J824 – Malabsorption test - with C substrate
OHIP Cardio-Thoracic Surgery Code — NUCLEAR MEDICINE - IN VIVO · Schedule of Benefits
A diagnostic test for malabsorption using a C¹⁴ substrate. This is a nuclear medicine in-vivo procedure. The service fee is comprised of a professional component ('P' fee) for the physician's interpretation and a technical component ('H' fee) for the facility costs. As per , the technical component ('H' fee) is not eligible for payment if the service is rendered outside of a hospital. As per , referrals from an Oral and Maxillofacial Surgeon are insured when rendered in a hospital in connection with a medically necessary dental surgical procedure.
When to Use
- Use J824 when performing a C14-labeled substrate malabsorption test specifically for diagnostic investigation of suspected malabsorption syndromes.
- Use this code when the professional interpretation is provided by a nuclear medicine specialist in a hospital setting to ensure eligibility for both the professional and technical components.
Common Pitfalls
- Billing the 'H' (technical) component for services rendered outside of a hospital setting, which is strictly prohibited under GP11.
- Failing to document the required quality assurance processes for the technical component, which is a mandatory audit requirement for claiming the 'H' fee.
- Attempting to bill the 'H' component for an inpatient or a patient admitted within 24 hours of the diagnostic service, as this is excluded under payment adjustment rules.
Billing Tips
- Ensure the referral source is clearly documented as a physician or an eligible Oral and Maxillofacial Surgeon to satisfy the GP111 referral requirement.
- When providing urgent, non-elective services in a hospital, append the appropriate Special Visit Premium (e.g., C102-C110) to the professional component to maximize reimbursement.
Effective: April 1, 2025
B. Nuclear Medicine - IN VIVO
NUCLEAR MEDICINE - IN VIVO
Diagnostic
Nuclear Medicine - IN VIVO
For the technical component, the physician must have the necessary training and experience to personally render the technical component of the service.
For the technical component, the physician must maintain documentation that describes the process by which the physician monitors quality assurance in accordance with professional standards.
Referral from an Oral and Maxillofacial Surgeon is only insured if the test is rendered in connection with a dental surgical procedure provided by an oral and maxillofacial surgeon in a hospital and it is medically necessary for the patient to receive the dental surgical procedure in a hospital; or on the order of an oral and maxillofacial surgeon who has reasonable grounds to believe that a dental surgical procedure will be required and it will be medically necessary for the patient to receive it in a hospital.
Fee is comprised of a technical component (H) and a professional component (P).
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