J138 – Intracavitary ultrasound
OHIP Cardio-Thoracic Surgery Code — DIAGNOSTIC ULTRASOUND · Schedule of Benefits
Intracavitary ultrasound (e.g. transrectal, transvaginal) is a diagnostic ultrasound procedure of the pelvis. This service is comprised of a professional component (P fee) of $26.50 and a technical component (H fee) of $48.75. According to of the Schedule, the claim for the technical component is submitted using the fee schedule code with the suffix B and the claim for the professional component is submitted using the fee schedule code with a suffix C. The technical component of a diagnostic service listed in the column headed with an "H" and rendered outside of a hospital is not eligible for payment under the Health Insurance Act ().
When to Use
- Use J138C for the professional interpretation of a transvaginal ultrasound performed to investigate pelvic pain or adnexal masses.
- Use J138C for the professional interpretation of a transrectal ultrasound performed for prostate assessment when clinically indicated.
- Use J138B only when the technical equipment is owned and operated within a hospital or an approved independent health facility (IHF).
Common Pitfalls
- Billing J138B in a community office setting will result in a rejection, as the technical component is not an insured service outside of a hospital or IHF.
- Submitting J138 in conjunction with G900 will trigger a rejection because residual urine measurement is considered inclusive to the pelvic ultrasound procedure.
- Claiming J138 alongside J165 will result in a payment of nil, as these codes are mutually exclusive for the same diagnostic encounter.
Billing Tips
- Ensure you append the correct suffix: use J138C for the professional fee and J138B for the technical fee, as submitting the base code J138 without a suffix will cause a claim error.
- Verify that the referring physician or nurse practitioner has provided a clear clinical indication, as diagnostic ultrasounds are strictly non-insured when requested for IVF or artificial insemination purposes.
Effective: April 1, 2025
G. Diagnostic Ultrasound
DIAGNOSTIC ULTRASOUND
Diagnostic
Diagnostic Ultrasound
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