P020

PDF page 533 / K3

OBSTETRICS
 PREAMBLE
  10. The listings for “Attendance at labour and delivery” and for “Attendance of obstetric
      consultant(s) at delivery” may not be claimed by any physician when a patient is transferred to a
      second physician for normal obstetrical care.
    11. Ordinary immediate care of the newborn is included in the labour-delivery fee and when the
        service is rendered by the anaesthesiologist, it is included in the anaesthetic benefit. A life
        threatening emergency situation requiring active resuscitation of the newborn provided by any
        physician may be claimed under codes G521, G522, G523. When indicated, endotracheal
        intubation and tracheo-bronchial toilet should be billed under G211 and not as G521, G522,
        G523.
    12. When an obstetrician routinely transfers all newborns to another physician, the latter may not
        claim a consultation for these transferals. If the baby is well, the physician should claim newborn
        care in hospital plus attendance at maternal delivery (H007/H267) if this service is provided. If
        the baby is sick, the physician may claim a general assessment and attendance at maternal
        delivery (H007/H267) if this service is provided plus daily visits for as long as his/her services
        are required.
    13. If an obstetrician who normally cares for newborns him/herself or transfers the care of newborns
        to a family physician, refers a newborn to a paediatrician because of the complexity, obscurity or
        seriousness of the case, the latter may claim for this service according to the following
        guidelines:
        a. If attendance at maternal delivery is provided, C263 may be claimed in addition to H267 if a
           general assessment of the baby is carried out. A postnatal consultation of the baby, (C265)
           may not be claimed in addition to attendance at maternal delivery (H267).
        b. If attendance at maternal delivery (H267) is not provided, a postnatal consultation (C265)
           may be claimed, if rendered, whether or not a prenatal consultation has already been
           claimed.
    14. Physicians may claim for assisted breech delivery under fee code P020 when the service
        includes spontaneous delivery to the umbilicus, with extraction of the shoulders, arms and
        head.
    15. See General Preamble GP103 for After Hours Premiums.
    16. If claims are being submitted in coded form, the obstetrician should add the suffix “A” to the
        listed procedural code, the assistant should add the suffix “B” to the listed procedural code, and
        the anaesthesiologist should add the suffix “C” to the listed procedural code.

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#
                                                 OBSTETRICS
    LABOUR - DELIVERY
                                                                                         Asst         Surg         Anae
    # P006 Vaginal .....................................................................................    512.65
    # P020 Operative delivery, defined as any of: i) forceps or vacuum-
              assisted delivery, ii) breech delivery, or iii) shoulder dystocia
              using advanced maneuvers ................................................                     535.60 6
    # E502    - vaginal birth after caesarean section (VBAC) whether
                successful or unsuccessful .........................................add                      51.00
          [Commentary:
          P006 and P020 include the repair of a tear or episiotomy extension, first or second degree,
          when rendered.]
    # P018 Caesarean section...................................................................          6  579.80 7
    # P041 Caesarean section including tubal interruption........................                        6  609.20 7
    # P042 Caesarean section including hysterectomy .............................                        8 1004.60 8
    # E500    - for the third and each subsequent delivery, subject to the
                payment rules set out below, for each additional delivery, to
                P006, P018, P020, P041 or P042...............................add                            148.60
    # E499    - for the second caesarian delivery, subject to the payment
                rules set out below, to P018, P041 or P042 ...............add                               397.75
          Payment rules:
          1.For vaginal deliveries of two or more infants, P006 or P020 as appropriate is eligible for
            payment for the first delivery, in addition to 85% of P006 or P020 as appropriate for the
            second delivery, and E500 for the third and each subsequent delivery.
           2.For vaginal delivery of the first infant followed by caesarean section, one of P018, P041 or
             P042 as appropriate is eligible for payment, in addition to 85% of P006 or P020 as
             appropriate, and E500 for the third and each subsequent delivery.
           3.For multiple deliveries by caesarean section only (with or without trial of labour), one of P018,
             P041 or P042 as appropriate is eligible for payment, in addition to E499 for the second
             delivery and E500 for the third and each subsequent delivery.
           4.Despite payment rules above, for spontaneous vaginal deliveries between 20 and 23 weeks
             gestational age, only P006 is eligible for payment, regardless of the number of fetuses
             delivered.
           5.Despite payment rules above, for multiple deliveries by caesarean section only between 20
             and 23 weeks gestational age, only one of P018, P041 or P042 as appropriate is eligible for
             payment, in addition to E499 for the second delivery. E500 is not eligible for payment for the
             third or subsequent deliveries.
           6.For delivery of one or more fetuses known to be stillborn in addition to delivery of one or more
             live fetuses, only the delivery of live fetuses is eligible for payment in accordance with the
             payment rules above. If all fetuses are known to be stillborn, only one of P006, P018, P020,
             P041 or P042 as appropriate, is eligible for payment.
        Attendance at labour
      P038   - when patient transferred to another centre for delivery ....                           211.20
         Attendance at labour and delivery
          Payable to a physician other than an obstetric consultant for attending labour and delivery
          when the physician either assists at vaginal delivery or surgery, gives anaesthetic at a
          caesarean section or operative delivery, or resuscitates the newborn.

