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The fetal contraction stress test, identified by CPT® Code 59020, is a diagnostic procedure used to assess the fetal heart rate response to uterine contractions. This test is also referred to as an oxytocin challenge test. During the procedure, two belts equipped with sensors are placed around the patient's abdomen. One belt is designed to monitor the fetal heart rate, while the other measures the timing and duration of uterine contractions. These sensors are connected via wires to a recording device that captures and displays the fetal heart rate alongside the strength and duration of the contractions. If the fetus changes position, the heart rate monitor may be adjusted accordingly to ensure accurate readings. The test typically lasts for 10 minutes, during which the fetal heart rate and any spontaneous uterine contractions are recorded on an external fetal monitor. If no spontaneous contractions occur within this timeframe, an intravenous infusion of oxytocin, commonly known as Pitocin, is administered. The infusion starts at a low dose and is gradually increased until three contractions are recorded within a 10-minute period, with each contraction lasting longer than 45 seconds. Alternatively, breast massage or nipple stimulation may be employed to induce contractions naturally, as this method encourages the body to produce oxytocin. The patient manually massages her nipple until contractions begin, and if a second contraction does not occur within 2 minutes, further stimulation is applied. If contractions do not manifest within 15 minutes, both nipples may be stimulated, with the procedure being repeated on one breast for a maximum of 10 minutes. It is important to note that while nipple stimulation can be effective, it may lead to prolonged and uncontrolled contractions, prompting some physicians to prefer the oxytocin infusion method for its controlled approach.
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The fetal contraction stress test is performed for several specific indications, which include the following:
The fetal contraction stress test involves several procedural steps that are crucial for accurate assessment. The first step is the placement of two belts around the patient's abdomen. One belt is equipped with a sensor that continuously monitors the fetal heart rate, while the other belt measures the timing and duration of uterine contractions. These sensors are connected to a recording device that captures the data for analysis. The monitoring begins with a 10-minute observation period during which the fetal heart rate and any spontaneous uterine contractions are recorded on an external fetal monitor. If no spontaneous contractions are detected during this initial 10-minute period, the next step involves administering an intravenous infusion of oxytocin (Pitocin). The infusion starts at a low dose, which is gradually increased until the desired response is achieved—specifically, until three contractions occur within a 10-minute timeframe, with each contraction lasting longer than 45 seconds. Alternatively, if the physician opts for a non-pharmacological approach, breast massage or nipple stimulation may be employed to induce contractions. In this case, the patient manually massages her nipple to stimulate the release of oxytocin naturally. If a second contraction does not occur within 2 minutes of the first, the patient is instructed to massage the nipple again. Should contractions not occur within 15 minutes, both nipples may be stimulated, and this procedure can be repeated on one breast for a maximum of 10 minutes. It is important to note that while nipple stimulation can be effective, it may lead to prolonged and uncontrolled contractions, which is why some physicians prefer the controlled method of oxytocin infusion.
After the fetal contraction stress test is completed, the patient is monitored for any immediate effects of the procedure, particularly in relation to uterine contractions and fetal heart rate patterns. The results of the test are analyzed to determine the fetal response to the contractions, which can provide critical information regarding fetal well-being. Depending on the findings, further monitoring or interventions may be necessary. Patients may be advised to rest and may receive instructions regarding any follow-up appointments or additional testing that may be required based on the test results. It is essential for healthcare providers to communicate the outcomes of the test clearly to the patient and discuss any implications for ongoing prenatal care.
| Short Descr | FETAL CONTRACT STRESS TEST | Medium Descr | FETAL CONTRACTION STRESS TEST | Long Descr | Fetal contraction stress test | Status Code | Active Code | Global Days | 000 - Endoscopic or Minor Procedure | PC/TC Indicator (26, TC) | 1 - Diagnostic Tests for Radiology Services | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Procedure or Service, Multiple Reduction Applies | ASC Payment Indicator | Office-based surgical procedure added to ASC list in CY 2008 or later with MPFS nonfacility PE RVUs; payment based on MPFS nonfacility PE RVUs. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P6C - Minor procedures - other (Medicare fee schedule) | MUE | 2 | CCS Clinical Classification | 139 - Fetal monitoring |
| 26 | Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | GC | This service has been performed in part by a resident under the direction of a teaching physician |
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| Pre-1990 | Added | Code added. |
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