X091 – Chest and abdomen - two views
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
A diagnostic radiology procedure providing two radiographic views of the chest. The service is comprised of a technical component (H fee) for the image acquisition and a professional component (P fee) for the interpretation.
As per , the technical component is not eligible for payment if rendered to a hospital in-patient or an out-patient who is admitted to the same hospital within 24 hours for the same condition. Claims for the technical component are submitted with suffix B and the professional component with suffix C.
Note from the Schedule: Miniature chest film for survey purposes only is not an insured benefit.
When to Use
- Use X091 when the clinical requirement necessitates imaging of both the chest and abdomen in a single encounter, such as assessing for free air or foreign body ingestion.
- Select X091 over separate codes like X090 (chest) and X092 (abdomen) when the two-view protocol is specifically ordered as a combined diagnostic study.
Common Pitfalls
- Billing the technical component (suffix B) for hospital in-patients or patients admitted within 24 hours of the service will result in an automatic rejection per GP11.
- Attempting to bill X091 for miniature chest films used for routine screening or survey purposes is strictly prohibited and considered a non-insured service.
Billing Tips
- Ensure the professional component (suffix C) is billed separately from the technical component (suffix B) to comply with the split-fee structure for diagnostic radiology.
- When performing urgent interpretations in an acute care hospital setting, verify eligibility for C107, C108, or C109 premiums, as these are only payable for on-site services and not for remote PACS interpretations.
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.
Miniature chest film for survey purposes only is not an insured benefit.
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