J197 – Penile pressure recordings - two or more pressures
OHIP Cardio-Thoracic Surgery Code — DIAGNOSTIC ULTRASOUND · Schedule of Benefits
J197 is a vascular laboratory service for penile pressure recordings, requiring two or more pressure measurements. This entry represents the professional component (P) of the service, with a fee of $7.80. A claim for the professional component is submitted using this fee schedule code with a suffix C (i.e., J197C), as per instructions on . The technical component (H) is billed separately.
When to Use
- Use J197C when performing a professional interpretation of penile pressure recordings that specifically includes two or more distinct pressure measurements.
- Use this code for the professional component (P) of vascular laboratory services when the technical component (H) is billed separately by the facility.
Common Pitfalls
- Submitting J197 without the 'C' suffix will result in a rejection, as the professional component must be explicitly identified as J197C per GP11.
- Billing J197C for services rendered outside of a hospital setting is an audit risk, as the technical component is not an insured service in non-hospital facilities.
- Failing to ensure the documentation reflects at least two distinct pressure measurements, which is a mandatory requirement for this specific code.
Billing Tips
- Always verify that the facility has billed the technical component (H) separately to avoid claim reconciliation issues.
- Ensure the referral source is documented, as this diagnostic service strictly requires a referral from a physician, nurse practitioner, or oral maxillofacial surgeon.
Effective: April 1, 2025
G. Diagnostic Ultrasound
DIAGNOSTIC ULTRASOUND
Diagnostic
Diagnostic Ultrasound
The physician submitting a claim for the professional component is responsible for the complete quality assurance process for all elements of the service.
All insured services must be documented in appropriate records to establish that: 1. an insured service was provided; 2. the service for which the account is submitted is the service that was rendered; and 3. the service was medically necessary.
Male
This service has a separate technical component (H fee) which must be claimed separately, typically by the facility. As per , the technical component of a diagnostic service rendered outside of a hospital is not an insured service.
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