J876 – Gastro-esophageal reflux
OHIP Cardio-Thoracic Surgery Code — NUCLEAR MEDICINE - IN VIVO · Schedule of Benefits
Gastro-oesophageal reflux study is a diagnostic procedure within the Nuclear Medicine section. Payment for this service is divided into a technical component ('H' fee) and a professional component ('P' fee). Per of the Schedule, the technical component claim is submitted with suffix 'B' and the professional component with suffix 'C'. The technical component is only payable if the physician has the necessary training and experience and maintains quality assurance documentation. The professional component is for the physician's interpretive service.
When to Use
- Use J876 for the diagnostic investigation of gastro-esophageal reflux via nuclear medicine scintigraphy when clinical suspicion warrants objective assessment.
- Select J876 when performing the specific reflux study protocol rather than general gastrointestinal imaging codes like J877.
Common Pitfalls
- Failing to split the claim into the 'B' suffix for the technical component and the 'C' suffix for the professional component will result in automatic rejection.
- Billing the technical component (suffix 'B') without maintaining the required quality assurance documentation on-site is a significant audit risk.
- Attempting to bill J876 with a Special Visit Premium for elective or non-urgent interpretations is invalid; the service must be non-elective and require urgent clinical management.
Billing Tips
- Ensure your billing software is configured to append the correct suffix (B or C) to the J876 code, as the OHIP system treats these as distinct claim lines for the technical and professional components.
- When providing urgent, non-elective services in a hospital setting, verify that the patient meets the acute care criteria before appending a Special Visit Premium (e.g., C104 or C110).
Effective: April 1, 2025
B. Nuclear Medicine - IN VIVO
NUCLEAR MEDICINE - IN VIVO
Diagnostic
Nuclear Medicine - IN VIVO
For the technical component, the physician must maintain documentation describing the quality assurance process in accordance with professional standards.
All insured services require documentation in the medical record to establish that the service was provided, is the service submitted for payment, and was medically necessary.
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