J835

PDF page 340 / B2

NUCLEAR MEDICINE - IN VIVO
      PREAMBLE
  OTHER TERMS AND DEFINITIONS
    1. Professional and technical components are claimed separately. Claims for the technical
       component H are submitted using listed fee code with suffix B. Claims for professional
       component are submitted using listed fee code with suffix C. (e.g. J802C)
                   2. For services rendered outside a hospital setting the only fees billable under the Health
                      Insurance Act are listed under P (use suffix C). Costs for the technical component of these
                      services are only billable under the Integrated Community Health Services Centres Act, 2023.
                   3. With the exception of J818, J835, J834, J880 or when SPECT is claimed, if quantification or
                      data manipulation is carried out in addition to visual inspection of imaging studies, add 30% to
                      the appropriate professional benefit. For claim purposes, use prefix “Y”. Such activity must add
                      significant diagnostic information not available by inspection alone and does not include simple
                      image enhancement techniques such as smoothing, background subtraction, etc. Recording of
                      images on videotape for replay and production of images on the video display of a computer do
                      not in themselves justify the additional benefit. The claims for cardiac wall motion studies and
                      calculation of ventricular ejection fraction (J811 and J813) already include an allowance for data
                      manipulation as a general rule and no additional benefit may be claimed. The additional
                      computer benefit may be claimed only when additional cardiac quantifications are performed
                      i.e. stroke volume ratio and volume response curves and/or phase analysis.
                    4. If examination of Brain, Lung, Liver or Spleen is limited to one view, the benefit (H and P) is to
                       be reduced by 50%.
                    5. Repeat studies on the same day may be claimed only after exercise or drug intervention.
                    6. When tomographic examination (SPECT) is billed, the 30% add-on referred to in paragraph 3
                       may not be claimed.
                    7. Interpretation of a computed tomography (CT) scan performed as a component of a Nuclear
                       Medicine examination (e.g. SPECT/CT) is not eligible for payment.
                    8. Costs for the technical component of services rendered in an ICHSC are listed in the Schedule
                       of Facility Costs.
                    9. The technical and professional fee components for myocardial perfusion imaging,
                       echocardiography, and exercise stress testing are not eligible for payment in the routine
                       preoperative preparation or screening of a patient for surgery where the patient will undergo a
                       low-risk procedure or has a low risk of perioperative cardiac complications, unless there is a
                       clinical indication for such investigations other than solely for preoperative preparation of the
                       patient.
                                          [Commentary:
                                          1.Studies have indicated that for non-cardiac surgery, there may be no clinical benefit and
                                            there may be harm in performing functional cardiac testing in patients with low operative risk
                                            and little or limited benefit in moderate risk patients. Ordering of functional cardiac testing
                                            should done in accordance with accepted clinical guidelines such as those produced by the
                                            American College of Cardiology and American Heart Association.]

Master, record 2814. Record Layout PDF, page 1.

J83520260401999999990000000000000001529500000000000000000000000000000658000

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.