J818 – Thyroid scintigraphy with 99m Tc or 131 I
OHIP Cardio-Thoracic Surgery Code — NUCLEAR MEDICINE - IN VIVO · Schedule of Benefits
A thyroid scintigraphy procedure performed with either Technetium-99m (Tc99m) or Iodine-131 (I-131). This service is a diagnostic nuclear medicine test that produces images of the thyroid gland to assess its function and identify abnormalities. The service fee is divided into a professional component (P Fee) and a technical component (H Fee), which are billed separately using suffixes J818C and J818B respectively.
Per the commentary on page of the Schedule, indications for thyroid scanning include:
- Hyperthyroidism (including nodules associated with hyperthyroidism)
- Congenital hypothyroidism
- Masses in the neck or mediastinum suspected to be thyroid in origin
- Assessment of multinodular glands to guide tissue sampling
- Assessment of nodules with equivocal Fine Needle Aspiration findings.
When to Use
- Use J818 for the diagnostic evaluation of hyperthyroidism to differentiate between Graves' disease, toxic multinodular goiter, or toxic adenoma.
- Use J818 to assess thyroid nodules with equivocal Fine Needle Aspiration (FNA) results to determine if the nodule is hyperfunctioning (hot).
- Use J818 for the localization of suspected ectopic thyroid tissue in patients with congenital hypothyroidism or neck/mediastinal masses.
Common Pitfalls
- Failing to bill the professional (J818C) and technical (J818B) components separately; billing only the base code will result in rejection.
- Billing J818 for routine investigation of adult hypothyroidism, which is explicitly excluded by the Schedule commentary.
- Attempting to bill J818 for thyroid nodules smaller than 1 cm, as these are generally considered too small for accurate scintigraphic assessment.
Billing Tips
- Ensure the technical component (J818B) is not claimed if the patient is an inpatient or if the service is rendered in a hospital setting where the hospital provides the equipment.
- Always verify that the referral source is a physician, nurse practitioner, or oral maxillofacial surgeon, as per the requirements in GP111.
Effective: April 1, 2025
B. Nuclear Medicine - IN VIVO
NUCLEAR MEDICINE - IN VIVO
Diagnostic
Nuclear Medicine - IN VIVO
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