Ob-Gyn Coding Alert

Question: My ob-gyn delivered twins for a patient at 19 weeks. Both babies were delivered vaginally and alive, but they both died shortly after delivery. Should I report 59400 (Routine obstetric care including antepartum care, vaginal delivery and postpartum care), 59409-52 with 644.21 (Early onset of delivery; delivered, with or without mention of antepartum condition)?

Connecticut Subscriber

Answer: Yes, if the babies were born alive, you should report a delivery. However, you should not use 59409-52 (Vaginal delivery only [with or without episiotomy and/or forceps]; reduced services) for the second twin. Use modifier -51 (Multiple procedures) instead. Keep in mind that you might want to add modifier -52 (Reduced services) to the global code if you have provided only a few antepartum visits during the pregnancy (such as fewer than five).