# twins,different days/MD



## Karen A. (Dec 2, 2011)

OB 1 delivered one twin vaginally late in evening. 2nd twin was delivered by c-section several hours later-the next calendar day by OB 2. OB1 & OB2 are partners. Third OB partner, was assistant surgeon for c-section. Im billing 59400 vaginal-global w/post partum for baby 1. Baby 2, I'm billing 59514-c-section only and 59514-80. My question is:do I need a modifier for the c-section done in the global period of the vaginal delivery? -79 would be my guess?


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## ajs (Dec 2, 2011)

Karen Acton said:


> OB 1 delivered one twin vaginally late in evening. 2nd twin was delivered by c-section several hours later-the next calendar day by OB 2. OB1 & OB2 are partners. Third OB partner, was assistant surgeon for c-section. Im billing 59400 vaginal-global w/post partum for baby 1. Baby 2, I'm billing 59514-c-section only and 59514-80. My question is:do I need a modifier for the c-section done in the global period of the vaginal delivery? -79 would be my guess?



Actually, even though they were born on different days you should bill the second birth first with 59510 for Global care with c-section del because the reimbursement is higher.  Then bill the first delivery with 59409-51.  The assistant on the c-section will bill 59514-80. Be sure to coordinate the diagnosis codes.

This is from the Medical Newswire:  (I cut it down to just your scenario)

"*Master Twin-Delivery Coding With This Modifier Know-How*"
When your ob-gyn delivers one baby vaginally and the other by cesarean, you should report two codes, but you'll only report one code if your ob-gyn delivers both babies by cesarean. Find out which codes to report by reading these scenarios and discover the coding solutions.
Peggy Stilley, CPC, ACS-OB, OGS, clinic manager for Oklahoma University Physicians in Tulsa, and Jenny Baker, CPC, professional services coder of Women's Health at Oregon Health and Sciences University in Portland. 


*Choose 2 Codes for Vaginal, Then Cesarean*
If the physician delivers the first baby vaginally but the second by cesarean, assuming he provided global care, you should choose two codes.

 Solution: 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. "You'll bill the cesarean first because of the higher RVUs [relative value units]," Stilley says.
The diagnoses for the vaginal birth will include 651.01 and V27.2 as diagnoses, Baker says.
For the second twin born by cesarean, use additional ICD-9 codes to explain why the ob-gyn had to perform the c-section--for example, malpresentation (652.6x, Multiple gestation with malpresentation of one fetus or more)--and the outcome (such as V27.2), experts say.
Hint: You should always be sure that you're billing the global code for the more extensive procedure, Baker says. For example, the work relative value unit for 59400 is 23.03, and the RVU for 59510 is 26.18--a difference of about $120."


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## Karen A. (Dec 3, 2011)

*great info, thanks for sharing!*

Thank you for sharing this great information. Billing that way does make complete sense. I think the different delivery days and twins got me over-thinking the situation. I just became a COBGC last month, I truly enjoy these coding challenges! Thanks again for sharing. I'm not familiar with the "medical newswire" you quoted. Is this a subscription newswire?


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