# Twin delivery modifiers



## szrogers (Feb 11, 2008)

I am new to OB/GYN, and I have a couple of questions.  My doctor sees only high-risk patients, there is no global period for our patients.  So, say a patient is flown in from out of town with PROM and doctor decides to do a c-section right away, do I code for the admission with a -57 or just the 59514 and no admission? 

Second question:  On twin deliveries, what modifier (if any) does anyone else use? The society for maternal-fetal medicine says to use a -22, but that says there needs to be additional documentation, or should you use a -59? 

Finally, is pregnancy considered a "problem"?

I would appreciate if there was any insight out there for me!


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## awcoder (Jul 2, 2008)

*Help*

does anyone have a answer to this and also some info if there is a different way to report delivery of twins vaginal or c/section


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## Lisa Bledsoe (Jul 2, 2008)

There are two ways to code twins.  You can use modifier -22 on the delivery code - some payers will want documentation, some will recognize the twin ICD-9 and pay accordingly (good luck).  Another way is to report the delivery code on two line items and append modifier -51 to the second line.  I don't believe pregnancy is considered a problem, but the PROM would be.  As for coding an admit and mod -57...I think it would depend on the situation.  If your doctor knows before the patient even arrives (via communication with the physician transferring to your doc) the delivery is imminent, then maybe an admit code/-57 is not appropriate; but if he/she has to evaluate and make the decision upon patient arrival, then it would be appropriate.  This is just my opinion...


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## ladyk113 (Jul 8, 2008)

*Problems, problems*

So here's my theory...  On the admit with a 57 mod- I don't think so because the patient has to be admitted in order to perform a c-sect.  It would be considered part of the global package.  If the doctor admitted her on say Tuesday and did the c-sect on Wednesday after OBS- absolutely.  You'd have to that on a case by case basis.  Depends on if he knew ahead of time that she'd be an immediate delivery.

On the twin delivery deal I have had experience on that.  Depends on your ins carrier really.  I bill 59400 (global ante, and post-partum care with vag delivery, 59510 for c-sect) and then a 59409 (delivery only or 59514 c-sect only) with mod 59 for the twin.  Think about if you had a mom in labor that delivered the first one vaginally but maybe the second one is breech and had to have emergency c-section- you can't put a 22 on either of those.  If you saw the patient for ultrasounds and billed them out you don't put a mod 22 on them do you???  You would bill one sono normally (like 76815) and then same sono with a mod 59 for the 2nd baby.  At least that is what I do.  Some insurance companies will pay a little extra for the mod 22 for the delivery of the second twin but that is something you'd have to know about prior to billing.  And you can always appeal...  I love OB but it is tricky.


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