J168 – Nuchal translucency for Prenatal Genetic Screening
OHIP Cardio-Thoracic Surgery Code — DIAGNOSTIC ULTRASOUND · Schedule of Benefits
A limited ultrasound examination to measure nuchal translucency for Prenatal Genetic Screening. This service is limited to a maximum of one per pregnancy. For multiple gestations, J169 can be added for each additional fetus.
When to Use
- Use J168 when performing a targeted ultrasound specifically to measure nuchal translucency as part of the first-trimester prenatal genetic screening program.
- Use J168 in conjunction with J169 when the patient has a multiple gestation pregnancy to account for the additional fetus measurement.
Common Pitfalls
- Billing J168 on the same day as any other ultrasound service under the 'Abdomen and Retroperitoneum', 'Pelvis', or 'Pregnancy' categories will result in an automatic rejection.
- Attempting to bill J168 more than once per pregnancy is a common audit trigger, as it is strictly limited to a single occurrence per patient per gestation.
- Failing to include the technical component (H) only when the service is performed in a hospital or licensed Independent Health Facility leads to claim adjustments.
Billing Tips
- Ensure that J169 is appended to J168 for every additional fetus in a multiple gestation to capture the appropriate fee for the extra work involved.
Effective: April 1, 2025
G. Diagnostic Ultrasound
DIAGNOSTIC ULTRASOUND
Diagnostic
Diagnostic Ultrasound
Female
This service has a technical component (H) fee and a professional component (P) fee. The technical component is payable only when the service is rendered in a hospital or a licensed Independent Health Facility.
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. See .
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