X049 – Scapula - two views
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
This service is for a two-view X-ray examination of the scapula. It is a diagnostic radiology procedure. For three or more views, see billing code X213. As per the Diagnostic Radiology section, this service includes both a technical component (H) and a professional component (P) for interpretation. See general preamble pages and for rules governing payment of diagnostic services and applicable special visit premiums.
When to Use
- Use X049 when exactly two views of the scapula are performed to evaluate trauma, fracture, or pathology.
- Use this code for standard diagnostic scapular imaging when the clinical request does not necessitate the more extensive series covered by X213.
Common Pitfalls
- Billing X049 in conjunction with X213 for the same patient on the same day will result in a rejection, as these are mutually exclusive.
- Submitting X049 when three or more views were actually performed is a billing error; X213 must be used for three or more views.
- Attempting to claim special visit premiums for services rendered via PACS or outside of an acute care hospital setting is a frequent cause of audit recovery.
Billing Tips
- Ensure the number of views is clearly documented in the radiology report to support the selection of X049 over X213.
- When providing urgent, non-elective interpretations in an acute care hospital, verify that you are using the correct special visit premium (C108-C110 or C105-C107) based on the time of day and patient status.
Effective: April 1, 2025
D. Diagnostic Radiology
DIAGNOSTIC RADIOLOGY
Diagnostic
Diagnostic Radiology
All insured services must be documented in appropriate records to 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 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 this upon request by the MOH.
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