Notification



Notification Issue Date:



Claim Payment Policy


Title:Billing Requirements for Multiple Births for Professional Providers

Policy #:00.10.38a

This policy is applicable to the Company’s commercial products only. Policies that are applicable to the Company’s Medicare Advantage products are accessible via a separate Medicare Advantage policy database.

Application of Claim Payment Policy is determined by benefits and contracts. Benefits may vary based on product line, group or contract. Medical necessity determination applies only if the benefit exists and no contract exclusions are applicable. Individual member benefits must be verified.

In products where members are able to self-refer to providers for care and services, members are advised to use participating providers in order to receive the highest level of benefits.When services can be administered in various settings, the Company reserves the right to reimburse only those services that are furnished in the most appropriate and cost-effective setting that is appropriate to the member’s medical needs and condition. This decision is based on the member’s current medical condition and any required monitoring or additional services that may coincide with the delivery of this service.

For more information on how Claim Payment Policy Bulletins are developed, go to the About This Site section of this Medical Policy Web site.



Policy

Coverage is subject to the terms, conditions, and limitations of the member's contract.


Multiple births are covered and eligible for reimbursement consideration by the Company.

The Company has established the attached requirements for reporting of multiple births. Refer to Attachments A, B, C, and D for reporting requirements and examples of multiple birth coding scenarios.

The codes listed in the Coding Table of this policy are eligible for reimbursement consideration.

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


REQUIRED DOCUMENTATION

The individual's medical record must reflect the medical necessity for the care provided. These medical records may include, but are not limited to: records from the health care professional's office, hospital, nursing home, home health agencies, therapies, and test reports.

The Company may conduct reviews and audits of services to our members, regardless of the participation status of the provider. All documentation is to be available to the Company upon request. Failure to produce the requested information may result in a denial for the service.
Guidelines

BENEFIT APPLICATION

Subject to the terms and conditions of the applicable benefit contract, multiple births are covered under the medical benefits of the Company's products.

BILLING GUIDELINES

Multiple surgery reduction guidelines are applied to procedure codes reported for multiple births.

Additional reimbursement may be considered on a post-payment basis for cesarean delivery of triplets or more.

Description

A multiple birth is the delivery of two or more neonates (i.e., twins, triplets, or other high-order multiples [quadruplets, etc.]) that have been carried by the same mother during the same pregnancy.
Generally, the delivery of a neonate is reported using a procedure code that represents routine obstetric care. However, if more than one neonate is delivered, in some delivery scenarios, additional procedure codes may be required to represent the subsequent delivery of additional neonates.

Routine obstetric care includes the following components:
  • Antepartum care includes, when provided in its entirety, monthly visits up to 28 weeks’ gestation; biweekly visits to 36 weeks’ gestation; and weekly visits until delivery, which is a total of approximately 13 antepartum visits.
  • Delivery services include the admission to the hospital for the delivery, admission history and physical examination, management of uncomplicated labor, and vaginal delivery (with or without episiotomy, with or without forceps) or cesarean (C-section) delivery.
  • Postpartum care includes hospital and office visits following vaginal or cesarean (C-section) delivery.

As used in this policy:
  • Professional health care provider refers to the professional provider who performs the health care service, as well as to any professional provider in the same provider group practice.
  • Neonate refers to the newborn (newborn baby) at the time of delivery.
  • Baby A refers to the first neonate delivered. Baby B, C, etc. refers to subsequently delivered neonates.
    References


    American Congress of Obstetricians and Gynecologists [ACOG]. 2016 Procedural coding In Obstetrics And Gynecology. 2016. Avaliable at: https://www.acog.org/-/media/Departments/Coding/2016ProceduralCodinginObGyn.pdf. Accessed: 11/07/2019.

    American Congress of Obstetricians and Gynecologists [ACOG]. Reporting A Service with Modifier 22. ACOG. Available at: https://www.acog.org/About-ACOG/ACOG-Departments/Coding/Reporting-a-Service-with-Modifier-22?IsMobileSet=false. Accessed 11/07/2019.

    American Medical Association [AMA]. Current Procedural Terminology Professional. ed. 2020. Chicago, Il 60611 AMA; 2019.

