J166 – Multiple gestation, for each additional fetus
OHIP Cardio-Thoracic Surgery Code — DIAGNOSTIC ULTRASOUND · Schedule of Benefits
This code is for an ultrasound service for a high-risk or complicated multiple gestation pregnancy and is payable as an add-on to J160 for each additional fetus. This diagnostic procedure includes both a technical component (H-fee) and a professional component (P-fee). The service includes all common and specific elements of a diagnostic procedure as outlined in the General Preamble.
When to Use
- Use J166 for each additional fetus beyond the first when performing a comprehensive ultrasound scan for a multiple gestation pregnancy already billed under J160.
- Apply this code specifically when the ultrasound examination requires detailed assessment of multiple fetuses in a high-risk or complicated pregnancy setting.
Common Pitfalls
- Billing J166 without a corresponding J160 claim will result in an automatic rejection as it is strictly an add-on code.
- Attempting to bill J166 in conjunction with J168 is prohibited and will trigger a claim rejection due to the specific restriction between these codes.
- Failure to maintain documentation of the quality assurance process for the technical component can lead to audit recovery of the entire fee.
Billing Tips
- Ensure the number of units for J166 matches the number of additional fetuses scanned beyond the first, as J160 covers the initial fetus.
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 the above upon request by the MOH.
The physician must maintain documentation that describes the process by which the physician monitors quality assurance in accordance with professional standards.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.