H263 – Low birth weight newborn uncomplicated care - thereafter
OHIP Obstetrics Code — CONSULTATIONS AND VISITS · Schedule of Benefits
This service is a subsequent visit for the ongoing, uncomplicated care of a low birth weight newborn or infant. It follows the initial assessment and care provided under H262. As per the definition on , low birth weight baby care applies to any assessment of a well newborn/infant weighing less than 2.5 kilograms at birth.
When to Use
- Use H263 for daily subsequent hospital visits for a low birth weight infant who has already received the initial assessment under H262.
- Apply this code for ongoing monitoring of an uncomplicated infant weighing less than 2.5kg at birth who does not require the intensity of a critical care or neonatal intensive care code.
Common Pitfalls
- Claiming H263 for infants weighing 2.5kg or more at birth, which will result in a rejection as the weight threshold is strictly defined in GP33.
- Billing H263 in conjunction with a general subsequent visit code like C002, which is redundant and will trigger a billing edit for duplicate services.
- Failing to ensure the infant is under 2 years of age, as the code is restricted to this specific age demographic.
Billing Tips
- Ensure the birth weight is clearly noted in the patient's chart to support the use of H263 over standard subsequent visit codes during an audit.
- If the infant requires more complex care, evaluate whether the clinical status warrants a shift to neonatal intensive care codes rather than the uncomplicated H263.
Effective: April 1, 2004
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Assessments
Applies to a newborn or infant less than 2 years of age.
In surgical cases requiring medical direction, standard in-hospital medical fees are to be claimed in addition to the surgical fee. This includes all operations on babies under one year of age, and all other older children who require medical supervision.
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