J858 – Brain scintigraphy - except cerebral perfusion
OHIP Cardio-Thoracic Surgery Code — NUCLEAR MEDICINE - IN VIVO · Schedule of Benefits
J858 is a nuclear medicine diagnostic procedure for brain scintigraphy. It comprises two distinct components: a technical component (H-fee) and a professional component (P-fee).\n\n**Billing and Component Rules ():\n- Claim Submission:** The technical component is claimed using suffix 'B' (J858B), and the professional component is claimed using suffix 'C' (J858C).\n- Technical Component (H-fee) Eligibility:\n - The H-fee is not payable if rendered outside of a hospital.\n - The H-fee is not payable for hospital in-patients.\n - The H-fee is not payable for a patient who receives the service at a hospital and is admitted to the same hospital within 24 hours for the same condition.\n\nProfessional Component (P-fee) Eligibility:\n- The P-fee is for the physician's interpretation and report.\n- Eligible for special visit premiums for non-elective, urgent interpretations in a hospital setting (see 'Add-On Eligible Codes' and associated notes).
When to Use
- Use J858 for brain scintigraphy studies that are specifically excluded from cerebral perfusion imaging protocols.
- Use J858 when performing diagnostic brain imaging in a hospital setting for outpatients or emergency department patients who are not subsequently admitted within 24 hours.
Common Pitfalls
- Billing the technical component (J858B) for hospital in-patients, which is strictly prohibited under GP11 rules.
- Attempting to claim both J858 and J902 on the same day for the same patient, as these are mutually exclusive per study.
- Submitting claims for the technical component (J858B) when the service is rendered via remote PACS, as special visit premiums and technical fees require physical presence in the hospital.
Billing Tips
- Ensure the professional component (J858C) is billed separately from the technical component (J858B) to ensure accurate processing of the P-fee and H-fee respectively.
- When providing urgent, non-elective interpretations in the hospital, append the appropriate special visit premium (e.g., C109, C108, or C110) to the J858C professional fee claim.
Effective: April 1, 2025
B. Nuclear Medicine - IN VIVO
NUCLEAR MEDICINE - IN VIVO
Diagnostic
Nuclear Medicine - IN VIVO
The technical component is only eligible for payment where the physician has the necessary training and experience to personally render the technical component of the service.
The physician maintains documentation that describes the process by which the physician monitors quality assurance in accordance with professional standards.
The physician submitting a claim for the technical component is responsible for the complete quality assurance process for all elements of the technical component, including data acquisition, reporting, and record keeping.
The fee listed under 'H' is for the technical component (90.40).
The fee listed under 'P' is for the professional component (44.80).
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