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P004
P004 – Minor prenatal assessment
OHIP Plastic Surgery Code — OBSTETRICS · Schedule of Benefits
A minor prenatal assessment is a routine visit for antenatal care. As a type of minor assessment, as defined on , it generally includes a brief history of the presenting complaint, the necessary physical examination, advice to the patient, and an appropriate record. This service also includes all applicable common and specific elements of assessments outlined in the Schedule of Benefits (-).
When to Use
- Use P004 for routine, uncomplicated prenatal visits where the assessment focuses on standard monitoring such as blood pressure, fundal height, and fetal heart rate.
- Use P004 when performing a minor follow-up assessment for a pregnancy-related concern that does not meet the complexity requirements of a full prenatal examination (P003).
Common Pitfalls
- Billing P004 on the same day as a general assessment code (A-series) or a consultation will result in a rejection due to the restriction on concurrent assessment codes.
- Attempting to bill P004 alongside A920 or A922 for early pregnancy management will lead to automatic claim denial.
- Failing to recognize that P004 is a minor assessment; billing it for high-acuity or complex prenatal complications may lead to audit scrutiny if the documentation does not support the minor nature of the visit.
Billing Tips
- P004 is eligible to be billed on the same day as P005 (Prenatal assessment, subsequent), allowing for combined billing if both services are rendered and documented separately.
- Ensure the E080 premium is appended if the P004 visit occurs within 14 days of a non-obstetrical acute care hospital discharge, provided the patient meets the primary care physician criteria.
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