OHIP Billing Codes for OBSTETRICS AND GYNAECOLOGY

A205 Consultation*

A935 Special surgical consultation (50 minute minimum, refer to SoB page GP19)

A206 Repeat consultation*

A203 Specific assessment*

A204 Partial Assessment

C205 Consultation*

C935 Special surgical consultation (50 minute minimum, refer to SoB page GP19)

C206 Repeat consultation*

C203 Specific assessment*

C204 Specific re-assessment*

*The Papanicolaou smear is included in the consultation, repeat consultation, general or specific assessment (or re-assessment), or routine post-natal visit when pelvic examination is normal part of the foregoing services. However, the add-on codes E430 or E431 can be billed in addition to these services when a papanicolaou smear is performed outside hospital.

E082 MRP Premium – Add this to Admission consultation/assessment if you are MRP, per SoB page GP42:

Please refer to the SoB pages GP16-19 and A127 for the detailed Consultation payment rules.

For emergency calls and other special visits to inpatients use General Listings and Premiums when applicable.

Not eligible for payment to Emergency Department Physicians (see definition GP67)

Hospital Out-Patient Department

The “C” prefix consult codes are strictly for non-emergency inpatient consults (and therefore no special visits apply).

* When billing Special Visit Premiums, use A-prefix consultation or assessment. Please refer to the SoB page GP 65-68 for the detailed Special Visit Premium payment rules.

P003 General assessment (major prenatal visit)

P005 Antenatal preventative health assessment

P004 Minor prenatal assessment

P006 Vaginal

P020 Operative delivery, i.e. mid-cavity extraction or assisted breech delivery

E502 - vaginal birth after caesarean section (VBAC) whether successful or unsuccessful

P018 Caesarean section

P041 Caesarean section including tubal interruption

P042 Caesarean section including hysterectomy

P009 Attendance at labour and delivery

C989 Special visit for first obstetrical delivery with sacrifice of office hours

E411 Sole delivery premium - Payable in addition to labour and delivery fees P006A, P009A, E414, P018A, P020A, P038A or P041A if sole delivery in calendar day, to maximum of 25 sole delivery premiums per physician per fiscal year.

P007 Postnatal care in hospital and/or home

P008 Postnatal care in office

P030 Cervical ripening using topical, oral or mechanical agents, maximum once per pregnancy. Payable in conjunction with P023

P023 Oxytocin infusion for induction or augmentation of labour

P025 Non stress test

H001 Newborn care in hospital and/or home

H002 Low birth weight baby care (uncomplicated) - initial visit

H003 Low birth weight baby care (uncomplicated) - subsequent visit per visit

Physician – other than an Emergency Department Physician (refer to GP104)

E409 Evenings (17:00h – 24:00h) Monday to Friday or daytime and evenings on Saturdays, Sundays, Holidays

E410 Nights (00:00h – 07:00h)

G334 Telephone supervisory fee for ovulation induction with human menopausal gonadotropins or gonadotropin-releasing hormone (not eligible for payment same day as visit), to a maximum of 10 per cycle (per call)

G489 Venipuncture - adolescent or adult

G345 Complex single agent or multi-agent therapy – chemotherapy and/or biologic agent(s) that can cause vesicant damage, infusion reactions, cardiac, neurologic, marrow or renal toxicities that may require immediate intervention by the physician

Reproductive medicine (refer to J66)

G015 FSH (pituitary gonadotrophins)

G016 TSH (thyroid stimulating hormone)

G017 Prolactin

G018 Estradiol

G019 LH (luteinizing hormone)

G020 Progesterone

G021 HCG (human chorionic gonadotrophins) quantitative

Reproductive medicine (refer to J69)

G009 Urinalysis, routine (includes microscopic examination of centrifuged specimen plus any of SG, pH, protein, sugar, haemoglobin, ketones, urobilinogen, bilirubin)

G010 One or more parts of above without microscopy

ENDOSCOPY (refer to V8)

Z731 Initial investigation of abnormal cytology of vulva and/or vagina or cervix under colposcopic technique with or without biopsy(ies) and/or endocervical curetting

Z787 Follow-up colposcopy with biopsy(ies) with or without endocervical curetting

Z730 Follow up colposcopy without biopsy with or without endocervical curetting

Note: 1. A screening colposcopy is included in the assessment. 2. Z720 is not eligible for payment with Z730, Z731 or Z787.

The MDBilling.ca automated codes allow a physician to bill a single code (A20XA) for a “follow up”, and our software will automatically choose the highest paying assessment based on existing assessment codes previously billed in our database. The algorithm will choose the highest paying assessment code first, and subsequently bill assessment codes in decreasing fee value per the rules from the OHIP Schedule of Benefits (section GP23-25).

Service codes for rounding will differ depending on the number of days the patient has been admitted. The MDBilling.ca automatic codes allow a physician to enter one code for rounding. Our software system will automatically choose the correct (and highest paying) inpatient subsequent visit service allowed based on the admission date entered.

See General Preamble GP44 to GP45 for terms and conditions.

C122, C123 are not eligible for payment:

b. for a patient admitted for obstetrical delivery or newborn care; or

c. for any visit rendered by a surgeon during the 2 days prior to non-Z prefix surgery

HOW TO USE:

IPTMA (MRP Rounding): Our system will choose the correct inpatient subsequent visit code and add the MRP premium (E083) for you.

IPTXA (Non-MRP - covering): Our system will choose the correct inpatient subsequent visit code for you.

C142 + E083 1st day following transfer from ICU

C143 + E083 Second day following transfer from ICU

C124 + E083 Day of discharge (patient must be in hospital for at least 48 hours).

Other Visits

C121 Additional visit due to intercurrent illness

C208 Concurrent Care

C982 Palliative Care

C777 Intermediate assessment - Pronouncement of death

C771 Certification of death

Automatic Codes (K01XA / K04XA)

When billing counselling codes, there are limits on the number of units billable before the need to select a different service code (refer to OHIP Schedule of Benefits section A19).

HOW TO USE:

Simply bill K01XA (Individual Counselling) or K04XA (Group Counselling), and the system will search for existing counselling codes in our database and choose the appropriate counselling code for you.

Note:

Detention (K001) time may be payable following a consultation or assessment when a physician is required to spend considerable extra time in treatment or monitoring of the patient. See OHIP Schedule of Benefit page GP29 for further information.

K005 Primary mental health care

K014 Counselling for transplant recipients, donors or families of recipients and donors

K015 Counselling of relatives - on behalf of catastrophically or terminally ill patient

K002 Interview with relatives