J158 – Limited ultrasound for high risk pregnancy or complications of pregnancy
OHIP Cardio-Thoracic Surgery Code — DIAGNOSTIC ULTRASOUND · Schedule of Benefits
A limited diagnostic ultrasound performed for a high-risk pregnancy or for complications of pregnancy. This service has two components: a professional component (P-fee) for the interpretation and report, and a technical component (H-fee) for performing the scan. Per , the technical component is only payable when the service is rendered in a hospital. This service can be enhanced with a fetal Doppler evaluation by adding J167 if specific criteria are met.
When to Use
- Use J158 for a focused ultrasound scan to assess fetal well-being in a high-risk pregnancy, such as monitoring for suspected intrauterine growth restriction or placental insufficiency.
- Use J158 when investigating specific pregnancy complications like vaginal bleeding or suspected oligohydramnios, provided the scan is limited in scope rather than a comprehensive anatomical survey.
Common Pitfalls
- Billing the technical component (H-fee) for J158 when the ultrasound is performed in a private office setting, which is strictly prohibited under GP11.
- Attempting to bill J158 alongside a comprehensive ultrasound code (like J160) on the same day for the same patient, which will trigger a rejection for duplicate service.
Billing Tips
- Always append J167 to J158 if you perform a fetal Doppler evaluation for fetal anemia or IUGR, ensuring your clinical notes explicitly document the percentile measurements required by the J167 criteria.
Effective: April 1, 2025
G. Diagnostic Ultrasound
DIAGNOSTIC ULTRASOUND
Diagnostic
Diagnostic Ultrasound
The physician submitting a claim for the technical component is responsible for the complete quality assurance process for all elements of the technical component of the service, including data acquisition, reporting, and record keeping. The physician must be able to demonstrate this upon request by the MOH.
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