A665 – Prenatal Consultation
OHIP General Listings Code — Paediatrics (26) · Schedule of Benefits
A prenatal consultation is the service rendered by a paediatrician upon request of a physician or nurse practitioner who considers a fetus of greater than 20 weeks gestation to be at risk or in jeopardy by reason of continuation of pregnancy in the presence of maternal and/or fetal distress.
When to Use
- Bill A665 when a pediatrician is consulted by an OB/GYN for a fetus over 20 weeks gestation with suspected intrauterine growth restriction and oligohydramnios.
- Use A665 when a family physician requests a pediatric consultation for a pregnant patient with a history of stillbirth and current concerns for fetal well-being due to maternal hypertension.
- Bill A665 when a midwife consults a pediatrician regarding a fetus over 20 weeks gestation presenting with non-reassuring fetal heart rate patterns during the third trimester.
Common Pitfalls
- Claims for A665 are often rejected if the written report to the referring provider is missing or incomplete, failing to detail findings, opinions, and recommendations.
- Billing A665 without a valid written request from a physician or nurse practitioner, or if the request lacks essential patient and provider identification, will lead to rejection.
- A665 is incorrectly billed if the fetus is not greater than 20 weeks gestation or if there is no documented maternal or fetal distress placing the pregnancy at risk.
Billing Tips
- Ensure the written report accompanying A665 is clearly addressed to the referring physician, nurse practitioner, or dental surgeon and retained in your records, unless a common medical record exists.
- A pediatrician can bill A665 for a prenatal consultation and subsequently bill C265 for a post-natal consultation on the same infant, as these are distinct services.
Effective: June 1, 2025
Consultations and Visits
Paediatrics (26)
Consultations and Visits
Consultation
The consultant must prepare a written report (including findings, opinions, and recommendations) to the referring physician, nurse practitioner or dental surgeon.
The consultant is required to perform a medical specific assessment, including a review of all relevant data.
The request identifies the consultant by name and/or the specialty being consulted, the referring physician, nurse practitioner or dental surgeon by name and billing number, and identifies the patient by name and health number.
A copy of the written request for the consultation, signed by the referring physician, nurse practitioner or dental surgeon must be kept in the consulting physician’s medical record, except in the case of a consultation which occurs in a hospital, long-term care institution or multi-specialty clinic where common medical records are maintained. In such cases, the written request may be contained on the common medical record.
The written request sets out the information relevant to the referral and specifies the service(s) required.
A prenatal consultation by a paediatrician does not preclude the paediatrician from claiming a post-natal consultation on the infant.
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