Twin Pregnancy Codes

[Rahul]

hi,
there is no mention about Twin pregnancy codes in the Blitz videos. Can you pls guide about it pertaining to the delivery of twin pregnancy.. if both vaginally, or if vaginally & one cesarean, or both cesarean.. if any modifiers need to put, etc.
thanks
rahul pawargi

 

[Laureen]

H Rahul,

That was a head scratcher for me so I had to go out and do some research. This is what a coder that codes fo OB shared on another discussion board.

On the twin delivery deal I have had experience on that. Depends on your ins carrier really. I bill 59400 (global ante, and post-partum care with vag delivery, 59510 for c-sect) and then a 59409 (delivery only or 59514 c-sect only) with mod 59 for the twin. Think about if you had a mom in labor that delivered the first one vaginally but maybe the second one is breech and had to have emergency c-section- you can't put a 22 on either of those. If you saw the patient for ultrasounds and billed them out you don't put a mod 22 on them do you??? You would bill one sono normally (like 76815) and then same sono with a mod 59 for the 2nd baby. At least that is what I do. Some insurance companies will pay a little extra for the mod 22 for the delivery of the second twin but that is something you'd have to know about prior to billing. And you can always appeal... I love OB but it is tricky.

Keep in mind that you will not get tricky questions like this on the board exam!

 

[Robn]

Twin c-sect was on board exam. I remember that one because it made me think. There wasn't two codes so I did 59510. I hope that was correct.I just took it today BTW. I also used Blitz videos which helped a lot

 

[Carolyn Heath]

If you look in the pink block in Laureen's post, it tells you how to code for a twin c-sect. Good for you in taking the exam. I hope that you pass the exam.

 

[Robn]

On the board exam there was no modifiers but there was supporting ICD-9 CM codes. It was a problem free twin pregnancy and delivery. In real life it would be different. I kept hearing Laureen saying in my head pick the best of the 4 possible answers. I also could picture her hitting me in head every time I went to read the blip instead of going to answers first. It took some training to do that because in class you didn't have the answers to go to

 

[Ruth Sheets]

This was covered some more on the December 2012 Q&A Webinar.
View the replay atwww.cco.us and click on Q and A Webinar Replay link. This is a replay club so you get access to all the past replays as well as future ones.

From our forum:

• On the twin delivery deal I have had experience on that.
• Depends on your insurance carrier really. I bill 59400 (global ante, and post-partum care with vaginal delivery, 59510 for c-sect) and then a 59409 (delivery only or 59514 c-sect only) with mod 59 for the twin.

• Think about if you had a mom in labor that delivered the first one vaginally but maybe the second one is breech and had to have emergency c-section- you can't put a 22 on either of those.
• If you saw the patient for ultrasounds and billed them out you don't put a mod 22 on them do you??? You would bill one sono normally (like 76815) and then same sono with a mod 59 for the 2nd baby. At least that is what I do. Some insurance companies will pay a little extra for the mod 22 for the delivery of the second twin but that is something you'd have to know about prior to billing. And you can always appeal... I love OB but it is tricky.

Pregnancy & Delivery is indeed tricky. What you need to keep in mind is that you are not only dealing with insurance carriers but also statistics. They want to know:
1. How many babies were born?
2. How was the delivery done?
3. What was the outcome?

Alicia also gave some examples on the webinar.