J831 – Biliary scintigraphy
OHIP Cardio-Thoracic Surgery Code — NUCLEAR MEDICINE - IN VIVO · Schedule of Benefits
Biliary scintigraphy is a nuclear medicine diagnostic procedure. It has two components: a professional component ('P' fee) for the physician's interpretation and report, and a technical component ('H' fee) which covers the cost of the equipment, supplies, and technical staff, typically paid to the hospital. The physician bills for the professional component.
When to Use
- Use J831 when interpreting a hepatobiliary iminodiacetic acid (HIDA) scan to assess gallbladder function or patency of the biliary tree.
- Use this code for the professional interpretation component when a patient presents with suspected acute cholecystitis or biliary obstruction requiring nuclear medicine imaging.
Common Pitfalls
- Billing J831 for services rendered via PACS or remote teleradiology platforms, as the professional component is only eligible when performed in a hospital setting.
- Attempting to bill the technical component (H-fee) alongside the professional component; the physician must only claim the professional fee.
Billing Tips
- Ensure the claim is linked to a valid hospital-based referral, as J831 is strictly a diagnostic service requiring a physician or nurse practitioner order.
- If providing urgent, non-elective interpretation in a hospital setting after hours, ensure you select the appropriate C-series special visit premium (e.g., C109, C108, or C110) rather than billing J831 in isolation.
Effective: April 1, 2025
B. Nuclear Medicine - IN VIVO
NUCLEAR MEDICINE - IN VIVO
Diagnostic
Nuclear Medicine - IN VIVO
A service is only eligible for payment to the Supervising Physician when the medical record of the patient(s) identifies the following information at the time of the provision of the service: a. The Supervising Physician; b. The Medical Trainee and level of training; c. The description of the insured service performed by the Medical Trainee; d. Patient consent to the Supervision of services of a Medical Trainee; and e. Where the service rendered is a Time-Based service, the Supervising Physician has at a minimum, reviewed the nature and outcome of the service and the patient record(s), with the Medical Trainee.
In addition to the requirements above, the Supervising Physician must have: a. signed off on the service rendered by the Medical Trainee in the patient's medical record; or b. where the Supervising Physician was not immediately available to sign off on the service rendered by the Medical Trainee, the Medical Trainee has written the date and time a discussion occurred with the Supervising Physician regarding the provision of the service in the patient's medical record.
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