J843 – Red cell volume
OHIP Cardio-Thoracic Surgery Code — NUCLEAR MEDICINE - IN VIVO · Schedule of Benefits
Red cell volume determination is an in vivo nuclear medicine study of the hematopoietic system. The service is comprised of two distinct claimable components: a technical component ('H' fee) and a professional component ('P' fee). The technical component covers the performance of the procedure, while the professional component covers the interpretation and report. Claims for the technical component should be submitted with suffix 'B', and claims for the professional component should be submitted with suffix 'C'.
When to Use
- Use J843 for the quantification of red cell mass in patients with suspected polycythemia vera or other myeloproliferative disorders where hematocrit levels are equivocal.
- Use this code when performing a differential diagnosis for unexplained erythrocytosis to distinguish between absolute polycythemia and relative polycythemia (spurious erythrocytosis).
Common Pitfalls
- Failing to submit the technical component with suffix 'B' and the professional component with suffix 'C' will result in automatic claim rejection.
- Billing the technical component without maintaining documented evidence of the required quality assurance process for data acquisition and record keeping is a significant audit risk.
- Attempting to bill J843 without a valid referral from a physician, nurse practitioner, or oral maxillofacial surgeon as mandated by GP5:19.
Billing Tips
- Ensure the professional interpretation and report are clearly linked to the specific technical data acquired to satisfy the documentation requirements for the professional component (suffix 'C').
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.
Claims for the technical component (H fee) should be submitted using the fee schedule code with suffix 'B'. Claims for the professional component (P fee) should be submitted using the fee schedule code with suffix 'C'.
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