J889 – Therapeutic sleep study
OHIP Cardio-Thoracic Surgery Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
Overnight sleep study with continuous monitoring of oxygen saturation, ECG and Ventilation (airflow and respiratory effort) and additional monitoring to stage sleep (including all of the following: EEG, EOG and sub-mental EMG). A specialized facility is: a. a facility where patients are on ventilatory support and that specializes in the treatment of adults with conditions such as amyotropic lateral sclerosis or polio; or b. a paediatric hospital where there is a Paediatric ICU and that treats children with respiratory control disorders.
When to Use
- Use J889 for overnight polysomnography in specialized facilities for patients requiring ventilatory support, such as those with ALS or post-polio syndrome.
- Use J889 for pediatric patients in hospitals with a PICU who require sleep staging and respiratory monitoring for complex respiratory control disorders.
Common Pitfalls
- Billing J889 alongside any EEG codes (G414, G415, G541, etc.) will result in an automatic rejection as these are considered bundled into the sleep study.
- Attempting to claim special visit premiums with J889 is prohibited and will trigger a rejection, as sleep studies are excluded from premium eligibility.
- Submitting J889 and J890 for the same patient within a 12-hour window is a billing violation; ensure the service dates and times are distinct.
Billing Tips
- Ensure you split the claim into the technical component (suffix B) and the professional component (suffix C) to receive payment for both parts of the service.
- Verify that the recording includes all required parameters (EEG, EOG, sub-mental EMG, and respiratory effort) to avoid audit recovery for insufficient diagnostic data.
Effective: April 1, 2025
J. Diagnostic and Therapeutic Procedures
DIAGNOSTIC AND THERAPEUTIC PROCEDURES
Therapeutic
Diagnostic and Therapeutic Procedures
If the recording does not contain information sufficient for a diagnostic interpretation as determined in accordance with CPSO Standards, the service is not eligible for payment.
The physician submitting a claim for the technical component is responsible for the complete quality assurance process for all elements of the technical component of the service, including data acquisition, reporting, and record keeping. The physician must be able to demonstrate the above upon request by the MOH.
For diagnostic services with both technical (H) and professional (P) components listed under one fee schedule code, the components are claimed separately. The claim for the technical component is submitted using the fee schedule code with suffix B and the claim for the professional component is submitted using the fee schedule code with a suffix C.
For services rendered on or after July 1, 2010, the 12 month period for usage limits is determined from July 1, 2009 onwards.
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