# twin delivery



## maryjane.kelley@shcr.com (Jan 4, 2013)

Can someone please help me with the proper way to code for a twin delivery?
My research shows to use a modifier 22 with the delivery code. Is that correct?
Thank you, MJ


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## monicahkfan (Jan 14, 2013)

I use mod 22 also at my office.


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## rharmon (Jan 15, 2013)

*twin delivery - vaginal*

Solution: When your ob-gyn delivers both babies vaginally, 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.


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## bonzaibex (Jan 18, 2013)

Definitely check your payer guidelines.  Some want a 22 modifier.  Some want it billed as rharmon notes above.  Unless payer states otherwise, I bill as follows:
1 c/s, 1 vag = 59510+59409-59-51
2 vag = 59400+59409-59-51
2 c/s = 59510 (extra work is not significant enough for separate billing of extra babe)

You also want to check your payer specific guidlines for their rules on extra antepartum visits.  Our BCBS payer states extra visits outside the normal pre-natal schedule are payable if complication dx applies, and we can bill regular E/M+25 modifier as we go.  UHC states extra $$ is warranted if number of PN visits exceeds 14.  I can't remember off the top of my head if they want a 22 modifier on the global or if we bill for extra visits at end of pregnancy.  But you get my drift.  I don't think I've ever been able to find Cigna guidelines...

Becky, CPC


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