Ob-Gyn Coding Alert

Experts advise how to ethically get the most for twin pregnancy services You may not code for multiple-gestation services every day, but don't let your skills get rusty. If you're not capturing all the associated services, your practice's bottom line could suffer.

Our experts answer the five most frequently asked questions regarding multiple- gestation care and delivery: 1. How Should I Report Twin Delivery? If your patient is having twins, most ob-gyns first attempt a vaginal delivery as long as the physician hasn't identified any complications. In this case, you should report 59400 (Routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy, and/or forceps] and postpartum care) for the first baby and 59409-51 (Vaginal delivery only [with or without episiotomy and/or forceps]; multiple procedures) for the second.

"I have also appended modifier -22 (Unusual procedural services) to the global delivery (59400) if the patient has had more than the average 13 visits," says Brenda Dombkowski, CPC, a coding specialist at Obstetric-Gynecology & Infertility Group in Cheshire, Conn. "Check with your payer because this may vary with each of them."

Best bet: Send a letter of explanation with the claim to avoid immediate denial by the claim processor, says Cheryl A. Lewis, CPC, billing manager for ZIA Ob-Gyn Ltd. in Yuma, Ariz. "A simple form letter explaining the high-risk nature of multiple-gestation pregnancies will routinely go straight to medical review and save the hassle of denial resubmissions or lost reimbursement through write-offs."

If the physician delivers the first baby vaginally but the second via cesarean, assuming he provided global care, report 59510 (Routine obstetric care including antepartum care, cesarean delivery, and postpartum care) for the second baby and 59409-51 for the first, says Peggy Stilley, CPC, office manager for Women's Healthcare Specialists, an Oklahoma University-based private ob-gyn practice in Tulsa. You should include 651.01 (Twin pregnancy; delivered, with or without mention of antepartum condition) and V27.2 (Twins, both liveborn) as diagnoses, she adds.

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, Twins, both liveborn), Stilley points out.

Multiple via c-section: When the doctor delivers all of the babies, whether twins, triplets, etc., by cesarean, you should submit 59510 with modifier -22 appended. Because the ob-gyn made only one incision, he performed only one cesarean, but the modifier shows that the physician performed a significantly more difficult delivery due to the presence of multiple babies. Be sure to include a letter with the claim that outlines the additional work that the ob-gyn performed to give the carrier a clear picture of [...]