J873 – Malabsorption test - with whole body counting
OHIP Cardio-Thoracic Surgery Code — NUCLEAR MEDICINE - IN VIVO · Schedule of Benefits
J873 is a diagnostic procedure listed under the Gastrointestinal System subsection of Nuclear Medicine - In Vivo studies. It is a malabsorption test performed using whole body counting. This service has a technical component (H) fee of $137.70 and a professional component (P) fee of $14.25. As per , these components are generally claimed separately.
When to Use
- Use J873 when performing a formal malabsorption study specifically requiring whole body counting to quantify isotope retention, distinguishing it from simpler breath tests like J874.
- Select this code for the investigation of complex malabsorption syndromes where standard blood-based absorption tests are insufficient or contraindicated.
Common Pitfalls
- Failing to append the correct suffix (J873B for the technical component and J873C for the professional component) will result in automatic claim rejection.
- Billing J873 in conjunction with other diagnostic nuclear medicine codes without clear clinical justification for separate procedures can trigger audit flags for unbundling.
- Attempting to bill the professional component (J873C) without maintaining the required quality assurance documentation for the technical component (J873B) is a common compliance failure.
Billing Tips
- Ensure the technical component (J873B) is only claimed if the facility owns or operates the whole body counting equipment and meets the specific quality assurance standards outlined in GP8.
- Always verify that the clinical indication for whole body counting is explicitly documented to support the higher technical fee compared to standard isotope uptake studies.
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 that 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 has the necessary training and experience to personally render the technical component of the service; and the physician maintains documentation that describes the process by which the physician monitors quality assurance in accordance with professional standards.
Per , for diagnostic services with both technical and professional components listed under one fee schedule code, the technical and professional components are claimed separately. The claim for the technical component is submitted using the fee schedule code with the suffix B and the claim for the professional component is submitted using the fee schedule code with a suffix C.
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