J816 – Adrenal scintigraphy with iodocholesterol
OHIP Cardio-Thoracic Surgery Code — NUCLEAR MEDICINE - IN VIVO · Schedule of Benefits
Adrenal scintigraphy using iodocholesterol as the radiopharmaceutical. This service is comprised of a professional component (P Fee) for interpretation and a technical component (H Fee) for performing the scan. The technical component is not eligible for payment if rendered outside of a hospital, or for hospital in-patients, or for patients who are admitted to hospital within 24 hours of the service for the same condition. See for details.
When to Use
- Use J816 specifically for adrenal scintigraphy using iodocholesterol to localize suspected aldosterone-secreting or cortisol-secreting adrenal adenomas.
- Select this code when the clinical objective is functional imaging of the adrenal cortex, distinguishing it from anatomical imaging like CT or MRI.
Common Pitfalls
- Billing the technical component (H fee) for patients who are admitted to the hospital within 24 hours of the service will lead to automatic rejection.
- Submitting the technical component for services rendered in a non-hospital setting is prohibited and will result in audit recovery.
Billing Tips
- Ensure your documentation explicitly confirms the use of iodocholesterol, as the MOH may audit to verify the specific radiopharmaceutical used for J816 versus other adrenal imaging codes.
Effective: April 1, 2005
B. Nuclear Medicine - IN VIVO
NUCLEAR MEDICINE - IN VIVO
Diagnostic
Nuclear Medicine - IN VIVO
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 the above upon request by the MOH.
All insured services must be documented in appropriate records. The Act requires that the record establish that: 1. an insured service was provided; 2. the service for which the account is submitted is the service that was rendered; and 3. the service was medically necessary.
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