J169 – Multiple gestation, for each additional fetus
OHIP Cardio-Thoracic Surgery Code — DIAGNOSTIC ULTRASOUND · Schedule of Benefits
This is an add-on service for a nuchal translucency ultrasound for prenatal genetic screening in a multiple gestation pregnancy. It is to be added to J168 for each additional fetus. The fees are separated into a technical component (H) of $33.15 and a professional component (P) of $16.35.
When to Use
- Use J169 for the second fetus in a twin pregnancy when performing a nuchal translucency scan billed under J168.
- Use J169 twice for a triplet pregnancy, billing one J168 for the first fetus and two units of J169 for the subsequent fetuses.
Common Pitfalls
- Billing J169 without an accompanying J168 will result in an automatic rejection as it is a mandatory add-on code.
- Attempting to bill other pregnancy-related ultrasound codes on the same day for the same patient will trigger a rejection due to the global restriction on diagnostic ultrasound services.
- Claiming the technical component (H) for J169 when the scan is performed in a private clinic setting, as this component is only payable when rendered in a hospital.
Billing Tips
- Ensure the number of units for J169 matches the number of additional fetuses scanned beyond the first one covered by J168.
- Verify that the facility setting is correctly identified in your billing software to ensure the technical component (H) is only applied for hospital-based services.
Effective: April 1, 2025
G. Diagnostic Ultrasound
DIAGNOSTIC ULTRASOUND
Diagnostic
Diagnostic Ultrasound
Female
Payment rules: Ultrasound services listed under the headings "Abdomen and Retroperitoneum" or "Pelvis" or "Pregnancy" rendered on the same day to the same patient by any physician as J168 are not eligible for payment.
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