Maternity Billing and Multiple Birth Billing

Date: 08/25/17

Maternity Billing and Multiple Birth Billing

There has been an increasing number of multiple birth claims with denials for the second or subsequent births. The information below will help when billing these claims to Magnolia Health.

All maternity related services billed must include the TH modifier on the claim line. This modifier is used to track data and to bypass the physician visit limits for antepartum office visits.

The first birth should be billed with the appropriate delivery code (with or without postpartum care) based on the delivery services provided.  A delivery code with postpartum care can only be billed once per delivery. When no postpartum care is provided, the first delivery will be billed for delivery only.

The additional births must be billed on a single line as deliveries only.  Multiple surgery rules will apply to this line so it must be billed with the modifier 51. 

National Correct Coding Initiative (NCCI) in Medicaid procedure-to-procedure rules apply when certain maternity codes billed are repeated on another claim line. These additional lines will require the NCCI associated modifier 59 on the line to identify the service as separate and distinct from the previous line.

When there are multiple delivering physicians, each surgical line of the assistant surgeon claim must be identified with the modifier 80. An assistant surgeon is a licensed physician who actively assists the physician in charge of a case in performing a surgical procedure.

Team or co-surgeons must be identified by the appropriate modifier and must be a different specialty than the physician in charge of the case.

Information on NCCI in Medicaid can be located at: https://www.medicaid.gov/medicaid/program-integrity/ncci/index.html