Ob-Gyn Coding Alert

Everyone hopes to be paid for all services provided, and while delivering more than one baby may not be twice the work, it is certainly more work and more risk than delivering one. Suzy Nelson, practice manager of New Conceptions Womens Health Care, Anchorage, AK, wants to know the proper way to code multiple births. Is there a specific code for delivering multiples or do you bill for multiple deliveries? The answer is no and sometimes. No, there is not a specific CPT code for delivering multiple births and sometimes, the way to code a multiple birth is to code for each delivery. Here are some tips for coding multiple deliveries in several different scenarios.

Multiple Vaginal Deliveries.
In an uncomplicated vaginal delivery you will code the global vaginal delivery code (59400 or 59610) linked to the appropriate 5-digit diagnosis code for the firstborn. Then code the vaginal delivery only (59409-51 or 59612-51, not the global code) linked to the appropriate 5-digit diagnosis code for additional births.

Multiple Cesarean Deliveries.
In this case, code only the global cesarean delivery code (59510 or 59618) linked to the appropriate 5-digit diagnosis code. If the cesarean delivery was more difficult than usual you can add a modifier 22 (Unusual Services).

Vaginal Delivery Followed by Cesarean Delivery.
In this situation, the vaginal delivery came first, but its always best to code the most extensive procedure first. So, first code the global cesarean code (59510 or 59618) linked with the appropriate 5-digit diagnosis code and then code the vaginal delivery only (59409 or 59612-51) linked to the appropriate 5-digit diagnosis code.

Tip: If the insurer pays less for a cesarean than a vaginal delivery you may have to reverse this order and list the vaginal delivery first.

Medicaid Plans

In many states where Medicaid coverage does not acknowledge global codes, you can try coding two delivery only codes linked to the appropriate multiple birth diagnosis codes. But each state varies in its requirements and payments. For example, Nelson reports that in Alaska the state Medicaid office has created a code (9409M) for multiple deliveries and pays $675 for each additional delivery. So check into your states requirements and code appropriately.

According to several ob/gyn practice managers and coding consultants, no matter how you code a multiple birth, many payers are only reimbursing for one delivery. Apparently, in the past, when payment for a single delivery was higher, it was not a critical issue and payers became accustomed to compensating for only one delivery. The experts advise continuing to code the service as above and do everything you can to get the payers to acknowledge the extra services provided in a multiple delivery.