Commercial

Medical Policy

Policy Attachment

Attachment to Policy #

00.10.38a

Attachment:

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:

Baby A refers to the first neonate delivered. Baby B, C, etc. refers to subsequently delivered neonates.
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
C-Section & Vaginal	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:

5/15/2024

Commercial

Medical Policy

Notification

Policy Attachment