X037 – Pelvis and/or hip(s) - two views
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
A diagnostic radiology procedure for the pelvis and/or hip(s) involving two views, for example, an Anteroposterior (AP) and frog view of both hips, or an AP of both hips plus a lateral view of one hip. This service is comprised of a professional component ('P' fee) for the interpretation and a technical component ('H' fee) for performing the procedure. See for rules regarding the payment of technical and professional components.
When to Use
- Use X037 when performing a standard two-view hip series, such as an AP pelvis combined with a single lateral view of the symptomatic hip.
- Use X037 for a bilateral hip study consisting of an AP view of both hips and a frog-leg lateral view of both hips, provided the total view count is two.
- Select X037 over X036 when the clinical requirement necessitates two distinct radiographic projections rather than a single view.
Common Pitfalls
- Do not bill the technical component (H-fee) for any patient who is an inpatient at the time of the service or admitted within 24 hours of the procedure.
- Avoid billing X037 if the study requires three or more views; X038 is the appropriate code for three or more views of the pelvis and/or hips.
- Failure to maintain documented quality assurance protocols as mandated by GP11 is a significant audit risk for the technical component claim.
Billing Tips
- Ensure the referral source is a physician, nurse practitioner, or oral maxillofacial surgeon to satisfy the mandatory referral requirement for diagnostic imaging.
- Apply the appropriate age-based premium (e.g., AGE_PREMIUM_5_TO_16_YEARS) to the professional component when the patient meets the specific age criteria to maximize the claim value.
Effective: April 1, 2025
D. Diagnostic Radiology
DIAGNOSTIC RADIOLOGY
Diagnostic
Diagnostic Radiology
In accordance with , the physician submitting a claim for the technical component is responsible for the complete quality assurance process and must maintain documentation that describes the process by which the physician monitors quality assurance in accordance with professional standards. The physician must be able to demonstrate this upon request by the MOH.
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