Notification



Notification Issue Date:



Policy Attachment


Attachment to Policy # 00.10.38a


Attachment:C

Policy #:00.10.38a

Description:CODING SCENARIOS FOR REPORTING HIGH-ORDER MULTIPLE (TRIPLETS, QUADRUPLETS, ETC) BIRTHS WHEN ROUTINE OBSTETRIC (GLOBAL MATERNITY/OBSTETRIC [OB]) CARE WAS 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 HIGH-ORDER MULTIPLES
WHEN ROUTINE OBSTETRIC (GLOBAL MATERNITY/OBSTETRIC [OB]) CARE WAS PROVIDED

This attachment describes examples of coding scensarios for reporting high-order multiple (triplets, quadruplets, etc.) births when routine obstetric (global maternity/obstetric [OB]) care was 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 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), the babies were delivered vaginally
  • 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
  • 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
All Vaginal
Baby A
59400
Baby B
59409
Modifier 59
Baby C
59409
Modifier 59
All C-Section
Babies A, B, C, etc.
59510
Modifier 22
Completed VBAC
Baby A
59610
Baby B
59612
Modifier 59
Baby C, etc.
59612
Modifier 59
Attempted VBAC
Babies A, B, C, etc
59618
Modifier 22
Partially Completed VBAC
Baby C: C-Section
59618
Baby A: Vaginal
59612
Modifier 51
Baby B: Vaginal
59612
Modifier 59
OR
Babies B, C, etc: C-Section
59618
Modifier 22
Baby A: Vaginal
59612
Modifier 51
C-Section & Vaginal
Baby C: C-Section
59510
Baby A: Vaginal
59409
Modifier 51
Baby B: Vaginal
59409
Modifier 59
OR
Babies B, C, etc: C-Section
59510
Modifier 22
Baby A: Vaginal
59409
Modifier 51
    

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

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