J128 – Abdominal scan - limited study
OHIP Cardio-Thoracic Surgery Code — DIAGNOSTIC ULTRASOUND · Schedule of Benefits
J128 is a limited ultrasound study of the abdomen and/or retroperitoneum. Examples include an examination focused on the gallbladder only, the aorta only, or a follow-up study. The service is listed with a professional component ('P' fee) and a technical component ('H' fee) (). The professional component is for the physician's interpretation and report, while the technical component covers the use of equipment and staff for performing the scan. Billing rules for these components are detailed in the General Preamble ().
When to Use
- Use J128 for a focused, single-organ abdominal ultrasound, such as a gallbladder-only scan to rule out cholelithiasis, rather than a comprehensive survey.
- Use J128 for follow-up abdominal imaging where only a specific previously identified pathology requires monitoring, as opposed to a full abdominal scan.
- Use J128 for limited retroperitoneal scans, such as an isolated aortic diameter measurement for aneurysm surveillance.
Common Pitfalls
- Billing J128 when a comprehensive abdominal ultrasound (J135) was actually performed; ensure the scope of the examination matches the 'limited' definition.
- Failing to submit the technical component with the 'B' suffix and the professional component with the 'C' suffix, which will result in claim rejection or processing errors.
- Attempting to bill J128 alongside a comprehensive scan on the same day for the same patient, which is considered unbundling and will be rejected.
Billing Tips
- Always ensure the referral indicates a limited or focused study to justify the use of J128 over more comprehensive diagnostic codes.
- Maintain clear documentation of the specific limited scope of the scan to support the claim during any potential ministry audit of the technical component.
Effective: April 1, 2025
G. Diagnostic Ultrasound
DIAGNOSTIC ULTRASOUND
Diagnostic
Diagnostic Ultrasound, Diagnostic and Therapeutic Procedures
For the technical component, the physician must maintain documentation that describes the process by which the physician monitors quality assurance in accordance with professional standards.
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