X036 – Pelvis and/or hip(s) - one view
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
A diagnostic radiology service consisting of one view of the pelvis and/or hip(s). This service is listed with a technical component (H-fee) and a professional component (P-fee). As per , the technical component is not eligible for payment if the service is rendered outside a hospital, or for hospital in-patients (or out-patients admitted within 24 hours for the same condition).
When to Use
- Use X036 for a single-view pelvic or hip radiograph when a multi-view study (X037 or X038) is not clinically indicated or performed.
- Use this code for follow-up imaging where only a single projection is required to assess hardware position or fracture alignment.
Common Pitfalls
- Billing the technical component (H-fee) for hospital in-patients or patients admitted within 24 hours of the service, which is strictly prohibited under GP11.
- Submitting X036 when multiple views were actually performed, which should be billed under X037 or X038 to avoid under-coding and potential audit flags.
Billing Tips
- Ensure the referral source is documented as a physician, nurse practitioner, or oral maxillofacial surgeon to satisfy GP111 requirements for diagnostic imaging.
Effective: April 1, 2025
D. Diagnostic Radiology
DIAGNOSTIC RADIOLOGY
Diagnostic
Diagnostic Radiology
All insured services must be documented in appropriate records that establish: 1. an insured service was provided; 2. the service for which the account is submitted is the service that was rendered; and 3. the service was medically necessary.
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