X004 – Facial bones - three views
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
A radiological examination of the facial bones requiring three views. The service is divided into a technical component (H fee) representing the taking of the image, and a professional component (P fee) representing the interpretation. As per , dental x-rays of the teeth are not an insured benefit.
When to Use
- Use X004 when a formal radiological assessment of the facial bones is required for trauma or suspected pathology, specifically requiring three distinct views.
- Choose X004 over X003 when the clinical request necessitates more comprehensive imaging than a single or two-view study of the facial bones.
Common Pitfalls
- Billing X004 for dental or periodontal imaging is a non-insured service and will result in claim rejection or audit recovery.
- Failing to distinguish between the technical (H) and professional (P) components often leads to incorrect fee submission; ensure the correct suffix is applied to the code.
Billing Tips
- Ensure the referral source is documented as a physician, nurse practitioner, or oral maxillofacial surgeon to satisfy the mandatory referral requirement for diagnostic imaging.
Effective: April 1, 2025
D. Diagnostic Radiology
DIAGNOSTIC RADIOLOGY
Diagnostic
Diagnostic Radiology
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.
Dental x-rays of the teeth are not an insured benefit.
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