J201 – Duplex scan of extra-cranial vessels
OHIP Cardio-Thoracic Surgery Code — DIAGNOSTIC ULTRASOUND · Schedule of Benefits
Extra-cranial vessel assessment - above the aortic arch. Bilateral carotid and/or subclavian and/or vertebral arteries only. Duplex scan i.e. simultaneous real time, B-mode imaging and frequency/spectral analysis. This service has two components, a technical component (H) and a professional component (P).
When to Use
- Use J201 when performing a comprehensive duplex scan of the bilateral carotid, subclavian, and/or vertebral arteries for extra-cranial vascular assessment.
- Select J201 over J190 when the clinical requirement is a bilateral assessment of the specified extra-cranial vessels, as J190 is restricted when J201 is billed.
Common Pitfalls
- Attempting to bill J201 and J190 on the same day for the same patient will result in a rejection, as they are mutually exclusive.
- Failing to maintain the required quality assurance documentation for the technical component (H) puts the entire claim at risk during an audit.
- Billing the technical component (H) for hospital in-patients or patients admitted within 24 hours of the service is a violation of OHIP payment rules.
Billing Tips
- Ensure the referral source is a physician, nurse practitioner, or oral maxillofacial surgeon, as a valid referral is mandatory for this diagnostic service.
- When providing services in a hospital setting, verify if you are eligible to append the appropriate C-series special visit premiums for non-elective, urgent interpretations.
Effective: April 1, 2025
G. Diagnostic Ultrasound
DIAGNOSTIC ULTRASOUND
Diagnostic
Diagnostic Ultrasound, Diagnostic and Therapeutic Procedures
For the technical component, the physician must maintain documentation that describes the process by which the physician monitors quality assurance in accordance with professional standards.
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