Wiki Twin Delivery-help

[kelhop1@msn.com]

I thought I asked this question before Christmas, but I'm not seeing it, so please forgive me if this is a duplicate.

Patient pregnant with di/di twins comes in on 17th with premature rupture of membranes for twin A at 19.5 weeks. On 18th twin a is fetal demise and is delivered vaginally. Heartbeat still heard for twin B. On 19th twin A placenta still in uterine cavity likely cause of infection due to white count increasing. Physician recommends termination with induction at this time. delivery of twin B to avoid sepsis. Plan is for misoprostol 400 mcg p.o. !4-6 hours until delivery. Twin B is delivered vaginally.

I'm not sure how to bill Twin A-would it be an EM 99232?
I believe Twin B would be 59855

 

[nielynco]

I thought I asked this question before Christmas, but I'm not seeing it, so please forgive me if this is a duplicate.

Patient pregnant with di/di twins comes in on 17th with premature rupture of membranes for twin A at 19.5 weeks. On 18th twin a is fetal demise and is delivered vaginally. Heartbeat still heard for twin B. On 19th twin A placenta still in uterine cavity likely cause of infection due to white count increasing. Physician recommends termination with induction at this time. delivery of twin B to avoid sepsis. Plan is for misoprostol 400 mcg p.o. !4-6 hours until delivery. Twin B is delivered vaginally.

I'm not sure how to bill Twin A-would it be an EM 99232?
I believe Twin B would be 59855

Yes the delivery of Twin ! is an E/M service (plus any prolonged service time). And yes, I would us 59855 for Twin B.

 

[natashalage]

I am so sorry to intervene.. i am still learning these complex cases. I learned that if delivery prior 20w, w/out surgical intervention, we code it as E/M. So Twin A is e/m because it's 19w. Twin B was for termination of pregnancy But via oral meds ( P.O) not via P.V (vaginally) so we cannot code 59855, right? Thank you very much. I think it will be e/m and delivery of placenta?

 

[aheardcpc]

I am so sorry to intervene.. i am still learning these complex cases. I learned that if delivery prior 20w, w/out surgical intervention, we code it as E/M. So Twin A is e/m because it's 19w. Twin B was for termination of pregnancy But via oral meds ( P.O) not via P.V (vaginally) so we cannot code 59855, right? Thank you very much. I think it will be e/m and delivery of placenta?

Hi Natashalage,

It actually would be a delivery code for Twin B because they're now on the 20th week of gestation.

The descriptor for 59855 is "Induced abortion, by 1 or more vaginal suppositories (eg, prostaglandin) with or without cervical dilation (eg, laminaria), including hospital admission and visits, delivery of fetus and secundines." and according to ACOG, this is for before 20 weeks of gestation.

You would report an E/M for Twin A (under 20 weeks of gestation) and then the appropriate delivery code for Twin B.

Resource: https://www.acog.org/practice-manag...ling-for-interruption-of-early-pregnancy-loss

@nielynco @kelhop1@msn.com

Hope this helps.

Aisha Heard, CPC, CPMA, CRC, COBGC, CPB