Obstetrical Attendance Billing
The Physician’s Manual includes several obstetrical tariffs for different circumstances that arise during labour and delivery. Below is advice for when certain obstetrical tariffs apply and how they interact with one another. A consultant is a physician who receives a consultation, as defined in the Physician’s Manual, from the labour and delivery (L&D) physician. The consultant may assume responsibility for the labour or delivery depending on the circumstances.
Attendance by physician during labor and delivery, or caesarean section when no surgical assistance or anesthesia services are provided by the physician, and the delivery/procedure is carried out by a consultant.
Attendance by physician during labor when the physician must transfer the patient to another facility because of fetal or maternal indications.
Attendance by physician during labour and delivery, or caesarean section when the physician provides surgical assistance or anesthesia services and the delivery/procedure is carried out by a consultant.
Physician attending a delivery for the care of the newborn at the request of another physician (due to high risk delivery or caesarean section).
Claim Tariff 4825 for attendance during labour only when a labouring patient must be transferred from one facility to another. This service is most applicable to rural settings, where a patient must be transferred to a major centre to receive the necessary care. The physician does not accompany the patient during the transfer.
Tariff 4824 and Tariff 4826 apply when the L&D physician attending to a labour determines that, due to complications, they do not have the requisite skills or experience to deliver the newborn. The L&D physician will consult a colleague who will carry out the remainder of the delivery.
- If the L&D physician does not provide either anesthesia or surgical assistance but remains in attendance, Tariff 4824 is claimable.
- Tariff 4826 is claimable in addition to the anesthetic or surgical assistance benefits.
- In both of these scenarios, the consultant may claim a consultation, the appropriate delivery tariff, and any other associated services.
Do not claim Tariff 4826 in addition to surgical assistance benefits provided on pre-planned caesarean section services. For pre-planned, routine caesarean sections, the surgical assistant should claim the surgical assistant benefit outlined in the general schedule of the Physician’s Manual.
A consultation can occur from the L&D obstetrician to another obstetrician.
A physician may claim Tariff 4869 when providing care to a newborn immediately following a high-risk delivery or caesarean section. The claim must be made by a special report and substantiated by the physician who provided the obstetrical services.
Tariff 4869 may not be claimed in addition to any other obstetrical care services and may not be claimed by a physician who remains on standby for a potentially complex, high-risk delivery.