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PAP256

Billing for Multiple Births


Provider Administrative Policy

Section
Claims Submission
Policy Date
January 2010
Status/Date
Revised/August 2010
Provider Type(s)
Hospitals  

Disclaimer

Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts.

Policy

Billing for Multiple Births

When you submit a bill for multiple births, please code each birth separately. For vaginal deliveries, code the second and any subsequent births, with modifier 51. We do not give an allowance for routine obstetric care for the second and any subsequent children. The following chart lists the correct coding for multiple vaginal and C-section deliveries:

 Births

 Delivery         

 First  Code

 Second Code

Twins (2)

 Vaginal - both

59400

59409-51

Twins (2)

C-section - both

59510-22

 

Twins (2)

Combination

59510

59409-51

More (2+)

Vaginal - all

59400

59409-51 (for each child)

More (2+)

C-section - all

59510-22

 

More (2+)

Combination

59510

Based on number by c-section and number vaginal, following coding above

Using the coding structure above, we will allow 100 percent of the fee schedule or billed charges, whichever is less for the first twin and 50 percent of the fee schedule or billed charges, whichever is less for the second and each subsequent birth by vaginal delivery.

When multiple births occur via c-section, code one delivery with a modifier 22. 

Surgical assists are only allowed for C-section deliveries.  The assistant should not bill for the global maternity package that includes antepartum and postpartum care.  Rather, they can bill for the delivery only (CPT 59514 or 59620).  When assisting with a C-section for multiple births, code just one delivery  CPT with a modifier 22. 

Policy History

Date Action Reason
August 2010 Revised Assistant surgeon information added

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