J864 – Tear duct scintigraphy
OHIP Cardio-Thoracic Surgery Code — NUCLEAR MEDICINE - IN VIVO · Schedule of Benefits
Tear duct scintigraphy, also known as dacryoscintigraphy, is a diagnostic nuclear medicine procedure that uses a radiotracer to visualize the lacrimal drainage system. This test helps diagnose blockages or abnormalities in the tear ducts. This service is comprised of a technical component (fee H) and a professional component (fee P) which are claimed separately. As per the General Preamble (), the professional component ('P') involves the physician's interpretation and report, while the technical component ('H') covers the equipment, supplies, and personnel for performing the scan.
When to Use
- Use J864 to evaluate patients with suspected nasolacrimal duct obstruction or epiphora when anatomical imaging is inconclusive.
- Use this code to assess the functional patency of the lacrimal drainage system following surgical interventions like dacryocystorhinostomy.
Common Pitfalls
- Failing to bill the technical (H) and professional (P) components separately, which leads to claim rejection or underpayment.
- Billing the technical component (H) for hospital in-patients, which is strictly prohibited under GP11:25.
- Omitting the required referral from a physician, nurse practitioner, or oral maxillofacial surgeon, which is mandatory for all diagnostic nuclear medicine procedures.
Billing Tips
- Ensure the professional component (P) includes a formal, documented interpretation and report in the medical record to satisfy GP5:19 requirements.
- Maintain a robust quality assurance log for the technical component (H) to comply with the specific documentation mandate in GP11:25.
Effective: April 1, 2025
B. Nuclear Medicine - IN VIVO
NUCLEAR MEDICINE - IN VIVO
Diagnostic
Nuclear Medicine - IN VIVO
All insured services must be documented in the medical record to establish that the service was provided, was the service claimed, and was medically necessary. (:22)
The physician submitting a claim for the technical component must maintain documentation describing the process by which the physician monitors quality assurance in accordance with professional standards. (:25)
This service has two components: a technical component (Fee 'H') and a professional component (Fee 'P').
The technical component covers the cost of equipment, supplies, and personnel. (:25)
The professional component covers the physician's work in interpreting the results and providing a report. (:19)
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