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Posted By Barbara on 10-26-2018, 13:37:14 in Ob-Gyn
My provider did a vaginal twin delivery. Twin A was delivered vaginally form a vertex presentation. Twin B however, was found to be in transverse back up presentation. So the provider delivered under sonographic guidance, using internal podalic extraction and in a double footling breech presentation. Can anyone guide me on if there are any additional codes to bill under this scenario? thank you IA. barbara
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Posted By Melanie Witt on 11-01-2018, 16:22:54
Both ACOG and CPT have weighed in on this topic over the years. You will be billing the global code (or the delivery on code if the physician did not provide antepartum care) for twin B and then report 59409 for the vaginal delivery of twin A. Some payers may require a modifier -59 to be added to 59409, but most will not once it is clear via diagnostic coding that this was a twin. Specifically, CPT published the following information via the CPT Assistant August 2002:

If one twin is delivered vaginally and the other by cesarean delivery and the global obstetric care is provided by the same physician or same physician group, then report the global code 59510 or 59618, for the cesarean delivery, and 59409 or 59612, for the vaginal delivery with the '-51' modifier appended.
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