J206 – Duplex evaluation of portal hypertension
OHIP Cardio-Thoracic Surgery Code — DIAGNOSTIC ULTRASOUND · Schedule of Benefits
Duplex evaluation of portal hypertension with a professional component (P fee) and a technical component (H fee). This service must include doppler interrogation and documentation of the superior mesenteric vein, splenic vein, portal veins, hepatic veins, and hepatic arteries.
When to Use
- Use J206 when performing a comprehensive Doppler assessment specifically to evaluate portal venous flow dynamics in patients with known or suspected cirrhosis or portal hypertension.
- Select J206 instead of a general abdominal ultrasound (J135) when the clinical indication necessitates a detailed hemodynamic study of the portal, splenic, and mesenteric venous systems.
Common Pitfalls
- Billing J206 without explicit documentation of all five required vessels (superior mesenteric, splenic, portal, hepatic veins, and hepatic arteries) will result in a clawback during audit.
- Failing to submit the claim with the correct suffixes (J206B for the technical component and J206C for the professional component) will lead to automatic rejection by the Ministry.
Billing Tips
- Ensure the referring physician's requisition specifically requests a 'portal hypertension study' or 'Doppler evaluation of portal venous system' to satisfy the mandatory referral requirement.
Effective: April 1, 2025
G. Diagnostic Ultrasound
DIAGNOSTIC ULTRASOUND
Diagnostic
Diagnostic Ultrasound
The study must be specifically requested by the referring provider. A copy of the written request should be kept in the record as per general consultation requirements.
The report must include documentation of the superior mesenteric vein, splenic vein, portal veins, hepatic veins, and hepatic arteries.
The report must include documentation of doppler interrogation.
Not to be billed unless study specifically requested by referring provider.
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