J838 – GFR by blood sample method
OHIP Cardio-Thoracic Surgery Code — NUCLEAR MEDICINE - IN VIVO · Schedule of Benefits
Glomerular Filtration Rate (GFR) by blood sample method is a nuclear medicine diagnostic procedure. This service is comprised of two components listed in the Schedule of Benefits: - Technical Component (H) - Professional Component (P) The professional component fee is for the physician's work in interpreting the results. The technical component fee covers the cost of the facility, equipment, and technical staff. As per the general payment rules for diagnostic services on , the technical component ('H' fee) is not payable if rendered to a hospital in-patient or to an out-patient who is admitted to the same hospital within 24 hours for the same condition. The technical component is also not payable if rendered outside of a hospital.
When to Use
- Use J838 when performing a GFR measurement specifically via the blood sample method in a nuclear medicine department.
- Select J838 for patients requiring precise renal function assessment where standard serum creatinine-based eGFR equations are clinically insufficient.
Common Pitfalls
- Billing the technical component (H) for hospital in-patients or patients admitted within 24 hours of the service, which is strictly prohibited under GP11 rules.
- Attempting to bill the technical component for services rendered outside of a hospital setting, which will result in automatic rejection.
- Failing to maintain the required quality assurance documentation for data acquisition and reporting, which is a mandatory audit requirement for the technical component.
Billing Tips
- Ensure the professional component (P) and technical component (H) are billed separately as distinct line items to reflect the specific physician work versus facility costs.
- Verify that the referring physician or oral maxillofacial surgeon is clearly identified on the claim, as a valid referral is a prerequisite for this diagnostic service.
Effective: April 1, 2025
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.
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