J867 – First transit with blood pool images
OHIP Cardio-Thoracic Surgery Code — NUCLEAR MEDICINE - IN VIVO · Schedule of Benefits
A nuclear medicine cardiovascular first transit study that includes blood pool images. This service has two components: a technical component (H) and a professional component (P). According to the Schedule (:), claims for the technical component should be submitted with suffix B (e.g., J867B), and claims for the professional component should be submitted with suffix C (e.g., J867C).
When to Use
- Use J867 for cardiovascular first transit studies that specifically include blood pool imaging, distinguishing it from general cardiac nuclear studies like J804.
- Use this code when the clinical requirement is to assess both the initial bolus transit and the subsequent blood pool phase for diagnostic evaluation.
Common Pitfalls
- Submitting the technical component (J867B) for hospital in-patients or out-patients admitted within 24 hours of the service will result in a rejection per GP11.
- Failing to split the claim into the technical (B suffix) and professional (C suffix) components will lead to processing errors or payment denials.
- Billed services must be supported by documentation confirming the physician performed the complete quality assurance process for the technical component.
Billing Tips
- Ensure the technical component (J867B) is only claimed for non-hospital settings or eligible out-patient scenarios to avoid mandatory payment adjustments.
- When providing urgent, non-elective services in a hospital setting, verify eligibility for the appropriate Special Visit Premium (e.g., C108, C110) to supplement the professional component (J867C).
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 appropriate records to 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 (:).
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 (:).
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