J011 – Myelogram
OHIP Cardio-Thoracic Surgery Code — CLINICAL PROCEDURES ASSOCIATED WITH DIAGNOSTIC RADIOLOGICAL EXAMINATIONS · Schedule of Benefits
Myelogram is a diagnostic procedure performed to examine the spinal canal. It involves the injection of a contrast medium, followed by imaging studies. This fee code covers the performance of the procedure. It can be billed with add-on codes J038 for supine views requiring re-introduction of the spinal needle, or J020 for posterior fossa views.
When to Use
- Use J011 when performing a diagnostic myelogram involving the injection of contrast medium into the spinal canal followed by imaging.
- Use J011 as the base procedure code when you must also bill J038 for supine views requiring a second needle puncture.
- Use J011 as the base procedure code when you must also bill J020 for the inclusion of posterior fossa views.
Common Pitfalls
- Billing J038 without explicit documentation that the spinal needle was removed and re-introduced to obtain supine views.
- Attempting to bill J011 alongside other special visit premiums when the trauma premium E420 is already applied, as they are mutually exclusive.
- Failing to include the Injury Severity Score (ISS) in the medical record when claiming the E420 trauma premium for a myelogram.
Billing Tips
- Always append J038 or J020 as separate line items on the same claim as J011 to ensure the add-on fees are processed correctly.
- Ensure that if you are billing after-hours premiums E409 or E410, the procedure meets the non-elective criteria or was delayed by a surgical emergency.
Effective: April 1, 2026
E. Clinical Procedures associated with Diagnostic Radiological Examinations
CLINICAL PROCEDURES ASSOCIATED WITH DIAGNOSTIC RADIOLOGICAL EXAMINATIONS
Procedure
Clinical Procedures associated with Diagnostic Radiological Examinations
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