J860 – Ventilation and perfusion (V/Q) scintigraphy - same day
OHIP Cardio-Thoracic Surgery Code — NUCLEAR MEDICINE - IN VIVO · Schedule of Benefits
Perfusion and ventilation scintigraphy performed on the same day. This is a diagnostic nuclear medicine procedure that combines a ventilation scan (e.g., J887) and a perfusion scan (e.g., J859) to evaluate airflow and blood flow to the lungs. It is claimed as a single service when both components are performed on the same day. The service has separate professional ('P' fee) and technical ('H' fee) components.
When to Use
- Use J860 when a complete V/Q scan is performed on the same day to rule out pulmonary embolism, as it replaces the need to bill J859 and J887 separately.
- Use J860 for patients requiring a comprehensive assessment of both ventilation and perfusion to evaluate chronic obstructive pulmonary disease or pre-operative lung function.
Common Pitfalls
- Billing J859 and J887 on the same day as J860 will result in automatic claim rejection due to the restricted code relationship.
- Failing to bill the 'P' (professional) and 'H' (technical) components separately when applicable, as J860 is a composite code that requires both components to be accounted for correctly.
Billing Tips
- Ensure the technical component is only claimed if you personally oversee the quality assurance process, as the MOH requires documentation of this oversight upon audit.
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 this upon request by the MOH.
The technical component of a diagnostic procedure is only eligible for payment where the physician has the necessary training and experience to personally render the technical component of the service and maintains documentation that describes the process by which the physician monitors quality assurance in accordance with professional standards.
This service has separate professional ('P' fee) and technical ('H' fee) components. The 'P' fee is for the professional component (interpretation) and the 'H' fee is for the technical component (procedure performance and equipment).
The 'P' fee listed is 75.90. The 'H' fee listed is 171.85.
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