J878 – RBC scintigraphy
OHIP Cardio-Thoracic Surgery Code — NUCLEAR MEDICINE - IN VIVO · Schedule of Benefits
This service represents the technical component ('H') of an abdominal scintigraphy performed to identify the site of gastrointestinal bleeding using labelled red blood cells (RBCs). The technical component includes providing the premises, equipment, supplies, and personnel for the performance of the service, data acquisition, reporting, and record keeping (Source: :20, :25). Claims for the technical component are subject to specific eligibility and location restrictions.
When to Use
- Use J878 when performing the technical component of an RBC scintigraphy for a patient presenting with suspected occult gastrointestinal bleeding in an outpatient setting.
- Use this code specifically when the facility provides the radiopharmaceutical, equipment, and personnel for the scan, provided the patient is not a hospital inpatient.
Common Pitfalls
- Billing J878 for a patient who is admitted to the hospital within 24 hours of the scan for the same condition will result in a clawback as it is considered an inpatient service.
- Attempting to bill the technical component (H) for services rendered outside of a hospital setting is ineligible under the Health Insurance Act.
- Failing to maintain the required quality assurance documentation for the technical process makes the claim non-compliant during a Ministry audit.
Billing Tips
- Always append the SPECT add-on code J866 if tomographic imaging is performed alongside the RBC scintigraphy to maximize the technical component reimbursement.
- Ensure the referral source is limited to a physician or oral/maxillofacial surgeon to avoid automatic rejection of the claim.
Effective: April 1, 2025
B. Nuclear Medicine - IN VIVO
NUCLEAR MEDICINE - IN VIVO
Diagnostic
Nuclear Medicine - IN VIVO, Diagnostic and Therapeutic Procedures
The physician submitting a claim for the technical component must maintain documentation describing the process for monitoring quality assurance in accordance with professional standards. (Source: , )
The fee for this technical component ('H') is $143.20. (Source: )
Diagnostic procedures listed in the Nuclear Medicine section are insured when referred by an oral and maxillofacial surgeon under specific conditions. (Source: :125)
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