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J711
J711 – Metastatic squamous cell carcinoma – evaluation of neck nodes
OHIP Cardio-Thoracic Surgery Code — POSITRON EMISSION TOMOGRAPHY (PET) · Schedule of Benefits
Metastatic squamous cell carcinoma – evaluation of neck nodes.
When to Use
- Use J711 when a patient presents with biopsy-proven metastatic squamous cell carcinoma in the neck nodes but the primary tumor remains unidentified after standard clinical and radiologic workup.
- Select J711 specifically for PET imaging to localize the occult primary site, distinguishing it from J703 or J704 which are indicated for known primary staging or recurrence.
Common Pitfalls
- Billing J711 when a primary site has already been identified by CT or MRI, as this fails the 'unknown primary' requirement and will lead to claim rejection.
- Failing to document the prior radiologic and clinical investigations that failed to identify the primary site, which is a mandatory audit requirement for this specific code.
Billing Tips
- Ensure the referral explicitly states the primary site is unknown to satisfy the specific clinical condition requirement for J711.
- Do not attempt to stack J711 with other PET codes for the same patient encounter; it is intended as a standalone diagnostic investigation for the occult primary.
Provider Fee$0.00
Specialist Fee$0.00
Surgical Assistant Fee$0.00
Anaesthetist Fee$0.00
Non-Anaesthetist Fee$237.50
Effective: October 1, 2013
Category
B. Nuclear Medicine - IN VIVO
Subcategory
POSITRON EMISSION TOMOGRAPHY (PET)
Service Type
Diagnostic
Code Classes
Positron Emission Tomography (PET)
Referral RequiredFrom: Physician, NursePractitioner, OralMaxillofacialSurgeon
The medical record must establish that an insured service was provided, the service submitted is the service rendered, and the service was medically necessary.
J711 is only insured when the primary disease site is unknown after radiologic and clinical investigation.
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