J122 – Brain - complete, B-mode
OHIP Cardio-Thoracic Surgery Code — DIAGNOSTIC ULTRASOUND · Schedule of Benefits
A complete, B-mode ultrasound examination of the brain. The fee for this service is divided into a professional component (P) and a technical component (H). The professional component is for the physician's interpretation and report. The technical component covers the use of equipment and staff for image acquisition. As per , the technical component is not payable to the physician if rendered to a hospital in-patient or an out-patient who is subsequently admitted within 24 hours for the same condition.
When to Use
- Use J122 for a complete B-mode ultrasound examination of the brain, typically in neonates or infants with open fontanelles, to evaluate intracranial pathology.
- Use this code when performing a comprehensive diagnostic scan that exceeds the scope of limited or focused ultrasound assessments.
Common Pitfalls
- Billing the technical component (H) for hospital in-patients or out-patients admitted within 24 hours is a common audit trigger and will result in a rejection per GP11.
- Failure to maintain specific quality assurance documentation as required by GP11 can lead to full recovery of fees during an audit of diagnostic services.
Billing Tips
- Ensure the professional component (P) is billed only when you have personally interpreted the images and generated a formal report, as this is the primary requirement for the professional fee.
- Apply the appropriate age-based premiums (e.g., under 30 days or under 1 year) to the J122 fee to maximize reimbursement, as these are specifically permitted for diagnostic radiological examinations.
Effective: April 1, 2025
G. Diagnostic Ultrasound
DIAGNOSTIC ULTRASOUND
Diagnostic
Diagnostic Ultrasound
Physician must have the necessary training and experience to personally render the technical component of the service.
Physician must maintain documentation that describes the process by which the physician monitors quality assurance in accordance with professional standards.
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