J198 – Venous assessment - bilateral
OHIP Cardio-Thoracic Surgery Code — DIAGNOSTIC ULTRASOUND · Schedule of Benefits
A bilateral venous assessment that includes the evaluation of the femoral, popliteal, and posterior or tibial veins, utilizing appropriate functional manoeuvres. A permanent record of the findings is a required component of this service. This procedure has both a professional component (P) and a technical component (H). As per on , the claim for the technical component (H fee: $7.40) is submitted with suffix B, and the professional component (P fee: $9.90) is submitted with suffix C.
When to Use
- Use J198 when performing a comprehensive bilateral deep vein thrombosis (DVT) screening for patients presenting with bilateral leg swelling or suspected bilateral venous insufficiency.
- Use J198 instead of J199 when the assessment requires a full bilateral protocol rather than a unilateral or limited venous evaluation.
Common Pitfalls
- Submitting J198 without the correct suffix (B for the technical component and C for the professional component) will result in automatic rejection.
- Claiming J198 for a patient currently admitted for post-operative recovery is a violation of the Schedule of Benefits and will trigger an audit recovery.
- Failing to document the specific functional manoeuvres performed, such as distal augmentation or Valsalva, renders the claim non-compliant during a Ministry review.
Billing Tips
- Ensure your billing software is configured to split the claim into two separate submissions (J198B and J198C) to capture both the technical and professional components correctly.
Effective: April 1, 2025
G. Diagnostic Ultrasound
DIAGNOSTIC ULTRASOUND
Diagnostic
Diagnostic Ultrasound
A permanent record of the assessment is required.
Not to be claimed during surgery or during patient's post-operative stay in hospital.
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