X048 – Shoulder - two views
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
A diagnostic radiological examination of the shoulder requiring two views. This service has both a professional and a technical component. The technical component is subject to specific payment rules outlined on , including restrictions on payment when performed in a hospital setting or outside of a hospital. For an examination with three or more views, see X212.
When to Use
- Use X048 when exactly two radiographic views of the shoulder are performed for diagnostic purposes.
- Use X048 for standard shoulder series where the clinical requirement is limited to two projections, distinguishing it from the three-view requirement of X212.
Common Pitfalls
- Billing X048 when three or more views were actually performed, which should be billed as X212 to avoid audit discrepancies.
- Attempting to bill X048 for services rendered outside of a hospital setting while incorrectly applying hospital-based special visit premiums like C102 or C104.
Billing Tips
- Ensure the number of views is clearly documented in the radiology report to support the selection of X048 over X212.
Effective: April 1, 2025
D. Diagnostic Radiology
DIAGNOSTIC RADIOLOGY
Diagnostic
Diagnostic Radiology
All insured services must be documented in appropriate records to establish that an insured service was provided, the service for which the account is submitted is the service that was rendered, and the service was medically necessary.
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