Notification



Notification Issue Date:



Policy Attachment



Attachment to Policy # 00.10.38a


Attachment:B

Policy #:00.10.38a

Description:MULTIPLE BIRTH CODING SCENARIOS FOR DELIVERY OF TWINS WHEN ANETEPARTUM CARE IS NOT PROVIDED

Title:Billing Requirements for Multiple Births for Professional Providers


Inclusion of a code in this table does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

The codes listed below are updated on a regular basis, in accordance with nationally accepted coding guidelines. Therefore, this policy applies to any and all future applicable coding changes, revisions, or updates.

In order to ensure optimal reimbursement, all health care services, devices, and pharmaceuticals should be reported using the billing codes and modifiers that most accurately represent the services rendered, unless otherwise directed by the Company.


EXAMPLES OF CODING SCENARIOS FOR DELIVERY OF TWINS
WHEN ANTEPARTUM CARE WAS NOT PROVIDED


This attachment describes examples of coding scenarios for reporting twin births when antepartum care was not provided by the same provider or provider group that delivers the neonates. For other examples of coding scenarios for multiple births, refer to the following policy attachments:
  • Attachment A: Examples of Coding Scenarios for Reporting Twin Births when Routine Obstetric (Global Maternity/Obstetric [OB]) Care was Provided
  • Attachment C: Examples of Coding Scenarios for Reporting High-Order Multiple (Triplets, Quadruplets, etc.) Births when Routine Obstetric (Global Maternity/Obstetric [OB]) Care was Provided
  • Attachment D: Examples of Scenarios for Reporting High-Order Multiple (Triplets, Quadruplets, etc.) Births when Antepartum Care was not Provided

AS USED IN THIS TABLE:
  • VBAC refers to a vaginal birth (delivery) after a previous cesarean (C-section) delivery
  • Completed VBAC refers to a a multiple birth where, after a previous C-section(s), both babies were delivered vagianlly
  • Attempted VBAC refers to, after a previous C-section, a vaginal delivery was attempted but not successful and, therefore, the babies were delivered by C-section

THE CODING SCENARIOS IN THIS TABLE ARE EXAMPLES AND DO NOT REPRESENT A COMPREHENSIVE LIST OF PROCEDURE CODE AND MODIFIER COMBINATIONS (THIS TABLE DOES NOT REPRESENT A COMPREHENSIVE LIST OF CODE COMBINATIONS)
Delivery Type
Baby
Code
Modifier
Both Vaginal
Baby A
59409
Baby B
59409
Modifier 59
OR
Baby A
59410
Baby B
59409
Modifier 59
Completed VBAC
Baby A
59612
Baby B
59612
Modifier 59
OR
Baby A
59614
Baby B
59612
Modifier 59
Both C- Section
Babies A & B
59514
Modifier 22
OR
Babies A & B
59515
Modifier 22
C-Section & Vaginal
Baby B: C-Section
59514
Baby A: Vaginal
59409
Modifier 51
OR
Baby B: C-Section
59515
Baby A: Vaginal
59409
Modifier 51
Attempted VBAC
Babies A & B
59620
Modifier 22
OR
Babies A & B
59622
Modifier 22

Version Effective Date: 12/30/2019
Version Issued Date: 12/30/2019
Version Reissued Date: N/A



2017 AmeriHealth.