J042 – Bronchogram with intra-tracheal catheter - bilateral
OHIP Cardio-Thoracic Surgery Code — CLINICAL PROCEDURES ASSOCIATED WITH DIAGNOSTIC RADIOLOGICAL EXAMINATIONS · Schedule of Benefits
This procedure is a bilateral bronchogram, which involves the introduction of an intra-tracheal catheter to administer a contrast medium. This allows for the radiological examination and imaging of the bronchial pathways on both sides. This code is for the bilateral procedure, while J003 covers the unilateral procedure.
When to Use
- Use J042 when performing a bilateral bronchogram requiring the placement of an intra-tracheal catheter for contrast administration.
- Select J042 specifically for bilateral imaging; do not use J003, which is restricted to unilateral procedures.
Common Pitfalls
- Attempting to bill a surgical assistant fee (M400B) directly with J042 will result in rejection; this requires prior authorization and a letter to a medical consultant.
- Failure to document the bilateral nature of the procedure in the clinical record can lead to audit recovery if the claim is flagged for review.
Billing Tips
- Ensure you apply the appropriate age-based premium (e.g., for patients under 16 years) as J042 is eligible for these percentage increases.
- If the procedure is performed on an emergency basis after hours, remember to append the correct premium (E409 or E410) to maximize the procedural fee.
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 that establish the service was provided, is the service for which the account is submitted, and was medically necessary.
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