Ob-Gyn Coding Alert

Question: What is the correct way to bill for delivery (either vaginal or c-section) for twins?

Arizona Subscriber

Answer: Your answer depends on the delivery method. Multiple vaginal: For vaginal births, you should report 59400 (Routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy, and/or forceps] and postpartum care) for the first baby and 59409- 51 (Vaginal delivery only [with or without episiotomy and/or forceps]; Multiple procedures) for the second.

Good advice: Send a letter of explanation with the claim to avoid immediate denial by the claim processor. A simple form letter explaining the high-risk nature of multiple-gestation pregnancies will routinely go straight to medical review and save the hassle of denial resubmissions or lost reimbursement through write-offs.

First vaginal, second cesarean: If the physician delivers the first baby vaginally but the second by cesarean, assuming he provided global care, report 59510 (Routine obstetric care including antepartum care, cesarean delivery, and postpartum care) for the second baby and 59409-51 for the first. You should include 651.01 (Twin pregnancy; delivered, with or without mention of antepartum condition) and V27.2 (Twins, both liveborn) as diagnoses.

For the second twin born by cesarean, use additional ICD-9 codes to explain why the ob-gyn had to perform the c-section -- for example, malpresentation (652.6x, Multiple gestation with malpresentation of one fetus or more) -- and the outcome (such as V27.2).

Multiple by c-section: When the doctor delivers all of the babies, whether twins, triplets, etc., by cesarean, you should submit 59510. Don't forget: You should add modifier 22 to 59510. Because the ob-gyn made only one incision, he performed only one cesarean, but the modifier shows that the physician performed a significantly more difficult delivery due to the presence of multiple babies.Be sure to include a letter with the claim that outlines the additional work that the ob-gyn performed to give the carrier a clear picture of why you're asking for additional reimbursement.