Q&A: CPT coding for multiple gestation
Q: How do you report the delivery of twins using CPT codes?
A: When coding for the delivery of twins, CPT code selection is driven by the method of delivery. In other words, whether the patient underwent a vaginal or cesarean delivery (C-section).
If a vaginal delivery is documented, the coder would report the appropriate CPT vaginal delivery code for the first-born baby. These include:
- 59400, routine obstetric care including antepartum care, vaginal delivery and postpartum care
- 59409, vaginal delivery only
- 59410, vaginal delivery only; including postpartum care
- 59610, routine obstetric care including antepartum care, vaginal delivery and postpartum care, after previous cesarean delivery
- 59612, vaginal delivery only, after previous cesarean delivery
- 59614, vaginal delivery only, after previous cesarean delivery; including postpartum care
The coder would report an additional vaginal delivery-only code for the second-born baby, then delineate between the codes by labelling them Twin A or Twin B. The coder should also append modifier -51 (multiple procedures) or -59 (distinct procedural service) to the code for the subsequent delivery.
If a C-section is documented, the coder would select the appropriate CPT cesarean delivery codes, including:
- 59510, routine obstetric care including antepartum care, cesarean delivery, and postpartum care
- 59514, cesarean delivery only
- 59515, cesarean delivery only; including postpartum care
- 59618, routine obstetric care including antepartum care, cesarean delivery, and postpartum care, following attempted vaginal delivery after previous cesarean delivery
- 59620, cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery
- 59622, cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery; including postpartum care
The coder would follow the same rules described above for reporting the delivery of multiple newborns. Notably, some insurance carriers will request that the hospital charge a global cesarean code for the pregnancy and add a modifier -22 (increased procedural service) for the additional work associated with the delivery of twins. Coders and billers should determine which method their carrier prefers.
Generally, if one twin is delivered vaginally and one twin is delivered through a C-section, report codes 59510 and 59409-51.
Editor’s note: Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, ICD-10-CM/PCS ambassador/trainer and an E/M, and procedure-based coding, compliance, data charge entry and HIPAA privacy specialist in Melba, Idaho answered this question during the HCPro webinar, Master Coding for Pregnancy, Delivery, and the Puerperium. She can be reached at webbservices.lori@gmail.com or http://lori-lynnescodingcoachblog.blogspot.com/.
This answer was provided based on limited information. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.
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