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E414
E414 – High risk obstetrical premium
OHIP Surgical Assists Code — OBSTETRICS · Schedule of Benefits
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 - significant placental insufficiency as demonstrated by absent umbilical vessel flow or reverse systolic/diastolic (S/D) ratio.
When to Use
- Use E414 when managing a vaginal delivery or C-section for a patient with confirmed IUGR below the 10th percentile, as documented in the prenatal record or ultrasound reports.
- Apply this premium during the delivery of a fetus at less than 32 weeks gestational age, ensuring the exact gestational age is clearly noted in the delivery summary.
- Bill this code when the patient presents with severe pregnancy-induced hypertension requiring active management during the labour and delivery process.
Common Pitfalls
- Do not bill E414 for routine high-risk conditions like gestational diabetes or mild hypertension, as it is strictly limited to the four specific clinical criteria defined in the Schedule of Benefits.
- Avoid billing E414 as a standalone service; it must be submitted in conjunction with the primary labour and delivery procedure code to be valid.
- Ensure the diagnosis code submitted with the claim matches the specific high-risk condition (e.g., IUGR or severe hypertension) to avoid automated rejections.
Billing Tips
- Always link the E414 premium to the primary delivery procedure code (e.g., P003 or P004) on the same claim to ensure the system recognizes the association.
- Maintain precise documentation of the specific qualifying condition—such as the S/D ratio or the specific percentile for IUGR—within the hospital delivery record to support the claim in the event of a post-payment audit.
Provider Fee$62.05
Effective: April 1, 2025
Since Apr 2004, this fee has increased 0.0% vs 57.0% CPI inflation
Category
K. Obstetrics
Subcategory
OBSTETRICS
Service Type
Premium
Code Classes
Obstetrics, Other Premiums (including After Hours Procedure Premiums)
Sex Restriction
Female
Payable in addition to labour and delivery procedures.
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