J006 – Discogram - one disc
OHIP Cardio-Thoracic Surgery Code — CLINICAL PROCEDURES ASSOCIATED WITH DIAGNOSTIC RADIOLOGICAL EXAMINATIONS · Schedule of Benefits
A discogram is a diagnostic procedure that involves injecting contrast material into the nucleus pulposus of an intervertebral disc, typically under fluoroscopic guidance, to visualize internal disc structure and assess for pathology. This service, J006, is for the procedure on a single disc. For each subsequent disc examined during the same session, bill J030.
When to Use
- Use J006 as the primary code for the first intervertebral disc injected with contrast material under fluoroscopic guidance.
- Use J006 in conjunction with J030 when performing a multi-level discogram, where J006 covers the first disc and J030 covers each subsequent disc.
Common Pitfalls
- Billing J006 multiple times for a multi-level procedure will result in rejection; only the first disc is billed as J006, with subsequent levels billed as J030.
- Failure to document the specific level of the disc injected (e.g., L4-L5) can lead to audit recovery, as the claim must match the specific anatomical site rendered.
Billing Tips
- Ensure the procedure note explicitly states the use of fluoroscopic guidance to support the clinical procedure category requirements for J006.
Effective: April 1, 2025
E. Clinical Procedures associated with Diagnostic Radiological Examinations
CLINICAL PROCEDURES ASSOCIATED WITH DIAGNOSTIC RADIOLOGICAL EXAMINATIONS
Procedure
Clinical Procedures associated with Diagnostic Radiological Examinations
All insured services must be documented in appropriate records. The Act requires that the record establish that: 1. an insured service was provided; 2. the service for which the account is submitted is the service that was rendered; and 3. the service was medically necessary.
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