J871 – Thyroid scintigraphy with I-123
OHIP Cardio-Thoracic Surgery Code — NUCLEAR MEDICINE - IN VIVO · Schedule of Benefits
Thyroid scintigraphy performed with Iodine-123 (I-123) is a diagnostic service. This service is comprised of two components: a technical fee (H Fee) payable to the facility, and a professional fee (P Fee) payable to the physician for interpretation. As per , the technical component of a diagnostic service with an 'H' fee is only eligible for payment when rendered in a hospital. This procedure is indicated for specific conditions such as hyperthyroidism, congenital hypothyroidism, and certain thyroid masses. For a full list of indications and limitations, see the commentary.
When to Use
- Use J871 for the diagnostic evaluation of hyperthyroidism or suspected thyroid-origin masses in the neck or mediastinum.
- Use J871 to assess thyroid nodules that have yielded equivocal results on prior Fine Needle Aspiration (FNA) biopsy.
- Use J871 for the investigation of congenital hypothyroidism, as it is generally not indicated for routine adult hypothyroidism.
Common Pitfalls
- Billing the technical component (J871B) for services performed outside of a hospital setting is a violation of GP11 and will result in rejection.
- Attempting to bill J871 for routine adult hypothyroidism investigation will lead to audit scrutiny as it falls outside the accepted clinical indications.
- Failure to use the correct suffix (J871B for technical, J871C for professional) will cause payment processing errors.
Billing Tips
- Ensure the medical record explicitly documents one of the five approved indications, such as 'equivocal FNA' or 'hyperthyroidism', to support the necessity of the scan.
- If performing an urgent, non-elective scan in a hospital setting after hours, ensure you are correctly appending the appropriate special visit premium (e.g., C109, C108, or C110) to the professional component.
Effective: April 1, 2025
B. Nuclear Medicine - IN VIVO
NUCLEAR MEDICINE - IN VIVO
Diagnostic
Nuclear Medicine - IN VIVO
General medical record requirements as per must be met, establishing medical necessity.
The medical record should document the indication for the scan, consistent with the payable conditions.
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