J012 – Nephrotomogram
OHIP Cardio-Thoracic Surgery Code — CLINICAL PROCEDURES ASSOCIATED WITH DIAGNOSTIC RADIOLOGICAL EXAMINATIONS · Schedule of Benefits
A nephrotomogram is a clinical procedure associated with diagnostic radiological examinations. Payment for this service is determined on an independent consideration (IC) basis, requiring a letter of explanation and supporting documentation with the claim. Anaesthesia services are payable with 6 base units plus time units.
When to Use
- Use J012 for nephrotomography procedures that require specialized clinical oversight and documentation beyond standard diagnostic imaging.
- Use this code when the complexity of the procedure necessitates an Independent Consideration (IC) claim due to the absence of a fixed fee in the Schedule.
Common Pitfalls
- Failure to include a detailed letter of explanation and an operative report will result in an automatic rejection of the IC claim.
- Submitting a claim without a direct comparison of the scope and difficulty of the procedure against non-IC procedures often leads to claim denial or significant payment reduction.
- Billing J012 without a valid referral from a physician, nurse practitioner, or oral maxillofacial surgeon is a violation of the billing requirements.
Billing Tips
- When calculating the IC fee, explicitly document the time and complexity involved to justify the amount claimed relative to established procedural fees.
- Ensure that any associated anaesthesia services are billed separately using the 6 base units plus time units, ensuring all relevant ASA or patient-specific modifiers are applied.
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
Claims for IC services must be submitted with a supporting letter explaining the amount of the fee claimed, and must include an appropriate operative or consultation report, and a comparison of the scope and difficulty of the procedure in relation to non-IC procedures in the Schedule.
The fee for this service is payable on an Independent Consideration (IC) basis.
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