J046 – Percutaneous nephrostomy
OHIP Cardio-Thoracic Surgery Code — CLINICAL PROCEDURES ASSOCIATED WITH DIAGNOSTIC RADIOLOGICAL EXAMINATIONS · Schedule of Benefits
Percutaneous nephrostomy involves the insertion of a drainage tube through the skin into the kidney, typically performed under imaging guidance. The anaesthesia fee is calculated based on 6 base units plus time units. Assistant at surgery is payable on an independent consideration basis by submitting the claim using fee code M400B. This procedure is eligible for various premiums, including age-based premiums for patients under 16, after-hours premiums (E409, E410), and the trauma premium (E420).
When to Use
- Use J046 for the primary insertion of a percutaneous nephrostomy tube under radiological guidance when the intent is to establish drainage for hydronephrosis or obstruction.
- Select J046 for patients requiring urgent renal decompression where the procedure is performed in an interventional radiology suite or operating room.
Common Pitfalls
- Do not bill J046B for an assistant without prior authorization from a medical consultant, as this will result in automatic rejection.
- Failure to document the Injury Severity Score (ISS) in the medical record will lead to the recovery of the E420 trauma premium during an audit.
- Billing E409 or E410 in conjunction with E420 is prohibited; the system will reject the claim if both after-hours and trauma premiums are submitted for the same service.
Billing Tips
- Ensure the surgical assistant submits their claim using code M400B to facilitate the independent consideration process required for this procedure.
- When billing for trauma, verify the patient's age to apply the correct ISS threshold (greater than 15 for age 16+, greater than 12 for under age 16) to ensure E420 eligibility.
Effective: April 1, 2026
E. Clinical Procedures associated with Diagnostic Radiological Examinations
CLINICAL PROCEDURES ASSOCIATED WITH DIAGNOSTIC RADIOLOGICAL EXAMINATIONS
Surgical
Clinical Procedures associated with Diagnostic Radiological Examinations, Urogenital and Urinary Surgical Procedures
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