P045 – Repair of third degree tear or episiotomy extension
OHIP Plastic Surgery Code — OBSTETRICS · Schedule of Benefits
Provides payment for the repair of a third-degree tear or episiotomy extension. This service must include the repair of the perianal sphincter and the perineum. This service is distinct from repairs of second-degree tears (e.g., superficial transverse perineal muscle) or tears not extending to the sphincter, which are considered integral to the main labour and delivery services (P006, P020) and are not separately billable as P045.
When to Use
- Use P045 specifically for the repair of a third-degree obstetric tear involving the anal sphincter complex.
- Use P045 for the repair of an episiotomy that extends into the perianal sphincter, provided the repair includes the sphincter itself.
Common Pitfalls
- Billing P045 for second-degree tears or repairs of the superficial transverse perineal muscle, which are bundled into the delivery fee (P006 or P020).
- Submitting P045 for routine episiotomy repairs that do not involve the perianal sphincter, as these are considered integral to the global labour and delivery service.
- Failing to distinguish between P045 (third-degree) and P046 (fourth-degree) based on the involvement of the rectal mucosa.
Billing Tips
- Ensure your operative note explicitly documents the involvement and repair of the perianal sphincter to justify the use of P045 over the inclusive delivery codes.
- Apply relevant after-hours premiums (E409A or E410A) to P045 if the procedure meets the non-elective criteria and time-of-day requirements.
Effective: April 1, 2025
K. Obstetrics
OBSTETRICS
Surgical
Obstetrics, Female Genital Surgical Procedures
1. Repair of a tear or episiotomy extension that does not extend into the perianal sphincter (third degree) is included in the labour and delivery fee (P006 and P020) and does not constitute P045 or P046.
2. Repair of the superficial transverse perineal muscle constitutes a repair of a second degree tear or episiotomy extension and does not constitute P045 or P046.
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