J304

PDF page 25 / GP11

Payment for Diagnostic and Therapeutic Services Rendered at a Hospital
  The technical component of a diagnostic and therapeutic service listed below and rendered in a
  hospital is payable at 86.10% of the listed fee in the column headed “T”.
  G104A, G111A, G121A, G127A, G140A, G143A, G146A, G149A, G152A, G153A, G167A,
  G174A,G181A, G209A, G284A, G308A, G310A, G311A, G315A, G414A, G440A, G441A, G442A,
  G443A,G448A, G451A, G455A, G466A, G471A, G519A, G540A, G541A, G542A, G544A, G554A,
  G570A,G574A, G582A, G585A, G647A, G648A, G651A, G652A, G654A, G655A, G682A, G683A,
  G684A,G685A, G686A, G687A, G688A, G689A, G694A, G695A, G815A, G850A, G851A, G852A,
  G853A,G854A, G855A, G856A, G857A, G858A, J301B, J304B, J324B, J327B

PDF page 411 / H3

PULMONARY FUNCTION STUDIES
      PREAMBLE
  OTHER TERMS AND DEFINITIONS
    1. Professional and technical components are claimed separately. Claims for technical component
       H are submitted using listed fee code with suffix B. Claims for professional component P are
       submitted using listed fee code with suffix C.
                   2. For services rendered outside a hospital setting (except for J301, J304, J324, and J327) the
                      only fees billable under the Health Insurance Act are listed under the column P (use suffix C).
                      Costs for the technical component of services rendered in an ICHSC are listed in the Schedule
                      of Facility Costs.
                   3. Each of the following tests designated by an individual code number is considered to be specific
                      and requires individual ordering.
                   4. Exercise assessment (J315, E450, E451, J316) requires a physician to be in attendance at all
                      times.
                   5. The technical and professional fee components for pulmonary function studies are not eligible
                      for payment in the routine preoperative preparation or screening of a patient for non-thoracic
                      surgery unless required for respiratory diagnosis, anaesthetic decision making or optimization
                      of a patient's respiratory disease prior to surgery.

PDF page 412 / H4

PULMONARY FUNCTION STUDIES
                                                                                                                       T            P
                 Simple spirometry
               J301 Volume versus Time Study - must include Vital capacity, FEV1,
                      FEV1 /FVC, and may include calculation of MMEFR(FEF25-
                      75) ......................................................................................     10.85           7.85
               J324   - repeat after bronchodilator...............................................                    3.25           4.20
                 Flow volume loop
               J304 Volume versus Flow Study - from which an expiratory limb, and
                       inspiratory limb if indicated, are generated. A flow volume
                       loop may include derivation of FEV1, VC, V50, V25 ............               21.55 12.85
               J327    - repeat after bronchodilator...............................................  3.25  7.65
                   Payment rules:
                   1.J301 or J324 are not eligible for payment same patient same day as J304 or J327.
                                          2.J301, J324, J304 and J327 must represent the best of three recorded test results or the study
                                            is not eligible for payment.
                                          3.J301 and J324 must be performed with a permanent record including a written interpretation
                                            by the physician or the study is not eligible for payment.
                                          4.J304 and J327 are only eligible for payment for a study that meets all of the following
                                            requirements:
                                              a.There is a permanent record that includes a written interpretation by the physician;
                                              b. The permanent record includes constituent graph(s), tracing(s) and measurements with a
                                                scale on the tracing or graph of:
                                                i. at least 5 mm per litre per second for flow; and
                                                ii. 10 mm per litre for volume.
                                              c.The physician claiming the professional component must be able to demonstrate
                                                appropriate training in pulmonary function testing interpretation.
                                          [Commentary:
                                          1.J304 and J327 are not eligible for payment in the absence of documented physician
                                            interpretation. Computer-generated or automated interpretation does not satisfy payment
                                            eligibility.
                                          2.Physicians should be prepared to provide to the ministry documentation demonstrating their
                                            training on request.]

