Notification



Notification Issue Date:



Policy Attachment



Attachment to Policy # 00.10.38a


Attachment:D

Policy #:00.10.38a

Description:MULTIPLE BIRTH CODING SCENARIOS FOR DELIVERY OF HIGH-ORDER MULTIPLES WHEN ANTEPARTUM CARE IS NOT PROVIDED

Title:Billing Requirements for Multiple Births for Professional Providers


EXAMPLES OF CODING SCENARIOS FOR DELIVERY OF HIGH-ORDER MULTIPLES
WHEN ANTEPARTUM CARE WAS NOT PROVIDED

This attachment lists procedure code and modifier reporting scenario requirements for the delivery of high-order multiples (triplets, quadruplets, etc.) when antepartum care was not provided by the same provider or provider group. 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 B: Examples of Coding scenarios for Reporting Twin Births when Antepartum Care was not 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

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), the babies were delivered vaginally
  • 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
  • Partially Completed VBAC refers to a multiple birth where, after a previous C-section(s), a minimum of one baby was delivered vaginally and a minimum of one baby was 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
All Vaginal
Baby A
59409
Baby B
59409
Modifier 59
Baby C
59409
Modifier 59
OR
Baby A
59410
Baby B
59409
Modifier 59
Baby C
59409
Modifier 59
Completed VBAC
Baby A
59612
Baby B
59612
Modifier 59
Baby C
59612
Modifier 59
OR
Baby A
59614
Baby B
59612
Modifier 59
Baby C
59612
Modifier 59
All C-Section
Babies A, B, C, etc.
59514
Modifier 22
OR
Babies A, B, C, etc.
59515
Modifier 22
Attempted VBAC
Babies A, B, C, etc.
59620
Modifier 22
OR
Babies A, B, C, etc.
59622
Modifier 22
C-Section & Vaginal
Babies B, C, etc: C-Section
59514
Modifier 22
Baby A: Vaginal
59409
Modifier 51
Partially Completed VBAC
Baby C: C-Section
59620
Modifier 22
Baby A: Vaginal
59612
Modifier 51
Baby B: Vaginal
59612
Modifier 59
OR
Baby C: C-Section
59622
Modifier 22
Baby A: Vaginal
59612
Modifier 51
Baby B: Vaginal
59612
Modifier 59

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



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