J859 – Perfusion lung scintigraphy
OHIP Cardio-Thoracic Surgery Code — NUCLEAR MEDICINE - IN VIVO · Schedule of Benefits
Perfusion lung scintigraphy is an in-vivo nuclear medicine study of the respiratory system, used to assess blood flow within the pulmonary arteries. This service is comprised of a professional component (interpretation, claimed with suffix 'C') and a technical component (performing the scan, claimed with suffix 'B'). The technical component is subject to specific payment rules when rendered in a hospital setting (see ). When performed on the same day as a ventilation lung scintigraphy (J887), the combined service should be claimed using J860.
When to Use
- Use J859 for a standalone perfusion lung scan when ventilation imaging is not performed.
- Use J859 when the clinical indication specifically requires assessment of pulmonary blood flow, such as suspected pulmonary embolism, without the need for a V/Q mismatch comparison.
Common Pitfalls
- Billing J859 and J887 separately on the same day instead of using the combined code J860 will result in claim rejection.
- Submitting the professional component without the 'C' suffix or the technical component without the 'B' suffix will cause processing errors.
- Failing to maintain documentation of the quality assurance process for the technical component puts the physician at risk during a Ministry of Health audit.
Billing Tips
- Always verify if a ventilation scan was performed on the same day; if so, you must bill the combined J860 code to ensure compliance and avoid audit triggers.
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.
This service is composed of a technical component (H) and a professional component (P).
Claims for the professional component should be submitted with suffix 'C', and claims for the technical component with suffix 'B'.
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