PDF page 413 / H5

PULMONARY FUNCTION STUDIES
                                                                                                      H      P
      Functional residual capacity
   J311   - by gas dilution method .......................................................           16.30   21.00
   J307 - by body plethysmography ..................................................                 17.50   21.35
       Note:
       J311 not to be claimed same patient same day as J307.
   J305 Lung compliance (pressure volume curve of the lung from TLC
          to FRC)...............................................................................     51.95   48.15
   J306 Airways resistance by plethysmography or estimated using
           oesophageal catheter.........................................................             16.20   19.20
   J303 Extra pulmonary airways resistance by plethysmography......                                  16.20   16.05
   J340 Maximum inspiratory and expiratory pressures ......................                           2.81    3.81
   J310 Carbon monoxide diffusing capacity by single breath method                                   21.40   21.55
   J308 Carbon dioxide ventilatory response ......................................                   19.90   14.60
     Stage I
   J315 Graded exercise to maximum tolerance (exercise must include
           continuous heart rate, oximetry and ventilation at rest and at
           each workload) ...................................................................        62.45   56.45
   E450   - J315 plus J301 or J304 before and/or after exercise. add                                 13.30    8.95
   E451   - J315 plus 12 lead E.C.G. done at rest, used for monitoring
             during the exercise and followed for at least 5 minutes
             post exercise.............................................................. add         18.10   27.85
     Stage II
   J316 Repeated steady state graded exercise (must include heart
           rate, oximetry, ventilation, VO2, VCO2, BP, ECG, end tidal
          and mixed Venous CO2 at rest, 3 levels of exercise and
           recovery) ............................................................................    90.00   72.70
   J330 Assessment of exercise induced asthma (workload sufficient to
          achieve heart rate 85% of predicted maximum; performance
          of J301 or J304 before exercise and 5-10 minutes post
          exercise).............................................................................     33.35   27.25
   J319 Blood gas analysis - pH, PO2, PCO2, bicarbonate and base
           excess ................................................................................   11.25   -
   J318 Arterialized venous blood sample collection (e.g. ear lobe) ...                               3.79   -
   J320 A-a oxygen gradient requiring measurement of RQ by
          sampling mixed expired gas and using alveolar air equation                                 27.55   12.85
   J331 Estimate of shunt (Qs/Qt) breathing pure oxygen ..................                           27.55   16.05
   J313 Mixed venous PCO2, by the rebreathing method ...................                             11.25    4.70

PDF page 414 / H6

PULMONARY FUNCTION STUDIES
                                                                                                   H            P
  Oxygen saturation
J323 - by oximetry at rest, with or without O2................................                     4.20         -
J332 - by oximetry at rest and exercise, or during sleep with or
       without O2...........................................................................     17.60         11.35
J334 - J332 with at least two levels of supplemental O2 ...............                          30.55         16.85
J336 - with single blind assessment of exercise on room air and
       with supplemental oxygen ..................................................               30.55         16.85
      Note:
      1.J323 is not eligible for payment when rendered with J332, J315, J316, G315, G319, G111,
        G112, G570, G571, G582, G583, G574, G575 or any overnight sleep study.
      2.J332 is not eligible for payment when rendered with J315, J316, G315, G319, G111, G112,
        G570, G571, G582, G583, G574, G575 or any overnight sleep study.
      3.J336 is only eligible for payment for evaluation of a patient to determine eligibility for funding
        under the Ontario Home Oxygen Program.
      4.J336 is not payable in addition to J332 or J334.
      5.J301, J304, J324, or J327 are not eligible for payment when rendered to a patient who does
        not have symptoms, signs or an indication supported by current clinical practice guidelines
        relevant to the individual patient’s circumstances.
      Medical record requirements:
      J323, J332, J334 or J336 are not eligible for payment unless a permanent record of the study is
      maintained.
J322 Standard O2 consumption and CO2 production......................                              5.30          6.45
J333 Non-specific bronchial provocative test (histamine,
       methacholine, thermal challenge) ......................................                   48.25         41.55
J335 Antigen challenge test ............................................................         51.85         30.95
                                                                                                              Fee
Z459 Arterial puncture for blood gas analysis..................................                               10.20
    Note:
    For home/self-care ventilation listing - see Diagnostic and Therapeutic Procedures page J50.

Master, record 2603. Record Layout PDF, page 1.

J30420260401999999990000000000000000215500000000000000000012850000000128500

Auxiliary master fields are preserved as raw scaled values. The linked layout calls them zero-filled, but this edition contains non-zero values. They are not presented as final dollar fees or PDF units.