P003 – General assessment (major prenatal visit)
OHIP Plastic Surgery Code — OBSTETRICS · Schedule of Benefits
A major prenatal visit that constitutes a general assessment. As per the definition of a general assessment on page , this service requires a full history (including presenting complaint, family medical history, past medical history, social history, and functional inquiry), and an examination of all body parts and systems (with exceptions for breast, genital, or rectal exams if not indicated or refused). It may include a detailed examination of one or more parts or systems. This is typically the major prenatal visit.
When to Use
- Use P003 for the initial comprehensive prenatal assessment when a full history and physical examination are performed, rather than a routine follow-up visit (P004).
- Use this code when the patient presents for their first major prenatal evaluation, ensuring the documentation reflects a complete system-by-system review as defined in GP21.
Common Pitfalls
- Billing P003 on the same day as A920 or A922 is prohibited; the system will reject the claim as these services are mutually exclusive.
- Failing to document a functional inquiry into all body systems will lead to audit recovery, as P003 requires a full general assessment standard, not just an obstetrical-focused exam.
- Attempting to bill P003 in conjunction with other general assessment codes (A-codes) for the same patient on the same day will trigger payment adjustments or rejections.
Billing Tips
- If the patient was recently discharged from an acute care hospital for a non-obstetrical reason (e.g., ICU admission), ensure you append the E080 premium to your P003 claim to capture the additional $25.25 fee.
Effective: April 1, 2026
K. Obstetrics
OBSTETRICS
Assessment
Obstetrics, Assessments
Requires a full history, the elements of which must include a history of the presenting complaint, family medical history, past medical history, social history, and a functional inquiry into all body parts and systems.
Requires an examination of all body parts and systems, except for breast, genital or rectal examination where not medically indicated or refused.
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