Blog/ Hospital billing
Payment for multiple births: how to calculate it
Understand the correct coding for the birth of twins and how multipliers apply to the care team’s fees depending on the delivery route, ensuring accurate billing for the care provided to each newborn
- By
- Rivio, Editorial team
- Published
- Reading time
- 2 minutes
Under the Brazilian Hierarchical Classification of Medical Procedures (CBHPM), billing for multiple births is handled in a specific way, with a clear distinction according to the delivery route.
The table includes two separate codes: one for cesarean deliveries, classified as the abdominal route, whether there is a single fetus or multiple fetuses; and another for vaginal delivery, classified as the vaginal route, when the pregnancy involves multiple fetuses.
This distinction is essential to ensure correct coding, avoid billing inconsistencies and reduce the risk of denials due to improper classification of the procedure.
To simulate the calculation of the amount for each delivery, we will use as an example the values from the CBHPM table published in October 2016.
Anesthetic procedures are classified from 0 to 8, and their respective tier values (CBHPM tiers) are listed in the CBHPM general instructions, as shown in the table below.
| Anesthesia tier | Local anesthesia |
|---|---|
| 0 | Local anesthesia |
| 1 | 3A |
| 2 | 3C |
| 3 | 4C |
| 4 | 6B |
| 5 | 7C |
| 6 | 9B |
| 7 | 10C |
| 8 | 12A |
Tier 4C = R$ 319.27
Assistant = 30% of the tier R$ 319.17 = R$ 95.78
Anesthesia tier 3 = 4C = R$ 319.17
The total amount for the procedure is the sum of Tier + Assistant + Anesthesia tier
R$ 319.27 + R$ 95.78 + R$ 319.17 = R$ 734.22
Tier 8B = R$ 826.43
Assistant = 30% of the tier R$ 826.43 = R$ 247.93
Anesthesia tier 5 = 7C = R$ 730.18
The total amount for the procedure is the sum of Tier + Assistant + Anesthesia tier, that is:
R$ 826.43 + R$ 247.93 + R$ 730.18 = R$ 1,804.54
Important
The care provided to the newborn after birth must also be billed, and it varies according to the risk of the delivery.
In a multiple birth, this amount must be multiplied by the number of newborns.
1.01.03.02-3 Newborn care in the delivery room (low-risk vaginal or operative delivery)
4C = R$ 319.27 x 2 (example: twin pregnancy) = R$ 638.54
1.01.03.03-1 Newborn care in the delivery room (high-risk vaginal or operative delivery)
5B = R$ 371.21 x 2 (example: twin pregnancy) = R$ 742.42
