J802 – Peripheral and superior vena cava venography
OHIP Cardio-Thoracic Surgery Code — NUCLEAR MEDICINE - IN VIVO · Schedule of Benefits
J802 represents a nuclear medicine venography study focused on the peripheral and superior vena cava. As a diagnostic service, it is comprised of two distinct claimable parts: a technical component (H-fee) and a professional component (P-fee). The technical component covers the cost of equipment, supplies, and personnel for performing the scan, while the professional component covers the physician's interpretation of the results.
When to Use
- Use J802 for nuclear medicine venography specifically indicated to evaluate the patency or obstruction of the superior vena cava in patients with suspected SVC syndrome.
- Use this code when performing peripheral venography to localize venous thrombosis or evaluate venous anatomy prior to complex central line placement or intervention.
Common Pitfalls
- Failure to bill both the technical (H-fee) and professional (P-fee) components separately, which results in incomplete reimbursement for the service provided.
- Attempting to bill J802 for routine diagnostic imaging that does not meet the nuclear medicine criteria, leading to automatic claim rejection.
- Claiming a special visit premium (e.g., C109, C108, C110) for J802 when the service was rendered remotely via PACS, which is strictly prohibited by the Schedule of Benefits.
Billing Tips
- Ensure the physician claiming the technical component (H-fee) maintains documented evidence of quality assurance oversight, as this is a specific audit requirement for this code.
- When providing urgent, non-elective services in a hospital setting, pair J802 with the appropriate Special Visit Premium (C109, C108, or C110) only if the physician is physically present in the hospital.
Effective: April 1, 2025
B. Nuclear Medicine - IN VIVO
NUCLEAR MEDICINE - IN VIVO
Diagnostic
Nuclear Medicine - IN VIVO
The physician claiming the technical component must have the necessary training and experience to personally render the technical component of the service.
The physician must maintain documentation that describes the process by which the physician monitors quality assurance in accordance with professional standards.
The physician submitting a claim for the technical component is responsible for the complete quality assurance process for all elements of the technical component of the service, including data acquisition, reporting, and record keeping. The physician must be able to demonstrate this upon request by the MOH.
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