Billing Medicaid for DELIVERY of TWINS

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:) Hi, I am in need of some help. My office is billing Medicaid for a c-section for twins, one cpt was 59515 and it was paid correctly, with no problems, and the other cpt that was billed was 59514, and this is where the problem comes up. Medicaid keeps saying that 59514 is a non covered procedure code. What I need to know is what the second cpt should be then? I have already been up and down the Medicaid and Medicare website, I have asked around and noone seems to know the answer. If anyone knows or can tell me more specifically where to look I would greatly appreciate it. Thank you for your time, Yailin F.:eek:
 

KARENR

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NC Medicaid will not pay for the second twin if delivered by c-section as they say it basically did not require any additional work. They will however, pay the 59409 vaginal birth was attempted but c-section was elected.

You may want to try to file an adjustment request on the required form w/all documentation appending modifer 22 and explain the additional work, but I have tried this several times and they say the claim processed correctly and required no additional work, therefore they will not pay.
 
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If anyone is familiar with Indiana medicaid, I am in need of some help. If an OBGYN does a c-section and deliveries 2 babies, do you code 59514-22?? I know he only mande 1 incision but delivered 2 babies. Do I need the 22 mod??
 

kdavidson

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Jennifer,
No, using the 22 modifier won't help. But definitely code as "high risk" since she had twins and only use the 59514 once.
 

ajs

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If anyone is familiar with Indiana medicaid, I am in need of some help. If an OBGYN does a c-section and deliveries 2 babies, do you code 59514-22?? I know he only mande 1 incision but delivered 2 babies. Do I need the 22 mod??
Many of the state Medicaid websites have guidelines for the providers on billing for particular scenarios. Have you checked to see if they have guidance on billing for twin c-section? You can use a modifier 22 to indicate the additional work involved since 2 babies were delivered, if the Medicaid program recognizes that modifier.
 
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