Called from outside the hospital: Only one call back is typically paid unless you can provide an exceptional reason for the extra call back. If you do try to bill more than one, you must submit with a note and Submission Code “D”.
00112 (0800-1759) Weekdays – Includes the visit fee
1202 (0800-1759) Weekends and Stat Holidays
Called from inside the hospital: Same rules apply as above
00123 (0800-1759) Weekends and Stat Holidays
Assessment Fee (13200): Billed in addition to a call out fee if no delivery fee is billed. If delivery occurs later that day, you require a note with the assessment stating the patient was not in labour.
14104 Vaginal Delivery
14105 Management of Labour and Transfer to Higher Level of Care Facility for Delivery
14108 Elective C/S – ADD SURGICAL ASSIST 00196
14109 Emergency C/S – ADD SURGICAL ASSIST 00196 (May also qualify for surgical surcharge)
BONUSES (Maximum of 25 total for the calendar year):
14004 Bonus on 14104
14005 Bonus on 14105
14008 Bonus on 14108
14009 Bonus on 14109
Complicated Deliveries: These fees are the same for OB and only one of you can bill them. Discuss with the OB if you request a consult to see who will bill these items if applicable.
4000 Complicated Delivery
4014 Forceps Delivery
4018 Vaginal Breech Delivery
4022 Repair of 3rd degree tear
4023 Repair extensive cerv./vag. laceration
4024 Repair of 4th degree tear
4026 Manual removal of retained placenta
Surgical Assist Fees:
00196 Surgical Assist – Operative Fee $314-523
00197 Surgical Assist – Operative Fee over $523
13194 First Surgical Assist of the day (GP only)
1210 (1800-2259) – 37.78% of Surgical Assist Fee
1211 (2300-0800) 60.57% of Surgical Assist Fee
1212 (0800-1759) Weekends and Stat Holidays – 37.78% of Surgical Assist Fee
Prolonged 2nd Stage: A note is required stating Time Fully Dilated, and Delivery time as well as 2nd stage prolonged. After 2 hours, 14199 is billable each half hour. Start time should be the start of 2nd stage, do not deduct the 2 hours.
Continuing Care Surcharges: Only billable during 2nd stage and after 30 minutes. A note record is required stating Time Fully Dilated and Time Delivered. Billable every additional 30 minutes or major portion thereof.
1207 (0800-1759) Weekends and Stat Holidays
Oxytocin – Continuous attendance or immediate availability required.
04118 First Hour (times must reflect first hour)
04119 Subsequent hours to a maximum of 10 hours (Start time should be start of the second hour)
Prostaglandin Gel or Cervidil: Only billable as a visit fee (00108 or 13200) unless it is the only fee item billed that day. A call out charge would then be billable with the visit and an electronic note stating “Prostaglandin gel/cervidil inserted"
13200 Outpatient 00108 Inpatient with 13108 1st Inpatient seen
00199 – Attendance during weekday hours with post-partum hemorrhage, or fetal compromise before start of second stage would be examples of when to bill this. There must be a detailed note record and a billed amount that seems fair and explainable.
04699 Examination of Ferning (Only billable with Outpatient Location Code)