Wiki Tricare Twin delivery billing/appeal

[msonger]

I have billed Tricare for twin delivery and they have denied on multiple occassions with 59409-51. I have submitted for medical review as well with operative report and it was denied for POS 21 (inpatient) which makes no sense.

Do you have any personal knowlege if mod 59 or 22 will be accepted by Tricare? Have you been successful to get paid for the twin delivery? Does it seem fair that Tricare would not pay for the second delivery?

 

[kvangoor]

Use the appropriate Cesarean delivery-only code for each subsequent newborn.
(Append with modifier -59) The secondary procedure will be allowed at 50% of the contracted rate for eachnewborn, subject to the member’s contract benefits.
You also might have to rebill as a corrected claim. I would call their provider line to verify this but this is what I have been doing, no problems so far!