An updated guide on the use of Prenatal Care OHIP Billing Codes P003, P004 and P005.
We often find there is some confusion among our physicians with the different types of OHIP billing codes for prenatal care visits. We have updated our quick reference guide to provide some clarity in order to help you bill more effectively. Below are the latest updates on prenatal care codes for billing:
- At the initial prenatal visit with your patient (i.e. major visit such as a physical assessment), you should bill with a P003 code.
- The following prenatal visits of these patients (i.e. minor visits) should be billed using a P004 code.
- The P005 code is billed when the antenatal preventative care assessment is completed. We recommend you complete the antenatal preventative care assessment during either the major visit (P003) or minor visit (P004) as you can bill it along with either of these two codes.
Get our updated Prenatal Care Quick Reference Guide: We recently published a new Quick Reference Guide for prenatal care billing codes. You can download it here.
Reminders: Antenatal Forms
The codes P003, P004, P005 and P008 are to be filled in the Ontario Perinatal Record (OPR) – previously known as the Antenatal Form. The form is effective July 1, 2017, and includes the following major updates:
- Expanded from 2 to 3 pages
The original two-page record has been expanded to three pages to allow for more thorough documentation of medical, genetic, and psychosocial issues (this is the requirement for billing P005).
- Now a total of 5 pages
It now includes a page of mental health screening resources and a standardized postnatal visit record (for a postnatal visit, you bill P008).
Updated sections & consolidations
- Updated genetic history and investigations
- Updated language respectful of gender identity and the multiple ways in which individuals may identify themselves as a parent
- Updated demographics to reflect newer methods of contact, planned place of birth, newborn care provider
- All lab and ultrasound tests are now on page 2
Working with the Ontario Perinatal Record (OPR)
The OPR contains:
- A comprehensive section on immunizations
- Prompts for special circumstances requiring time sensitive interventions
- Inclusion of mental health screening questions and tools
- Grouped and expanded discussion topics by trimester
Download the PDF version here.
Technical specifications for the electronic version of the OPR are now available. However, it is important to note that the versions change based on the EMR you are using. For details regarding which electronic version to use based on your EMR, please contact your vendor.
Need help with your prenatal billing? We can help!