J852 – Gallium scintigraphy - general survey
OHIP Cardio-Thoracic Surgery Code — NUCLEAR MEDICINE - IN VIVO · Schedule of Benefits
When to Use
- Use J852 for whole-body gallium-67 imaging when investigating occult infection, inflammation, or specific malignancies like lymphoma.
- Select J852 when the clinical objective requires a general survey rather than the targeted regional assessment provided by J853.
Common Pitfalls
- Billing J819 for SPECT imaging without ensuring each image represents a distinct organ or body area, which is a strict requirement for the add-on.
- Exceeding the maximum of 3 units of J819 per J852 examination, which will trigger an automatic rejection.
- Confusing J852 with J853; J852 is for a general survey, while J853 is specifically for regional imaging.
Billing Tips
- Always append J819 to J852 when SPECT tomography is performed to maximize the technical and professional fee recovery for the study.
Effective: April 1, 2025
B. Nuclear Medicine - IN VIVO
NUCLEAR MEDICINE - IN VIVO
Diagnostic
Nuclear Medicine - IN VIVO, Diagnostic and Therapeutic Procedures
The Act requires that the medical record establish that: 1. an insured service was provided; 2. the service for which the account is submitted is the service that was rendered; and 3. the service was medically necessary. See .
The physician submitting a claim for the technical component is responsible for the complete quality assurance process and must maintain documentation that describes the process by which the physician monitors quality assurance in accordance with professional standards. See .
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