# Vaginal Twin delivery



## duplicatesandra (Oct 28, 2011)

My OB/GYN delivery twins both vaginal. The patient has Medicaid.

I coded 59410 (for twin A) and 59409/59 (for twin B).

However Medicaid is deny the 59409/59(twnin B) stating that they have already paid.

Does anyone know the correct way for billing twin delivery both by vagnial for Medicaid?


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## ajs (Oct 28, 2011)

spierce said:


> My OB/GYN delivery twins both vaginal. The patient has Medicaid.
> 
> I coded 59410 (for twin A) and 59409/59 (for twin B).
> 
> ...



Did your OB not provide any of the prenatal care?  Just wondering why you were not billing 59400 for the first twin with 59409-59 for the second twin.  What diagnosis codes are you using?  You should have 651.01 and V27.2 on both codes to show a twin delivery.  If you are using 59410 because no prenatal care was done, then that part is correct.


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## OBcoder2017 (Mar 13, 2013)

*Medicaid Twin Delivery*

I also coded my vaginal twin delivery to Medicaid with 59400 and 59409-59 second twin with the twin dx and they denied.  I called them and they said they only pay delivery for one when they are both vaginal.  No extra money for the extra work.  I asked about modifier 22 on the delivery and she said no it would not result in any extra payment.  I said I guess the doc can walk out after the first one then and she just laughed.  So I guess there is nothing we can do?


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## Thouvenel (Mar 15, 2013)

I believe Texas Medicaid only pays for one delivery, unless the delivery is c-section and vaginal, then you can bill both.  But, as I'm unsure of this policy, you might try an appeal.  You have correctly submitted the claim with 59410 and 59409.


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## Emmy1260 (Mar 19, 2013)

According to CPT Assistant April 1997

Twin Deliveries: 

Both Vaginal: 59400 and 59409-51

Assuming the physician provides the pre- and post-natal care. 
Bill the global for the first twin and the delivery only for the second.

Dx codes should reflect twin gestation.


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