# Twin vaginal delivery assist



## Lisa Bledsoe (Nov 10, 2010)

Has anyone ever heard of an assistant for a twin vaginal delivery?  Both physicians are OB/GYN and part of the same practice.  They want to charge for an "assist for double set up/twin delivery".  The "assistant" was there in the delivery room and did help with ultrasound to ensure vertex presentation of twin B, but that is all.  They are disagreeing with me saying that they *can* code for this and I want to be *absolutely certain *before I take this further with them.  I know mod -80 is not applicable for 59400/59409 but is there another way to code for the assistant being present?  I don't think there is...
(other than the professional component of the ultrasound)


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## preserene (Nov 10, 2010)

Yes I do know this mandated assitance but i do not know how the payer react for payng.

Lisa, you have vast experience in this .My experience is nothing to that. But yet I try to  just suggest place my openion whether it would work out or not.

  I feel that the service can be ( regardless of billable or not). For example if it is triplets , quadruplets, what we do, if they need an assistant consultant or co surgeon or assistant surgeon
The same can be applicable to twins also in conditions with expected malpresentation (turning to) difficulties and with increasedmandatory  monitoring . Say for example even though cephalic presentation and with the mobile head still very high, while doing ARM during labor, the performing physician may need assistant surgeon to fix the head of the second of the twin into the pelvic cavity and more so with the Parotogram not satisfactory and quick delivery is warranted with cord twice/thrice around the neck etc etc. WE can not take every case for Cesar at this fully dilated cervix. This is just a tip of an iceburg . The doctors have many situations like this during labor to validate / justify the assistance of another OBGYN many times for Multiple pregnancy
So, what I am trying to say, is there are situations needing such care in Twin pregnancy delivery too. But appropriate Dx codes , labor complication/difficult situations etc has to be pertinently documented
Apart from the code US code, why don't we consider 59051 with modifier 99 t at hospital setting Internal Fetal Monitor               .  .As  Internal Fetal Monitor Billed With Modifier 99.
Please have a look this would go or not.                                                    
  Guide for amniocentesis/ (ARM) 28.x
 Internal Fetal Monitor               .  .As  Internal Fetal Monitor Billed With Modifier 99.
Billed With 
Modifier 99	CPT-4 code 59051 (fetal monitoring during labor by consulting physician with written report; interpretation only) with required
modifier 99 are entered in the Procedures, Services or Supplies field (Box 24D).  Code 59051 is reimbursable only with modifier 99, which, in this case, requires that the words “INDEPENDENT PROCEDURE” be included in the Reserved for Local Use field (Box 19).  Also required in this field is the date of delivery.
 In the Date(s) of Service field (Box 24A), the date that the internal fetal monitoring was performed, xx xx xxxx, is entered on claim line 1 as “062107”.  Enter Place of Service code “21” (inpatient hospital) in Box 24B.
 Enter the usual and customary charges in the Charges field 
(Box 24F).  Enter a 1 in the Days or Units field (Box 24G) for 59051.

Just read this, if not feasible, forget the existance of this posting!!
May be it would lead you to some mental click for better coding!!


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## usmso (Nov 12, 2010)

There used to be a code for Physician Stanby services.  I know it is not the delivery asst code they are wanting but i think that code is more applicable and would allow some type of reimbursement depending on what payor you are trying to bill.


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## preserene (Nov 12, 2010)

The stand by Service Physician will not take active part in the  procedure; it is one of the requirements for that service .Am I not right? USMSO


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## usmso (Nov 12, 2010)

That is not the way I interpret in my review of the CPT but it is still questionable for sure.  

Definition says:  Code 99360 is used to report physician standby service that is requested by another physician and that involves prolonged attendance without direct face to face patient contact. 

If he just did the ultrasound i think this could possibly fly but really not 100%


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## preserene (Nov 12, 2010)

As for SB Service,  it says the physician may not be providing care or service for other patients. (it is ok)
;not for proctoring other physician;not used if the physician was there till completion of the procedure. but all these three points can be waived out if otherwise as you said. BUT there would not be a requirement of the service at all if it does not involve face to face in twin Delivery suite.
Unless it is a consultant who stands by(without face to face) but not for proctoring.
The scenario does not seem so.
However I appreciate Your thought and the possiblity! Thank you


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## Lisa Bledsoe (Nov 15, 2010)

I have two real issues here:  one - the documentation only supports the ultrasound; two - vaginal delivery codes cannot be reported with mod -80.  I truly appreciate the input from both of you.  99360 states "...not used if the period of standby ends with the performance of a procedure subject to a "surgical" package by the physician who was on standby".  I think I will recommend 99360 and 76998-26.  My "educated guess" is that since the insurance is Anthem Blue Cross, we will be lucky to get paid for the US guidance at the very least.  Thank you for your help.


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