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Maternity Claims: Multiple Birth Reimbursement
Date Issued: 12/2/2014
Beginning September 1, 2014, EmblemHealth began adjusting the payment for multiple births for members in GHI plans. Payment method for submissions of claims for the delivery of a multiple birth is as follows:
- Payment is made for members, who deliver twins, triplets, quads, etc. for each vaginal delivery, or when the first baby is born vaginally and the subsequent babies are delivered via Cesarean section.
- If multiple births are via C-Section, only one procedure will be reimbursed (single or multiple births).
- All appropriate coding guidelines must be completed to include appropriate diagnoses related to multiple births and applicable modifiers related to multiple births.
| Delivery Method | Child(ren) | Procedure Code |
|---|---|---|
| ||
| Vaginal | First Newborn | 59400, 59409, or 59410 |
| ||
| Subsequent Newborn(s) | 59409 Modifier 51, 59 | |
| ||
| Vaginal Birth After Cesarean VBAC | First Newborn | 59610, 59612, or 59614 |
| ||
| Subsequent Newborn(s) | 59612 Modifier 51, 59 | |
| ||
| Vaginal Delivery followed by Cesarean Delivery (Vaginal delivery, then a Cesarean) | First Newborn | 59400, 59409 or 59410 |
| ||
| Subsequent Newborn(s) | 59514 Modifier 51,59 | |
| ||
| Cesarean | First Newborn | 59510, 59514 or 59515 |
| ||
| Subsequent Newborn(s) | No additional allowances for subsequent newborns delivered via the same incision reimbursed under the first newborn’s claim* | |
| ||
| Cesarean delivery, following attempted vaginal delivery after previous cesarean delivery | First Newborn | 59618, 59620, or 59622 |
| ||
| Subsequent Newborn(s) | No additional allowances for subsequent newborns delivered via the same incision reimbursed under the first newborn’s claim | |
Diagnoses Codes Required
| Diagnosis | Description |
|---|---|
| |
| 651.01 | Twin pregnancy, delivered |
| |
| 651.1 | Triplet pregnancy, delivered |
| |
| 651.21 | Quadruplet pregnancy, delivered |
| |
| 651.31 | Twin pregnancy with fetal loss and retention of one fetus, delivered |
| |
| 651.41 | Triplet pregnancy with fetal loss and retention of one or more, delivered |
| |
| 651.51 | Quadruplet pregnancy with fetal loss and retention or one or more, delivered |
| |
| 651.61 | Other Multiple pregnancy with fetal loss and retention of one or more fetuses, delivered |
| |
| V33.00 | Twin, unspecified whether mate stillborn or liveborn, born in hospital, delivered without mention of cesarean delivery |
| |
| V33.01 | Twin, unspecified whether mate stillborn or liveborn, born in hospital, delivered by cesarean delivery |
| |
| V32.00 | Twin, mate stillborn, born in hospital, delivered without mention of cesarean delivery |
| |
| V32.01 | Twin, mate stillborn, born in hospital, delivered by cesarean delivery |
| |
| V31.00 | Twin, mate liveborn, born in hospital, delivered without mention of cesarean delivery |
| |
| V31.01 | Twin, mate liveborn, born in hospital, delivered by cesarean delivery |
| |
| V34.00 | Other multiple, mates all liveborn, born in hospital, delivered without mention of cesarean delivery |
| |
| V34.01 | Other multiple, mates all liveborn, born in hospital, delivered by cesarean delivery |
| |
| V35.00 | Other multiple, mates all stillborn, born in hospital, delivered without mention of cesarean delivery |
| |
| V35.01 | Other multiple, mates all stillborn, born in hospital, delivered by cesarean delivery |
| |
| V36.00 | Other multiple, mates liveborn and stillborn, born in hospital, delivered without mention of cesarean delivery |
| |
| V36.01 | Other multiple, mates liveborn and stillborn, born in hospital, delivered by cesarean delivery |
| |
| V37.01 | Other multiple, unspecified whether mates stillborn or liveborn, born in hospital, delivered by cesarean delivery |
| |
| 651.91 | Unspecified multiple gestation, delivered |
| |
| 651.71 | Multiple gestation following (elective) fetal reduction, delivered, with or without mention of antepartum condition |
| |
| V27.2 | Twins, both live born |
| |
| V27.3 | Twins, one liveborn and one stillborn |
| |
| V27.4 | Twins, both stillborn |
| |
| V27.5 | Other multiple birth, all liveborn |
| |
| V27.6 | Other multiple birth, some liveborn |
| |
| V27.7 | Other multiple birth, all stillborn |