Twin deliver coding? Here's how you should go about it

Ob-gyn coding presents a lot of coding challenges before you. Sometimes you may find yourself in a fix trying to report twin cesarean delivery.

If so, you should take a dig at 59510 with modifier 22 attached. However, that may not always be the case. You will need to adjust your twin delivery reporting depending on an insurance company's preference.

So how should you report twin delivery?

Whenever a patient has twins, most ob-gyns first make an attempt at a vaginal delivery as long as the physician has not figured out any complications. Here in this situation, you should go for 59400 for the first baby and 59409-51 for the second.

Keep this in Remember: Both CPT and the American Congress of Obstetricians and Gynecologists (ACOG) recommend you use modifier 51 (Multiple procedures) for the second delivery. But then you may come face to face with some payers who want to see modifier 59 instead. Other coders report appending modifier 22 to the global delivery (59400) if the patient had more than the average of 13 visits and to account for the second delivery in instances where the payer does not permit separate billing for the additional delivery. When this piece of guidance is in writing, you should follow it.

Best option: Send a letter of explanation with the claim to stay away from immediate denial by the claim processor. A simple form letter talking about 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.

Report 44180 with unlisted code 58999

Here's a procedure that my ob-gyn documented: Excision granulation tissue vaginal cuff. Laparoscopy, extensive lysis of adhesions of the sigmoid colon to posterior cul-de-sac. Scissors used to cut it. Uterosacral stitch (out of peritoneum). Inspection pointed to connection of the granulation tissue through the vagina into peritoneum. All granulation tissue was removed from vagina along with inflammation and what appeared to be reaction to stitch. As such, how should I go about this particular ob-gyn coding scenario?

Well, you should report the lysis of adhesions with 44180 (Laparoscopy, surgical, enterolysis [freeing of intestinal adhesion] [separate procedure]) and the removal of the granulation from the vaginal cuff (performed vaginally) as 58999 (Unlisted procedure, female genital system [nonobstetrical]).

While reporting an unlisted procedure code, you have to let the payer know how to judge that your charge is reasonable based on the physician work.

Better still: In order to set your fee, check with your surgeon to see what procedure he would like to compare this work to. Also, you should let the payer know an equivalent of the approximate amount of work. In order to do this, review your physician's to note how the ob-gyn removed the granulation tissue.

If done by chemical cautery, you might compare the work to 17250 (Chemical cauterization of granulation tissue [proud flesh, sinus or fistula]). If done by destruction, say for instance by using a laser, by cryocautery you might compare the work to 57061 (Destruction of vaginal lesions[s]; simple [for instance, laser surgery, electrosurgery, cryosurgery, chemosurgery]) or 57065 (Destruction of vaginal lesion[s]; extensive [for instance, laser surgery, electrosurgery, cryosurgery, chemosurgery]). If he debrided the area, you might look to 11042 (Debridement, subcutaneous tissue [includes epidermis and dermis, if carried out]; first 20 sq cm or less), and if he excised the tissue, you would have to know the level of the area removed and take a look at 11440-11446 (Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane ...) as a contrast, as the vaginal canal would be consistent with a mucus membrane.

Do not bother trying to code for the stitch removal as since this service seems to be part of the adhesions involvement.