41 weeks gestation), Previous fetal demise (unexplained or recurrent risk), Amniotic fluid index (determination of the amniotic fluid volume), chitotriosidase activity in both maternal and cord serum and. Society for Maternal-Fetal Medicine (SMFM), Norton ME, Chauhan SP, Dashe JS. 2018;51(6):731-737. Increasing serum YKL-40 was related to maternal age, BMI and small-for-gestational age and may reflect an exaggerated inflammatory response. 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. Literature on the 7 most studied serum markers (A-disintegrin and metalloprotease 12 [ADAM 12], free -subunit of human chorionic gonadotropin [f-hCG], Inhibin A, Activin A, PP13, placental growth factor [PlGF], and pregnancy-associated plasma protein A [PAPP-A]) and Ut-A Doppler was primarily selected. Billing Coding and Reimbursement Guide MCI Screen. 2010;53(4):869-878. Example: -You might use the decreased fetal movement code (655.73) because the ob-gyn is monitoring the baby,- says Deanna Sherland, CPC, billing/surgery clerk at Midwest Women's Care in Belleville, Ill. Clin Lab. Curr Opinion Obstet Gynecol. Park HJ, Kim SH, Jung YW, et al. Inpatient Evaluation and Management (E/M) service provided within 24 hours of delivery. 2002;19(3):293-296. 1997;104(4):425-430. 2015;9:13-20. The authors concluded that the main drawback of this study was its sample size, which yielded only 9 cases of earlyonset PE. Example: A patient at 30 weeks presents to your ob-gyn in labor. Aetna considers the use of maternal serum ischemia-modified albumin as a biomarker for preeclampsia experimental and investigationalbecausethe effectivenessof this approach has not been established. 29. Manning F. Fetal assessment based on fetal biophysical profile scoring. PlGF-based testing to help diagnose suspected pre-eclampsia (Triage PlGF test, Elecsys immunoassay sFlt-1/PlGF ratio, DELFIA Xpress PlGF 1-2-3 test, and BRAHMS sFlt-1 Kryptor/BRAHMS PlGF plus Kryptor PE ratio). Am J Obstet Gynecol. The normotensive and pre-eclamptic groups were compared using parametric (Student's t-test) and non-parametric (Mann-Whitney U-test) tests. For 4 to 6 visits: Use CPT code 59425 For 7 or more visits: Use CPT code 59426 Once the appropriate code is selected, the below billing guidelines must be followed: When billing an E/M code for a patient seen 1-3 times, each date is reported individually with the corresponding visit date Find out, Learn These In-House Lab Codes And Lasso Reimbursement, Tests with different names don't always mean different codes, See How Your Hysterectomy Responses Measure Up. Mari G, Detti L, Oz U, et al. 3. The relationship between ophthalmic Doppler indices and PE could not be a consequence of trophoblast invasion and may be related to maternal hemodynamic adaptation to pregnancy. These researchers conducted a prospective cohort study of patients presenting for first trimester aneuploidy screening between 11 and 14 weeks' gestation. Oepkes D. Invasive versus non-invasive testing in red-cell alloimmunized pregnancies. Non-stress test: A fifteen year clinical appraisal. A CST or full BPP is considered medically necessary following an abnormal NST or modified BPP. They had a higher incidence of Ut-A Doppler bilateral notching, higher mean Ut-A Doppler-PI z-scores (p < 0.001) and UA PI z-scores (p = 0.03), but no significant difference in DV-PI z-scores or in the incidence of abnormal qualitative UA and DV patterns. The diagnostic value of the Doppler ultrasonography in distinguishing the endometrial malignancies in women with postmenopausal bleeding. When the same group physician and/or other healthcare professional provides all components of the OB package, the appropriate CPT code for the Global OB care is reported. } Martinez-Portilla and colleagues (2020) examined the predictive ability for adverse perinatal outcome of abnormal third-trimester UAD in late SGA fetuses. Utility of antepartum umbilical artery Doppler velocimetry in intrauterine growth restriction. Use the codes below for billing antepartum-only, postpartum-only, delivery-only or delivery and postpartum only services. Should older women have antepartum testing to prevent unexplained stillbirth? 2002;101(1):26-30. . padding-bottom: 4px; Question: During a laparoscopic supracervical hysterectomy (LSH), the ob-gyn performed a cervical suspension before morcellating [], Question: What is the correct diagnosis code for a patient who is currently 18 weeks [], Question: I-m wondering about Pap smears and risk factors. Plasma levels of PAPP-A and serum levels of alpha-fetoprotein, unconjugated estriol, human chorionic gonadotropin, and inhibin-A were measured, and sFlt-1/PlGF ratios were calculated. Although other trials would be desirable before asserting a definite lack of benefit (due to the problem of statistical heterogeneity and lack of power), umbilical Doppler examination cannot be recommended as a routine test in low- risk pregnancies.". Provider Policies, Guidelines and Manuals | Anthem.com 02-E018. Additionally, the AUC increased significantly from 0.82 to 0.88 when the PMDV was incorporated into the model containing clinical variables and UtA Doppler indices. Samples of maternal peripheral blood and umbilical venous blood were collected from 28 pre-eclamptic and 24 normotensive pregnant women and their newborns. ", 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. Answer: A NST is a discrete test that takes 20-40 minutes to complete and requires a notation of fetal movement as part of the test. They stated that further studies should be performed to confirm these findings and to verify the discriminatory capability of ophthalmic artery Doppler relative to the occurrence of PE in the general population. The authors concluded that abnormal UAD indices