J205 – Doppler evaluation of organ transplantation - arterial and/or venous
OHIP Cardio-Thoracic Surgery Code — DIAGNOSTIC ULTRASOUND · Schedule of Benefits
Performs a doppler evaluation of the arterial and/or venous systems of a transplanted organ. This service has both a professional component (P-fee) and a technical component (H-fee). The physician claiming the technical component must have the necessary training and experience and maintain quality assurance documentation, as per .
When to Use
- Use J205 for routine post-transplant surveillance doppler studies of a renal, hepatic, or pancreatic graft to assess vascular patency.
- Use J205 when investigating clinical suspicion of graft thrombosis or stenosis in a transplanted organ, provided the study focuses on the arterial or venous vasculature.
Common Pitfalls
- Billing the technical component (H-fee) for patients who are admitted to the hospital within 24 hours of the scan will result in a mandatory clawback.
- Attempting to claim the technical component (H-fee) for services performed within a hospital setting is a common rejection trigger, as this component is restricted to non-hospital facilities.
Billing Tips
- Ensure the professional component is billed separately from the technical component using the appropriate fee code modifiers if the physician performs both the scan and the interpretation in an eligible non-hospital setting.
Effective: April 1, 2025
G. Diagnostic Ultrasound
DIAGNOSTIC ULTRASOUND
Diagnostic
Diagnostic Ultrasound
In accordance with , all insured services must be documented in the medical record to establish that the service was provided, is the service for which the account is submitted, and was medically necessary.
As per , the physician submitting a claim for the technical component is responsible for the complete quality assurance process and must maintain documentation describing this process in accordance with professional standards.
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