# Twins



## armymomryan (Dec 1, 2010)

Need a little help on this;

Twins, baby "A: born vaginally, baby "B" malpositioned and C-section.

DX = 652.61 Malposition
        651.01 Vaginal delivery
        669.71 C-Section
        V27.2 Outcome of delivery

CPT codes  59409 Vaginal (delivery only)
                 59510 C-section (global)
                 58611 Bilateral tubal ligation done at same time of C-section

Am I even close on this one ? - Any help is greatly appreciated !


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## Lisa Bledsoe (Dec 1, 2010)

Looks pretty close to me.  I don't think you need 669.71 since the 652.61 indicates the reason for the c/s.  I would code:
59510 652.61, V27.2
59409-59 651.01, V27.2
58611 V25.2


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## tgessinger (Dec 1, 2010)

*Twin - Delivery Codes Answer*

Hi, 

Your CPT codes are correct, but I would suggest coding it this way. I am a OB/GYN coder and am thinking about reimbursement also when I give these suggestions. 

CPT code 59510 (C/S global) Dx code : 1st 651.01, 2nd 652.61 (Read the op report to see if you can get addtional details about what type of malpresentation, and you can then  code it as ie: breech or compound presentation) I would not use the 669.71 this code is normally used for a C/S without information as to why it was done or if it was a patient choice C/S. The indication is mentioned by the malpresentation, so this code would not be appropriate. Per ACOG it is appropriate to use the C/S as the "global" OB code due to higher reimbursement rates when delivery is involving both a vag delivery and C/S of twins. 

CPT code 59409-51 (Vag delivery) Dx code : 1st 651.01, and you need to read the Labor & delivery report from the hospital to see if any other codes would be appropriate also to code : ie: lacerations or fetal distress. You need to put the 51 modifier on the vag delivery code, since multiple procedures. 

CPT code 58611 is for the tubal during C/S. This is an add on code and needs no modifier. List this code last due to the low RVU's for reimbursement. Dx code : V25.2         

I hope this helps, if you need any additional help in the future please contact me at tmcgess@yahoo.com, I'd be happy to help with any OB/GYN coding you need help with. 

 Tia


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