PDF page 537 / K7

OBSTETRICS
 LABOUR - DELIVERY
                                                                                         Asst   Surg     Anae
   P009 Attendance at labour and delivery ...........................................           512.65
       Note:
       Anaesthesia or Assistant units are not eligible for payment when the same physician claims
       P009 on the same patient.
         [Commentary:
         See Obstetrics Preamble p. K1, paragraph "e" for the services included in attendance at labour.
         P009 or P038 is not payable if any of these component services of attendance at labour are not
         rendered.]
   P010 Attendance of obstetric consultant(s) at delivery .....................                 211.20
         Note:
         Amount payable for attendance of a physician other than an obstetric consultant at only
         delivery is nil.
       Special visit for first obstetrical delivery with sacrifice of office hours
        Payable in addition to first obstetric delivery in calendar day. Maximum of one per physician per
        calendar day. See General Preamble GP65 for definition of special visit.
   C989      - special visit for first obstetrical delivery with sacrifice of
               office hours .................................................................add 78.55
       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.
   E411        - sole delivery premium ...................................... add 100%

PDF page 538 / K8

OBSTETRICS
LABOUR - DELIVERY
                                                                                                       Asst        Surg         Anae
      High risk obstetrical premium
       Payable in addition to labour and delivery procedures when at least one of the following
       conditions are present: fetal prematurity (<32 weeks gestational age), severe pregnancy
       induced hypertension, intrauterine growth retardation (IUGR) less than 10th percentile, or
       significant placental insufficiency as demonstrated by absent umbilical vessel flow or reverse
       systolic/diastolic (S/D) ratio.
# E414 High risk obstetrical premium ............................................add                                62.05
# P045 Repair of third degree tear or episiotomy extension, must
         include repair of perianal sphincter and perineum ..............                                           82.15         6
# P046 Repair of fourth degree tear or episiotomy extension, must
         include repair of rectal mucosa, perianal sphincter and
         perineum .............................................................................                   200.00          6
         Note:
         1.Repair of a tear or episiotomy extension that does not extend into the perianal sphincter (third
           degree) is included in the labour and delivery fee (P006 and P020) and does not constitute
           P045 or P046.
         2.Repair of the superficial transverse perineal muscle constitutes a repair of a second degree
           tear or episiotomy extension and does not constitute P045 or P046.
         Claims submission instructions:
         Claims for P046 submitted by a provider with a specialty other than Obstetrics and Gynecology
         (20) must be submitted for manual review.

Master, record 3950. Record Layout PDF, page 1.

P02020260401999999990000535600000000000000000000000000000095760000000957600

Auxiliary master fields are preserved as raw scaled values. The linked layout calls them zero-filled, but this edition contains non-zero values. They are not presented as final dollar fees or PDF units.