X072 – Toe - two views
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
Diagnostic radiology of the toe, requiring two views (X072). This service is comprised of two components: a technical component (H) for performing the imaging, and a professional component (P) for the interpretation and report. A referral from an eligible practitioner is required. Referrals from a Dental Surgeon are only valid for insured dental procedures in a hospital. Referrals from an Oral and Maxillofacial Surgeon are only valid for diagnostic procedures rendered in a hospital in connection with a medically necessary hospital-based dental surgical procedure. See , , for details.
When to Use
- Use X072 when a patient requires a standard two-view radiographic assessment of the toe to rule out fracture or dislocation.
- Use X072 for follow-up imaging of a toe injury where exactly two views are clinically indicated to assess healing or alignment.
Common Pitfalls
- Billing X072 for a three-view study, which requires a different code; ensure the number of views matches the code definition to avoid audit discrepancies.
- Attempting to bill the technical component (H) for hospital in-patients, which is strictly prohibited under GP11 rules.
- Failing to ensure the referral source is an eligible practitioner, as referrals from non-eligible providers will result in automatic claim rejection.
Billing Tips
- Always verify if the patient is an in-patient or was admitted within 24 hours of the service, as the technical component (H) is ineligible for payment in these scenarios.
- When providing urgent after-hours interpretations in a hospital, ensure you select the correct special visit premium (C104, C107, C108, C110) based on the time and patient sequence, as these are the only eligible add-ons for diagnostic radiology.
Effective: April 1, 2025
D. Diagnostic Radiology
DIAGNOSTIC RADIOLOGY
Diagnostic
Diagnostic Radiology
The medical record must 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. ()
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