    Company benefit contracts

    Holden K, Orme N, eds. 2009 Ingenix Learning: Understanding Modifiers.West Valley City, UT: Ingenix, Inc.; 2008.


    Coding

    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.

    The Coding Table lists any CPT, ICD-9, ICD-10, and HCPCS billing codes related only to the specific policy in which they appear.

CPT Procedure Code Number(s)

59400
59409
59410
59510
59514
59515
59610
59612
59614
59618
59620
59622

REFER TO THE FOLLOWING POLICY ATTACHMENTS FOR REQUIREMENTS AND EXAMPLES OF CODING SCENARIOS FOR MULTIPLE BIRTHS:
  • Attachment A: Coding Requirements and Scenarios for Reporting Twin Births When Routine Obstetric (Global Maternity/Obstetric [OB]) Care Was Provided
  • Attachment B: Coding Requirements and Scenarios for Reporting Twin Births When Antepartum Care Was Not Provided
  • Attachment C: Coding Requirements and Scenarios for Reporting High-Order Multiple (Triplets, Quadruplets, etc.) Births When Routine Obstetric (Global Maternity/Obstetric [OB]) Care Was Provided
  • Attachment D: Coding Requirements and Scenarios for Reporting High-Order Multiple (Triplets, Quadruplets, etc.) Births When Antepartum Care Was Not Provided


    Professional and outpatient claims with a date of service on or before September 30, 2015, must be billed using ICD-9 codes. Professional and outpatient claims with a date of service on or after October 1, 2015, must be billed using ICD-10 codes.

    Facility/Institutional inpatient claims with a date of discharge on or before September 30, 2015, must be billed with ICD-9 codes. Facility/Institutional inpatient claims with a date of discharge on or after October 1, 2015, must be billed with ICD-10 codes.


    ICD-10 Procedure Code Number(s)

N/A


Professional and outpatient claims with a date of service on or before September 30, 2015, must be billed using ICD-9 codes. Professional and outpatient claims with a date of service on or after October 1, 2015, must be billed using ICD-10 codes.

Facility/Institutional inpatient claims with a date of discharge on or before September 30, 2015, must be billed with ICD-9 codes. Facility/Institutional inpatient claims with a date of discharge on or after October 1, 2015, must be billed with ICD-10 codes.


ICD-10 Diagnosis Code Number(s)

N/A


HCPCS Level II Code Number(s)

N/A


Revenue Code Number(s)

N/A


Misc Code

:


22 Increased Procedural Services

51 Multiple Procedures

59 Distinct Procedural Service


Coding and Billing Requirements


Cross References

Attachment A: Billing Requirements for Multiple Births for Professional Providers
Description: MULTIPLE BIRTH CODING SCENARIOS FOR DELIVERY OF TWINS WHEN ROUTINE OBSTETRIC (GLOBALE MATERNITY/OBSTETRIC [OB]) CARE WAS PROVIDED

Attachment B: Billing Requirements for Multiple Births for Professional Providers
Description: MULTIPLE BIRTH CODING SCENARIOS FOR DELIVERY OF TWINS WHEN ANETEPARTUM CARE IS NOT PROVIDED

Attachment C: Billing Requirements for Multiple Births for Professional Providers
Description: CODING SCENARIOS FOR REPORTING HIGH-ORDER MULTIPLE (TRIPLETS, QUADRUPLETS, ETC) BIRTHS WHEN ROUTINE OBSTETRIC (GLOBAL MATERNITY/OBSTETRIC [OB]) CARE WAS PROVIDED

Attachment D: Billing Requirements for Multiple Births for Professional Providers
Description: MULTIPLE BIRTH CODING SCENARIOS FOR DELIVERY OF HIGH-ORDER MULTIPLES WHEN ANTEPARTUM CARE IS NOT PROVIDED



Policy History

00.10.38a
This version of the policy will become effective 12/30/2019. The policy has been reviewed and updated to communicate the Company's continued position on Multiple Births.
Version Effective Date: 12/30/2019
Version Issued Date: 12/30/2019
Version Reissued Date: N/A

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Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania.