Commercial

Medical Policy

Notification

Billing Requirements for Multiple Births for Professional Providers

Notification Issue Date:

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.

Title:

Billing Requirements for Multiple Births for Professional Providers

Policy #:

00.10.38a

Policy

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 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.

References

American Congress of Obstetricians and Gynecologists [ACOG]. 2016 Procedural coding In Obstetrics And Gynecology. 2016. Avaliable at: https://www.acog.org/practice-management/coding. Accessed 04/23/2024.

American Congress of Obstetricians and Gynecologists [ACOG]. Reporting A Service with Modifier 22. ACOG. Available at: https://www.acog.org/practice-management/coding/coding-library#q=multiple. Accessed 04/23/2024.

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

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

ICD - 10 Procedure Code Number(s)

N/A

ICD - 10 Diagnosis Code Number(s)

N/A

HCPCS Level II Code Number(s)

N/A

Revenue Code Number(s)

N/A

MPMiscCodesNarrativesPub
Modifiers

22 Increased Procedural Services
51 Multiple Procedures
59 Distinct Procedural Service

Coding and Billing Requirements

Cross Reference

Policy History

Version Effective Date:

12/30/2019

Version Issued Date: