J839 – Cystography for vesicoureteric reflux
OHIP Cardio-Thoracic Surgery Code — NUCLEAR MEDICINE - IN VIVO · Schedule of Benefits
J839 represents a cystography procedure for vesicoureteric reflux, performed using in vivo nuclear medicine techniques. This service is comprised of two distinct components: a professional component (P-fee) and a technical component (H-fee). As per , these components must be claimed separately. The claim for the technical component is submitted using the fee schedule code with the suffix B (e.g., J839B), and the claim for the professional component is submitted using the fee schedule code with a suffix C (e.g., J839C).
When to Use
- Use J839 for nuclear medicine cystography specifically to evaluate vesicoureteric reflux, distinguishing it from standard radiographic cystography (e.g., J834).
- Apply this code when the procedure involves in vivo nuclear medicine radiopharmaceuticals to detect reflux, rather than traditional contrast-based imaging.
Common Pitfalls
- Failing to split the claim into J839B (technical) and J839C (professional) will result in immediate rejection or payment errors.
- Billing the technical component (J839B) for procedures performed outside of a hospital setting is strictly prohibited and will be clawed back during audit.
- Neglecting to maintain the required quality assurance documentation for the technical component (J839B) creates significant liability during an OHIP audit.
Billing Tips
- Ensure the professional component (J839C) is submitted by the physician responsible for the interpretation, while J839B covers the facility/technical overhead.
Effective: April 1, 2025
B. Nuclear Medicine - IN VIVO
NUCLEAR MEDICINE - IN VIVO
Diagnostic
Nuclear Medicine - IN VIVO
All insured services must be documented to establish that the service was provided, was medically necessary, and the service billed was the one rendered.
The physician submitting a claim for the technical component must maintain documentation describing the process for monitoring quality assurance in accordance with professional standards. The physician is responsible for the complete quality assurance process for all elements of the technical component, including data acquisition, reporting, and record keeping.
This service has a technical component (H) and a professional component (P) which must be billed separately using suffix B for the technical component and suffix C for the professional component.
As per (PDF Page: 25), the technical component of a diagnostic service listed in the column headed with an 'H' and rendered outside of a hospital is not eligible for payment under the Health Insurance Act.
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