X063 – Femur including one joint - two views
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
X063 is for a radiological examination of the femur including one joint, consisting of two views. This service includes both a professional component (P fee) for the physician's interpretation and report, and a technical component (H fee) for the use of equipment, supplies and technical staff. Refer to the 'Payment Adjustment Rules' for specific conditions under which the technical component may not be payable.
When to Use
- Use X063 for a standard two-view radiographic examination of the femur when the clinical indication requires visualization of the shaft and one adjacent joint.
- Select X063 when the imaging protocol is strictly limited to two views; if the clinical scenario necessitates three or more views, you must bill X223 instead.
Common Pitfalls
- Billing the technical component (H fee) for an in-patient or a patient admitted within 24 hours of the service is a common audit trigger and will result in automatic recovery.
- Submitting X063 for a three-view study is a frequent billing error; ensure the view count matches the code definition to avoid rejection or audit adjustments.
- Failing to document the written referral from a physician or nurse practitioner in the patient's chart is a primary cause for claim reversal during Ministry audits.
Billing Tips
- If the patient is under age 16, ensure you apply the appropriate age-based premium to the clinical procedure component to maximize the claim value.
- Verify the setting of the service before submission, as the technical component (H fee) is strictly restricted for services rendered outside of hospital environments or for hospital in-patients.
Effective: April 1, 2025
D. Diagnostic Radiology
DIAGNOSTIC RADIOLOGY
Diagnostic
Diagnostic Radiology
The medical record must 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.
A copy of the written request from the referring practitioner must be kept in the medical record.
This service is for two views. For three or more views, see X223.
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