Twin delivery claims: Submit picture perfect claims

If you thought you can report a twin caesarean delivery with the help of 59510 with modifier 22 attached, think again as this may not be the case always. You will need to adjust your twin delivery reporting as per the insurance company's preference.

Here are four tricky twin delivery situations to help you in your coding:

When it comes to patients having twins, most ob-gyns first attempt a vaginal delivery as long as the physician has not identified any complications.

In this instance, you should report 59400 for the first baby and 59409-51 for the second.

Remember: Both CPT and the American Congress of Obstetricians and Gynecologists (ACOG) recommend you use modifier 51 for the second delivery. But you may encounter some payers who want to see modifier 59 instead. Other coders report adding modifier 22 to the global delivery (59400) if the patient had more than the average of 13 visits and to account for the second delivery in cases where the payer does not permit separate billing for the additional delivery. When this instruction is in writing, you should follow it.

Best bet: 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 trouble of denial resubmissions or lost reimbursement through write-offs.

First delivery is vaginal, second is Cesarean. If the doctor delivers the first baby vaginally however the second through Cesarean, assuming he provided global care, go for 59510 for the second baby and 59409-51 for the first. You should report 651.01 with V27.2 as diagnoses.

For the second twin born by cesarean, go for more ICD-9 codes to explain why the ob-gyn had to carry out the cesarean.

All cesarean deliveries. When the doctor delivers all of the babies, whether twins, triplets, and the like by cesarean, you should submit 59510 with modifier 22 added. Since the ob-gyn made only one incision, he carried out only one cesarean, however the modifier shows that the doctor carried out a significantly more difficult delivery due to the presence of multiple babies. This can depend on the carrier too. Also ensure that you include a letter with the claim that outlines the additional work that the ob-gyn carried out to give the carrier a true picture of why you are asking for additional reimbursement.

Babies coming on different days. Once in a while, multiple-gestation babies will be born on different days. For instance a patient is at 38 weeks gestation and carrying twins in two sacs. While one membrane ruptures, the ob-gyn delivers the baby vaginally. After two days, the second ruptures, and the second baby delivers vaginally as well. In this instance, you should report the first baby as a delivery only (59409) on the DOS. You shouldn't bill the global first because you are still offering prenatal care due to the retained twin. You'll have to attach a letter explaining the situation to the insurance company.

For more on this, and for other medical coding updates, sign up for a one-stop medical coding guide like Supercoder.com