Special Medical Billing Dilemma

With multiple births becoming more and more commonplace, the reporting of twins on medical billing claims has become more routine and there are some special considerations when filing out your medical billing claims. If both babies are born by cesarean, bill only once. Remember, the doctor delivers all of the babies–whether twins, triplets, or more–by cesarean, you should submit 59510-22.

Report 59510 with modifier 22 (Unusual procedural services) appended, because even though only one incision was made, the modifier will testify to the fact that multiple babies were delivered. Be sure and include your medical documentation as to the reason for the necessity of the cesarean.

If the babies were born on different days, a solution would be to report the first baby as a delivery only (59409) on that date of service. For the second, you should bill the global code (59400), assuming the physician provided prenatal care, on that date of service. You will not submit a medical billing claim for the first twin because prenatal care was still ongoing due to the undelivered twin. In special instances such as this, be sure to attach a letter of explanation to insure you will get maximum reimbursement for this type of medical billing claim.

Note that many carriers will categorically deny the first claim you submit for the second delivery but will usually pay on appeal if you have firm documentation to back up your medical billing claim.

View all Articles by: Melissa Clark, CCS-P