I was taught that there is more than one acceptable way to code for twins born vaginally....first: you can code the full package as appropriate for the first twin (e.g. 59400 or 59610) with delivery-only code for the second twin (59409) or second: Assign package code only with modifier 22 to signal additional work for the second twin. AMA and ACOG support use of mod 22 if twin delivery is significantly more difficult. Be sure that the delivery note describes the extra work. Your clinic can decide how much to increase your usual fee if you decide to go that way. Hope that helps!
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