H267 – Attendance at maternal delivery
OHIP Obstetrics Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Attendance at maternal delivery requires constant attendance at the delivery of a baby expected to be at risk by a paediatrician, and includes an assessment of the newborn. Payment Rule This service is not eligible for payment if any other service is rendered by the same physician at the time of the delivery unless the newborn is sick in which case a medical specific assessment (C263) is payable in addition to attendance at maternal delivery if rendered.
When to Use
- Use H267 when you are requested to be present at a high-risk delivery (e.g., meconium aspiration risk, prematurity, or maternal complications) and the infant is born healthy, requiring only a routine assessment.
- Use H267 in conjunction with C263 when you attend a high-risk delivery and the newborn is born sick, requiring an immediate, comprehensive medical assessment.
Common Pitfalls
- Billing H267 when you are merely 'on-call' for the delivery suite rather than providing constant, direct attendance at the specific delivery.
- Attempting to bill a standard newborn examination (C263) as a standalone service when you have already claimed H267, without documenting the specific medical necessity that qualifies the newborn as 'sick'.
- Billing H267 for routine deliveries where there was no documented 'at-risk' status for the newborn prior to the delivery.
Billing Tips
- Ensure your documentation explicitly states the 'at-risk' factor (e.g., fetal distress, maternal diabetes, or meconium) to justify the attendance, as this is the primary audit trigger for this code.
- If the newborn requires resuscitation or intensive care, bill the appropriate resuscitation codes (e.g., P003) instead of or in addition to H267, ensuring you follow the specific OHIP rules regarding concurrent service billing.
Effective: April 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Assessments
The medical record should document that the newborn was expected to be at risk, justifying the paediatrician's attendance.
The physician's constant attendance at the delivery must be documented.
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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