J869 – Theranostic scintigraphy
OHIP Cardio-Thoracic Surgery Code — NUCLEAR MEDICINE - IN VIVO · Schedule of Benefits
Adrenal scintigraphy performed with Metaiodobenzylguanidine (MIBG). This is a diagnostic service listed in the Nuclear Medicine section of the Schedule. The service is comprised of two components: - Technical Component (H Fee): $555.35 - Professional Component (P Fee): $49.70 Claims for the technical component should be submitted with suffix 'B' and claims for the professional component with suffix 'C', as per .
When to Use
- Use J869 for the diagnostic localization of pheochromocytoma or paraganglioma using MIBG scintigraphy.
- Use this code when the clinical objective is to identify neuroendocrine tumors that specifically uptake MIBG, distinguishing it from general PET/CT imaging codes like J816.
Common Pitfalls
- Submitting both the technical and professional components under a single claim suffix will result in automatic rejection; you must split them into separate claims using suffix B for the technical and C for the professional component.
- Failing to maintain documented evidence of the quality assurance process for the technical component is a primary audit risk, as the physician claiming the B suffix assumes full responsibility for these standards.
Billing Tips
- Ensure the referring physician's name and billing number are accurately recorded on the claim, as J869 strictly requires a valid referral from a physician or oral maxillofacial surgeon per GP111.
- If performing this service in an urgent hospital setting after hours, ensure you select the appropriate special visit premium (e.g., C108, C110) based on the time and day to maximize the professional component reimbursement.
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 upon request by the MOH that they have the necessary training and experience to personally render the technical component and that they maintain documentation describing the quality assurance process in accordance with professional standards.
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