X045 – Clavicle - two views
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
X045 is a diagnostic radiology service for the clavicle involving two views. The fee structure differentiates between services performed in a hospital setting, where only the professional component is billed by the physician, and services in non-hospital facilities (e.g., Independent Health Facilities) where a global fee covering both technical and professional components is applicable.
When to Use
- Use X045 when a patient presents with acute clavicle trauma and two distinct radiographic views are required to rule out a fracture.
- Use X045 for follow-up imaging of a healing clavicle fracture where the clinical standard of care necessitates two views to assess alignment or callus formation.
Common Pitfalls
- Billing X045 in conjunction with X209 for the same anatomical site on the same day will result in a rejection for duplicate service.
- Submitting X045 for a single-view study is an audit risk; ensure the requisition and report explicitly confirm that two views were performed and interpreted.
Billing Tips
- When performing this service in a hospital setting, ensure you are only billing the professional component, as the technical component is covered by the hospital's global budget.
- If the service is performed as an urgent, non-elective procedure in a hospital, append the appropriate Special Visit Premium (e.g., C108) to maximize the claim value.
Effective: April 1, 2025
D. Diagnostic Radiology
DIAGNOSTIC RADIOLOGY
Diagnostic
Diagnostic Radiology
All insured services must be documented in appropriate records. The Act requires that the record establish that: 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.
The technical component of a diagnostic procedure is only eligible for payment where the physician maintains documentation that describes the process by which the physician monitors quality assurance in accordance with professional standards.
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