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P042
P042 – Caesarean section including hysterectomy
OHIP Plastic Surgery Code — OBSTETRICS · Schedule of Benefits
P042 is the fee code for a Caesarean section including hysterectomy. This procedure involves the delivery of a baby through an incision in the mother's abdomen and uterus, followed by the surgical removal of the uterus in the same operative session. The fee is applicable for surgeon (A), assistant (B), and anaesthetist (C) services. Specific payment rules apply for multiple births and deliveries of stillborn fetuses, as detailed on page of the Schedule of Benefits.
When to Use
- Use P042 when a Caesarean section is performed and a hysterectomy is required during the same operative session for indications such as placenta accreta spectrum or intractable postpartum hemorrhage.
- Do not use P042 for a standard Caesarean section; use P018 for a primary C-section or P041 for a repeat C-section instead.
Common Pitfalls
- Billing P042 in addition to a separate hysterectomy code is a common error; P042 is a comprehensive fee that already includes the hysterectomy.
- Attempting to bill E500 for a third delivery when all fetuses are stillborn will result in rejection, as E500 is only eligible for live births in a multiple birth scenario.
- Failure to document the specific indication for the hysterectomy during the C-section can lead to audit scrutiny regarding the necessity of the combined procedure.
Billing Tips
- Ensure that if multiple deliveries occur, you only bill one primary code (P042) and use the appropriate add-on codes (E499 for the second, E500 for the third) to avoid claim rejection.
- If the procedure is performed after hours, remember to apply the relevant after-hours premium (E409 or E410) to the procedural fee, as P042 is eligible for these increases.
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