Wiki Twin Births

[mbcash]

Good afternoon. My normal coding job is Risk Adjustment and occasionally some commercial coding. I have no experience with OB cases so I am in need of help!
I have a delivery of di/di twins, fetus 1 NSVD and fetus 2 cesarean (none of which is in the ICD-10 guidelines). Pre-term, third trimester, 33 weeks, both live born. Cesarean performed for fetus 2 due to malpresentation. Do I treat each delivery as a separate incident and code accordingly or am I completely off? Thanks!

 

[natashalage]

Hello, I am still learning and highly suggest to wait for an expert answer (there are monitoring forum=Thank you)! Here is my thought:
1. code for vaginal delivery with dx: Di/di + preterm+ Outcome z37-live twins+ gestation z3a.33
2. code for cesarean with dx: Malpresentation fetus2 + Di/Di+ preterm+ Outcome +gestation z3a.33
3. 2 CPT codes will be on the same charge session for same patient, same dos and same MD.

 

[csperoni]

Assuming you are coding pro fee for the ob (don't know about the facility). Also assuming the vaginal was not a VBAC. @natashalage has it correct.

Scenario 1 - Dr is providing all antepartum, delivery and postpartum
59510 for Baby B - csection global.
59409 for Baby A - vaginal delivery only
You would not bill 2 global codes. Bill the global code that gives the higher reimbursement, even if it's not the chronological order of the deliveries.

Scenario 2 - Dr did NOT provide antepartum or postpartum and is ONLY delivering:
59514 for Baby B - csection delivery only
59409 for Baby A - vaginal delivery only

Some carriers may want -59 or -XU modifier on the second delivery.