Perfect your Twin Delivery Claims

You need to be well-versed with procedure and diagnosis codes if you are to code right for your ob-gyn practice.

Do you know how to report a twin cesarean delivery? A simple answer would be 59510 with modifier 22 attached. But this may not as simple as that. The fact is you will need to adjust your twin delivery reporting depending on an insurance company's preference. Here are two tricky twin situations to help your understanding so that you submit picture perfect claims in no time.

First Scenario:

Cesarean deliveries and what should be done in such instances

A doctor delivers twin deliveries (the same will be the case if the doctor carries out triplets by cesarean; in this situation, you should report 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 owing to the presence of multiple babies.

This can also depend on the carrier. For example, Colorado Medicaid allows you to bill for both babies, even though the physician makes only one incision. See to it that you include a letter with the claim that outlines the added work that the ob-gyn carried out to give the carrier a clear picture of why you are asking for more reimbursement.

Second scenario: The babies come out on different days.

Once in a while, multiple-gestation babies will be born of different days. Say for instance, a patient is at 38 weeks gestation and carrying twins in two sacs. One membrane ruptures and the ob-gyn delivers the baby vaginally. A couple of days later, the second ruptures and the second baby delivers vaginally too.

In this situation, you should report the first baby as a delivery only (59409) on that date of service (DOS). For the second one, you should go for the global code (59400), taking that the physician provided prenatal care, on that date of service. The reason why you should not bill the global first is that you're still offering prenatal care owing to the retained twin. You need to attach a letter explaining the situation to the insurance company. ICD-9 diagnosis codes will be important to the payment. See to it that you make use of the outcome codes (say for instance V27.2).

And when the ICD-10 system comes into effect in 2013, you will have to change how your report some of the codes like V27.2, 651.01, O30.001, O30.002, among others.