P006 – Vaginal delivery
OHIP Plastic Surgery Code — OBSTETRICS · Schedule of Benefits
Vaginal delivery. <br><br>Commentary:<br>P006 and P020 include the repair of a tear or episiotomy extension, first or second degree, when rendered.<br><br>Payment Rules for Multiple Births:<br>1. For vaginal deliveries of two or more infants, P006 or P020 as appropriate is eligible for payment for the first delivery, in addition to 85% of P006 or P020 as appropriate for the second delivery, and E500 for the third and each subsequent delivery.<br>2. For vaginal delivery of the first infant followed by caesarean section, one of P018, P041 or P042 as appropriate is eligible for payment, in addition to 85% of P006 or P020 as appropriate, and E500 for the third and each subsequent delivery.<br>3. For multiple deliveries by caesarean section only (with or without trial of labour), one of P018, P041 or P042 as appropriate is eligible for payment, in addition to E499 for the second delivery and E500 for the third and each subsequent delivery.<br>4. For spontaneous vaginal deliveries between 20 and 23 weeks gestational age, only P006 is eligible for payment, regardless of the number of fetuses delivered.<br>5. For multiple deliveries by caesarean section only between 20 and 23 weeks gestational age, only one of P018, P041 or P042 as appropriate is eligible for payment, in addition to E499 for the second delivery. E500 is not eligible for payment for the third or subsequent deliveries.<br>6. For delivery of one or more fetuses known to be stillborn in addition to delivery of one or more live fetuses, only the delivery of live fetuses is eligible for payment in accordance with the payment rules above. If all fetuses are known to be stillborn, only one of P006, P018, P020, P041 or P042 as appropriate, is eligible for payment.
When to Use
- Use P006 for a standard spontaneous vaginal delivery, including cases where a first or second-degree tear or episiotomy requires repair.
- Use P006 for spontaneous vaginal deliveries occurring between 20 and 23 weeks gestational age, regardless of the number of fetuses delivered.
Common Pitfalls
- Do not bill separately for the repair of a first or second-degree tear or episiotomy, as these are included in the P006 fee.
- Do not attempt to bill E500 for the third or subsequent delivery when the delivery occurs between 20 and 23 weeks gestational age, as it is explicitly excluded.
- Ensure you do not bill P006 for a stillborn delivery if another live fetus is delivered in the same event; only the live birth is eligible for payment.
Billing Tips
- If performing a vaginal birth after a previous caesarean section, remember to add the E502 flat fee to your P006 claim, provided the delivery is not between 20-23 weeks gestation.
- When managing multiple vaginal births, bill P006 at 100% for the first infant and 85% for the second, then use E500 for the third and any subsequent infants.
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