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E499
E499 – Second caesarean delivery
OHIP Surgical Assists Code — OBSTETRICS · Schedule of Benefits
This code represents an additional fee for the surgical delivery of a second infant via caesarean section during a multiple birth. It is payable in addition to the primary caesarean section codes P018 (Caesarean section), P041 (Caesarean section with tubal interruption), or P042 (Caesarean section with hysterectomy). Payment is subject to specific rules for multiple deliveries by caesarean section, including those with or without a trial of labour, those between 20 and 23 weeks gestational age, and when stillborn fetuses are involved.
When to Use
- Use E499 for the second infant delivered via caesarean section in a twin pregnancy, billed alongside the primary P018, P041, or P042.
- Apply E499 when performing a caesarean section for a multiple birth between 20 and 23 weeks gestation, provided at least one fetus is live-born.
Common Pitfalls
- Do not bill E499 if all fetuses are stillborn; in this scenario, only the primary caesarean code (P018, P041, or P042) is eligible for payment.
- Avoid billing E499 for a third or subsequent fetus, as it is strictly limited to the second delivery; E500 is the designated code for third or subsequent deliveries.
- Do not attempt to claim E499 for stillborn fetuses when other live fetuses are delivered in the same procedure, as only live-born deliveries are eligible for this additional fee.
Billing Tips
- Ensure E499 is submitted on the same claim as the primary caesarean code (P018, P041, or P042) to avoid automatic rejection.
- Apply after-hours premiums (E409 or E410) to the E499 fee if the procedure commences during the specified time windows, as E499 is considered an eligible procedural fee.
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