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P025
P025 – Non stress test
OHIP Plastic Surgery Code — OBSTETRICS · Schedule of Benefits
A non stress test payable only for high risk pregnancies. The service must include interpretation of the trace, discussion with the patient and providing a written report to be retained in the patient's permanent medical record. It may also include the application of the fetal monitor and data acquisition.
When to Use
- Use P025 for serial fetal heart rate monitoring in patients with documented high-risk conditions like gestational diabetes, pre-eclampsia, or intrauterine growth restriction.
- Bill P025 when performing a non-stress test as a standalone diagnostic procedure for high-risk surveillance, distinct from routine prenatal visits billed under A007 or A008.
Common Pitfalls
- Billing P025 for low-risk pregnancies or routine prenatal check-ups will trigger automated rejections or audit flags for inappropriate use of high-risk diagnostic codes.
- Failing to document the specific interpretation of the trace and the discussion with the patient in the chart is a primary cause of clawbacks during Ministry audits.
- Attempting to bill P025 in addition to a comprehensive assessment code on the same day often leads to payment denials unless the services are clearly distinct and medically necessary.
Billing Tips
- Ensure the high-risk diagnosis is clearly linked to the service in your billing software to justify the necessity of the P025 diagnostic procedure.
- If the non-stress test is performed as part of a larger obstetric assessment, ensure the documentation clearly separates the diagnostic interpretation of the trace from the clinical examination to support billing both codes.
Provider Fee$9.65
Effective: April 1, 2025
Since Apr 2004, this fee has increased 0.0% vs 57.0% CPI inflation
Category
K. Obstetrics
Subcategory
OBSTETRICS
Service Type
Diagnostic
Code Classes
Diagnostic and Therapeutic Procedures
A written report of the interpretation of the trace and discussion with the patient must be retained in the patient's permanent medical record.
Sex Restriction
Female
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