Maximize Reimbursement for Multiple Deliveries on Different Days
Published on Thu Jun 01, 2000
Reimbursement for antepartum, delivery and postpartum care of a patient who is carrying more than one fetus is a frequent source of frustration for coding and reimbursement staff many times its difficult to get any extra compensation for the extra work involved with monitoring the pregnancy and delivery of two or more babies. But when the twins arrive in two completely separate deliveries, coding and reimbursement circumstances change to the providers advantage.
Eileen Bradley is a coder who specializes in ob/gyn surgery billing for Brighams Surgical Group in Chestnut Hill, Mass. The group does the billing for the Brigham and Womens Hospital in neighboring Boston. She recounts a recent case when multiple births occurred on separate days. Twin one was delivered vaginally by vacuum extraction on Feb. 8, and twin two was delivered by cesarean section for failure to descend on Feb. 9. Bradley explains that there was a time lapse of at least six or seven hours between deliveries.
Second Delivery Is Billable Separately From Global
Under a normal multiple-gestation delivery, when the fetuses are delivered minutes apart, many providers dont have much success billing for the second baby as a second delivery, even when they bill correctly for both deliveries by reporting the code that represents the highest valued global service provided along with a second code for vaginal delivery only (59409 or 59612).
For some payers, however, reimbursement comes only from using a single CPT global ob care code, one that most closely represents the more extensive delivery (i.e., vaginal [59400] versus vaginal delivery after a previous cesarean delivery [VBAC, 59610] and cesarean versus failed trial of labor [59510 vs. 59618]). But the delay posed in Bradleys case will help in establishing that two distinct deliveries were performed. The correct code for twin two, delivered on Feb. 9 via cesarean, would be the global 59510 (routine obstetric care including antepartum care, cesarean delivery, and postpartum care). This code is reported instead of the global code for a vaginal delivery because it represents the most extensive service (i.e., there will be a longer follow-up period due to the cesarean delivery). Because it is unacceptable to bill twice for antepartum and postpartum care, a vaginal delivery charge only for the second twin is appropriate.
Catherine Brink, CMM, CPC, president of HealthCare Resource Management, a coding and reimbursement consulting firm in Spring Lake, N.J., points out that a modifier is needed for the second delivery. For the c-section delivery, says Brink, modifier -78 should be appended to 59510, to indicate a return to the operating room for a related procedure during the postoperative period (of the first vaginal delivery). You are informing the carrier that there was another procedure performed the day [...]
