# Billing for Twin Deliveries



## barbacasec (Jan 23, 2008)

When billing for the delivery of twins via the same method for twin "a" and "b" how do you bill for twin "b". Can you and is there a modifer that you should use?


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## Lisa Bledsoe (Jan 23, 2008)

Vaginal delivery for twin A is the global 59400.  Twin B is vaginal delivery only 59409 with modifier -51.  Same for C/S - 59510 for A and 59514 -51 for B.


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## cedwards (Jan 23, 2008)

Per example from CPT Assistant

The preferred method of reporting a vaginal delivery of twins, when the global obstetrical care is provided by one physician is by appending modifier 22 to the routine obstetric care including antepartum care, delivery and postpartum care.

Another way to report vaginal delivery of twins would be to use the routine global ob care for the first baby and the delivery only code for the second baby (with modifier 51, if needed).

Note:  If both twins are delivered via cesarean delivery, then you would only report the c-section global care code since only one c-section is performed.  However, if the c-section delivery is significanbtly more difficult, you might have an opportunity to add modifier 22.  ***According to ACOG, to add modifier 22 if delivery is significantly more difficult as compared to a single gestation pregnancy.***

One Vaginal and one cesarean 59510 or 59618 for twin B and 59409-59 or 59612-59 for twin A.  This communicates that both a cesarean and a vaginal birth were both performed.


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## amjordan (Jan 26, 2008)

In addition, each insurance company has a slightly different way they want multiple deliveries billed.  You can find the information in their policies.  I took our top 6 payers and put their multiple delivery policies in a simple one sheet table that the coders keep at their desk.


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