are associated with a 3- to 4-fold increase in the risk of stillbirth. Modifier 59 should be used when the injection is a separate service from other treatments. Provider Communications 05101, 05201, 05301, 05401, 17. Included studies were those that assessed the association of abnormal UAD parameters and stillbirth. PDF Global Maternity/Obstetric Package - Reliance Medical Management, LLC These factors may have contributed to the relatively small number of patients enrolled in this study. Prediction of preeclampsia. Non-global OB care, or partial services, refers to maternity care not managed by a single provider or group practice. Common tests include fetal movement assessment, non-stress tests (NST), contraction stress tests (CST), biophysical profile (BPP), modified BPP, and umbilical artery Doppler velocimetry. The results of 1 RCT showed significantly lower rates of obstetric interventions in patients assigned to Doppler, such as antepartum admission and labor induction. American College of Obstetricians and Gynecologists (ACOG). The 59025 CPT code procedure begins with the provider asking the female patient to lie on a bed. Lancet. Two strategies have been proposed by investigators as useful indicators of fetal anemia. Chapter 32 - Billing Requirements for Special Services Table of Contents (Rev. Some advocate liberal or primary use of fetal blood sampling, while others promote the use of non-invasive ultrasonography and Doppler assessment of umbilical venous and middle cerebral artery peak systolic velocity (MCA PSV). Ceska Gynekol. YKL-40, a 38-kDA macrophage-derived glycoprotein, is a member of the "mammalian chitinase-like proteins". 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. American Hospital Association ("AHA"). Ultrasound was used to assess uterine artery Doppler. Erskine RL, Ritchie JW. 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 necessity for these services. The predictors with the best test performance were BMI greater than 35 kg/m2 , with a specificity of 92 % (95 % CI: 89 to 95 %) and a sensitivity of 21 % (95 % CI: 12 to 31 %); BMI greater than 25 kg/m2 , with a specificity of 73 % (95 % CI: 64 to 83 %) and a sensitivity of 47 % (95 % CI: 33 to 61 %); 1st-trimester UtA pulsatility index or resistance index of greater than 90th centile (specificity 93 % (95 % CI: 90 to 96 %) and sensitivity 26 % (95 % CI: 23 to 31 %)); PIGF (specificity 89 % (95 % CI: 89 to 89 %) and sensitivity 65 % (95 % CI: 63 to 67 %)); and placental protein 13 (specificity 88 % (95 % CI: 87 to 89 %) and sensitivity 37 % (95 % CI: 33 to 41 %)). Biomed Instrum Technol. These researchers carried out a retrospective study including 161 patients during the 1st trimester screening between 11+0 and 13+6 weeks of gestation. 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. 1996;42(4):101-104. Detection rates for combinations of multiple markers varied between 38 % and 100 %. Clin Med Insights Reprod Health. 1993;100:733-741. Apply for the Job in Medical Claims Processor at El Paso, TX. 1999;33(2):143-151. Each component is assigned2 points, resulting in a score ranging from 0 to 10, with scores from 8 to 10 considered normal, 6 considered borderline, and below 6 considered problematic. Doppler assessment of the fetoplacental circulation in normal and growth-retarded fetuses. A total of 347 women were recruited, of whom 40 developed PE. Per ACOG coding guidelines, reporting of third and fourth degree lacerations should be identified by appending modifier 22 to the global OB code (CPT codes 59400 and 59610) or delivery only code (CPT codes 59409, 59410, 59612 and 59614). Binary logistic regression analysis was used to determine the 5 best combination models for early detection of late-onset PE. We and our partners use data for Personalised ads and content, ad and content measurement, audience insights and product development. Next, the provider uses an external monitor to evaluate the fetus. J Matern Fetal Neonatal Med. In this situation, you should include labor checks in the hospital admission fee (99221-99223), Sherland says. Copayments; Fee-for-Service. Therefore, you would not report a separate NST.Note: For a free PDF of an outpatient fetal monitoring template you can put to use in your practice, e-mail suzannel@eliresearch.com. 175: "Ultrasound in pregnancy" (2016) stated that "Umbilical artery Doppler velocimetry used in conjunction with standard fetal surveillance, such as non-stress tests, biophysical profiles, or both, is associated with improved outcomes in fetuses with fetal growth restriction. 24. 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). Serum YKL-40 increased from 12 to 20 weeks and decreased from 20 to 25 and 25 to 32 weeks of gestation. Naef RW 3rd, Morrison JC, Washburne JF, et al. 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. Gynecol Obstet Invest. Contractor Name . background: #5e9732; 1997;56(8):1981-1988. It relies on the premise that fetal oxygenation will be transiently worsened by uterine contractions. Contractor Number . Radiology, 76818, 59025 (Q&A) (May 1998) - AMA CPT Assistant Antepartum Fetal Surveillance - Medical Clinical Policy Bulletins - Aetna Fetal middle cerebral artery Doppler waveforms in twin-twin transfusion syndrome. Teixeira JM, Duncan K, Letsky E, et al. Antepartum care refers to the serious routine, regular obstetrical visits that are spread out during the 40 weeks of a typical pregnancy. The acoustic stimulation or vibration is for waking the baby or to cause it to react to the stimulus. What happens: During the NST procedure, the ob-gyn evaluates the patient and assesses fetal well-being without using IV medications, says Denell Engstrom, CPC, coding manager and billing specialist at the Woman's Clinic in Boise, Idaho.