J108 – Biometry (Axial length - A-mode)
OHIP Cardio-Thoracic Surgery Code — DIAGNOSTIC ULTRASOUND · Schedule of Benefits
This service is a quantitative A-mode ophthalmic echography procedure used for biometry, specifically measuring the axial length of the eye. As per the Schedule, this service is comprised of two components: a technical component ('H' fee) and a professional component ('P' fee). The technical component ('H') fee is eligible for payment only when the service is rendered in a hospital, but is not eligible for payment if rendered to an in-patient of a hospital, or an out-patient who is admitted within 24 hours in connection with the same condition. The 'H' fee is also not eligible for payment if rendered outside of a hospital (). The professional component ('P') is for the physician's interpretation and report.
When to Use
- Use J108 for pre-operative axial length measurement required for intraocular lens power calculation prior to cataract surgery.
- Use J108 when performing quantitative A-mode echography to assess ocular dimensions in patients with suspected staphyloma or high myopia.
Common Pitfalls
- Billing the technical 'H' fee for services rendered in a private clinic or office setting, which is strictly prohibited under GP11.
- Attempting to claim the technical 'H' fee for hospital in-patients, as the fee is specifically excluded for patients admitted within 24 hours of the procedure.
- Failing to maintain a formal quality assurance monitoring process for the technical component, which is a mandatory documentation requirement for MOH audit compliance.
Billing Tips
- Ensure the professional 'P' component is billed separately from the technical 'H' component to reflect the interpretation and report requirements.
- Always verify the patient's admission status at the time of service to avoid 'H' fee rejections for patients who are or will be admitted to the hospital within the 24-hour window.
Effective: April 1, 2025
G. Diagnostic Ultrasound
DIAGNOSTIC ULTRASOUND
Diagnostic
Diagnostic Ultrasound
For the technical component, the physician must maintain documentation describing the process for quality assurance monitoring in accordance with professional standards. The physician must be able to demonstrate this upon request by the MOH.
All insured services must be documented in appropriate records.
The medical record must establish that an insured service was provided, the service for which the account is submitted is the service that was rendered, and the service was medically necessary.
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