J316 – Repeated steady state graded exercise
OHIP Cardio-Thoracic Surgery Code — PULMONARY FUNCTION STUDIES · Schedule of Benefits
A repeated steady state graded exercise test, classified as a Stage II Pulmonary Function Study. This service requires monitoring the following parameters at rest, during three levels of exercise, and in recovery: heart rate, oximetry, ventilation, , , blood pressure (BP), electrocardiogram (ECG), end tidal and mixed venous .
When to Use
- Use J316 when performing a comprehensive cardiopulmonary exercise test (CPET) that specifically requires the measurement of VO2, VCO2, and mixed venous CO2 across three distinct exercise stages.
- Select J316 instead of simple spirometry (G571) or basic exercise stress testing (G020) when the clinical objective is to assess gas exchange efficiency and ventilatory thresholds in patients with complex pulmonary or cardiac limitations.
Common Pitfalls
- Claiming the professional component (J316C) without documenting the mandatory monitoring of all required parameters, including end-tidal and mixed venous CO2, at every stage of the test.
- Billing the technical component (J316B) without maintaining a formal quality assurance protocol for the equipment and personnel, which is a mandatory audit requirement under GP11.
Billing Tips
- Ensure the claim is split correctly by submitting J316C for the physician's interpretation and J316B for the technical facility fee, as these are distinct components with different eligibility criteria.
Effective: April 1, 2025
H. Pulmonary Function Studies
PULMONARY FUNCTION STUDIES
Diagnostic
Pulmonary Function Studies
The service must include heart rate, oximetry, ventilation, , , BP, ECG, end tidal and mixed Venous at rest, 3 levels of exercise and recovery.
A physician submitting a claim for the technical component must maintain documentation that describes the process by which the physician monitors quality assurance in accordance with professional standards.
This service has a professional component ('P' Fee) of $65.40 and a technical component ('H' Fee) of $90.00.
The professional component is for the physician's interpretation and is claimed by submitting the fee schedule code with suffix 'C'.
The technical component covers the equipment and personnel and is claimed by submitting the fee schedule code with suffix 'B'.
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