How to Accurately Code Twin Delivery Claims - OBGYN Billing & Coding Alert
Let's get into the four most tricky twin delivery questions while submitting your claim.
OB/GYN Medical Billing & Coding Alert
When babies are born on different calendar dates, what should we do for billing? How should you report a twin cesarean delivery?
The correct code is 59510 with a modifier 22, provided the documentation justifies substantial additional work. However, this may only sometimes apply in some cases.
What steps should you take when twins are born on different calendar dates—or even in different calendar years, as is the case with those born on December 31st and January 1st?
The answer should be that your twin delivery reporting according to the specific preferences of the insurance company.
How Should I Report Twin Delivery?
When a patient is expecting twins, most OB/GYNs typically aim for a vaginal delivery, provided there are no identified complications.
In this scenario, you should report 59400 (Routine obstetric care, including antepartum care, vaginal delivery [with or without episiotomy and/or forceps], and postpartum care) for the first baby and 59409-51 (Vaginal delivery only [with or without episiotomy and/or forceps]; multiple procedures) for the second baby.
Note: Both CPT and the American College of Obstetricians and Gynecologists (ACOG) advise using modifier 51 (Multiple procedures) for the second delivery. However, some payers may require modifier 59 (Distinct procedural service) instead. Additionally, other coders opt to append modifier 22 (Increased procedural services) to the global delivery code (59400) to account for the second delivery when the payer does not allow separate billing. If you receive written instructions to do so, you should follow them.
Best practice: Include a letter of explanation with the claim to prevent immediate denial by the claims processor. According to experts, a straightforward form letter outlining the high-risk nature of multiple-gestation pregnancies typically goes directly to medical review, helping to avoid the inconvenience of denied resubmissions or lost reimbursements through write-offs.
What if the First Delivery Is Vaginal, Second Is Cesarean?
If the physician delivers the first baby vaginally and the second via cesarean, and they provided global care, you should report 59510 (Routine obstetric care, including antepartum care, cesarean delivery, and postpartum care) for the second baby and 59409-51 for the first. Additionally, include one of the following twin diagnoses (O30.0-, Twin pregnancy) and report the outcome of the delivery by assigning a Z37 code (e.g., Z37.2, Twins, both liveborn).
For the second twin delivered by cesarean, use additional ICD-10 codes to clarify the reasons for the cesarean—such as malpresentation (O32.9XX0, Maternal care for malpresentation of fetus, unspecified, not applicable or unspecified)—along with the outcome code (e.g., Z37.2).
What Should I Do for All Cesarean Deliveries?
When a doctor delivers all the babies—whether twins, triplets, or more—via cesarean, you should submit code 59510 with modifier 22 attached. Although the OB/GYN makes only one incision, this modifier indicates that the physician performed a significantly more challenging delivery due to the presence of multiple babies. However, reimbursement policies can vary by carrier. For example, Colorado Medicaid allows billing for both babies, even though only one incision is made, according to experts.
Be sure to include a letter with the claim that details the additional work the OB/GYN performed. This helps provide the carrier with a clear understanding of why you are requesting additional reimbursement, as not all twin cesarean deliveries are considered equally difficult.
What if the Babies Come on Different Days?
In some cases, multiple-gestation babies may be born on separate days. For instance, if a patient is at 38 weeks of gestation with twins in two sacs, and one membrane ruptures, leading to vaginal delivery of the first baby, followed by the second baby being delivered vaginally two days later after the second membrane ruptures, here’s how to report it.
For the first baby, you should report the delivery as a separate procedure using code 59409 on the date of service. For the second baby, bill the global code 59400, assuming the physician provided prenatal care on that service date. It’s important not to bill the global code for the first baby since you are still offering prenatal care due to the retained twin. Additionally, consider appending modifier 59 (Distinct procedural service) to the first delivery, as it occurred during a different encounter.
Attach a letter explaining the situation to the insurance company, as proper documentation is crucial for payment. Also, include the relevant ICD-10 codes, particularly the outcome codes (for example, Z37.2).
BillingFreedom Is An Expert In OB Billing Solutions for Complex Scenarios
OB/GYN billing entails a lot of sensitive issues, and it becomes complex when it comes to issues such as multiple deliveries. At BillingFreedom OB/GYN Medical Billing, our team of seasoned professionals is equipped to handle even the most intricate billing situations. We understand obstetric practices' unique needs and are committed to maximizing reimbursements while minimizing denials. Our comprehensive OB/GYN billing services cover everything from coding for prenatal visits to postpartum care, ensuring accurate claim submissions and timely follow-ups. With our in-depth knowledge of industry guidelines and payer requirements, you can trust us to manage your billing efficiently. Let us take care of the complexities so you can focus on what matters most—providing exceptional patient care.
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