J872 – Metastatic survey with I-131
OHIP Cardio-Thoracic Surgery Code — NUCLEAR MEDICINE - IN VIVO · Schedule of Benefits
A nuclear medicine procedure for a metastatic survey using I-131. This service has two components: a technical component (H Fee of $240.60) and a professional component (P Fee of $49.70). The technical component is payable only when the requirements on are met, including physician training and quality assurance documentation.
When to Use
- Use J872 for the diagnostic imaging component of a metastatic survey specifically utilizing I-131, distinct from other diagnostic nuclear medicine codes like J870 or J871 which utilize different isotopes.
- Apply J872 when the physician performs the professional interpretation and the facility meets the technical quality assurance requirements outlined in GP11.
Common Pitfalls
- Billing the technical component (H fee) without maintaining the mandatory quality assurance documentation required by GP11, which is a common trigger for audit recovery.
- Attempting to bill J872 in conjunction with remote interpretation services (e.g., via PACS) for special visit premiums, as these are explicitly excluded under the C-code eligibility rules.
Billing Tips
- Ensure the claim clearly separates the professional (P) and technical (H) components, verifying that the facility's GP11 compliance is current before submitting the H fee.
- If performing this service as a non-elective, urgent hospital visit, ensure the clinical documentation explicitly justifies the urgency to support the eligibility of applicable C-series special visit premiums.
Effective: April 1, 2025
B. Nuclear Medicine - IN VIVO
NUCLEAR MEDICINE - IN VIVO
Diagnostic
Nuclear Medicine - IN VIVO
In accordance with , the physician submitting a claim for the technical component must maintain documentation that describes the process by which the physician monitors quality assurance in accordance with professional standards.
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