Coding Question of the Month
Each month, we feature the most frequently asked question received by ACOG’s Coding Department, and our response.
OCTOBER TOP CODING QUESTION
“What is the most appropriate way to report twin deliveries?”
To report a global vaginal delivery of twins, code 59400 (Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care) in addition to 59409 (Vaginal delivery only (with or without episiotomy and/or forceps)) appended with modifier 59 (Distinct procedural service) is appropriate.
If one twin is delivered vaginally and one twin is delivered by cesarean, reporting code 59510 (Routine obstetric care including antepartum care, cesarean delivery, and postpartum care) and code 59409 (Vaginal delivery only (with or without episiotomy and/or forceps) appended with modifier 51 (Multiple procedures) is appropriate.
If cesarean delivery of twins is performed, code 59510 (Routine obstetric care including antepartum care, cesarean delivery, and postpartum care) ONLY is appropriate. However, if the physician performed significant, additional work, modifier 22 (Increased procedural service) may be appended to the delivery code to indicate that significant additional work was performed.
Modifier 22 is reported when the work of the delivery required substantially greater physician work than usual, but the documentation must support the substantial additional work and the reason for the additional work, such as:
- Increased intensity or time
- Increased technical difficulty of performing the procedure
- Severity of patient’s condition
- Increased physical and mental effort required
If increased time was involved, the physician should specifically document the total time and how it compares with the typical time for the procedure. Note that insurers will manually review claims using this modifier. Therefore, when submitting the claim, the physician might find it helpful to submit a copy of the operative report and a brief cover letter indicating the reason for the additional work and an appropriate payment amount (e.g., 120% of usual fee).
Modifier 22 is not reported for additional antepartum visits for "high risk" patients.