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H262
H262 – Low birth weight newborn uncomplicated care - initial
OHIP Obstetrics Code — CONSULTATIONS AND VISITS · Schedule of Benefits
When to Use
- Use H262 for the initial assessment of a well newborn weighing less than 2.5kg who does not require intensive care or complex management.
- Use this code when providing the first medical evaluation for a low birth weight infant who remains stable and uncomplicated during the neonatal period.
Common Pitfalls
- Billing H262 for infants requiring intensive care or complex medical management, which should instead be billed under neonatal intensive care codes.
- Claiming H262 for subsequent daily visits; ensure all follow-up visits for the same patient are billed using H263.
- Failing to apply the mandatory age premium (AGE_PREMIUM_UNDER_30_DAYS) when the infant is less than 30 days old, which significantly increases the claim value.
Billing Tips
- Always verify the birth weight is documented as under 2.5kg in the chart to support the use of H262 over standard newborn assessment codes like A007.
- Ensure the age premium is correctly appended to the H262 claim to capture the 30% increase for infants under 30 days of age.
Provider Fee$0.00
Specialist Fee$58.20
Surgical Assistant Fee$0.00
Anaesthetist Fee$0.00
Non-Anaesthetist Fee$0.00
Effective: October 1, 2005
Category
A. Consultations and Visits
Subcategory
CONSULTATIONS AND VISITS
Service Type
Assessment
Code Classes
Assessments
Age Restriction
Patient must be a newborn or infant as defined on <SectionPages>GP2</SectionPages>.
Definition: Low birth weight baby care is any assessment of a well newborn/infant weighing less than 2.5 kilograms at birth.
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