X092 – Chest and abdomen - three or more views
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
A diagnostic radiology service for a chest X-ray involving three or more views. The service is divided into a technical component (H) and a professional component (P). The technical component covers the cost of the facility, equipment, and staff performing the imaging, while the professional component covers the physician's interpretation of the images. Per the Schedule, the H fee is $28.15 and the P fee is $12.40. Miniature chest films for survey purposes are not an insured benefit.
When to Use
- Use X092 when a patient requires a comprehensive chest series consisting of three or more views, such as PA, lateral, and oblique views, to evaluate complex pathology.
- Select X092 over X090 (single view) or X091 (two views) when the clinical indication necessitates a more detailed radiographic assessment of the thoracic cavity.
Common Pitfalls
- Billing the technical component (suffix B) for an in-patient or a patient who is admitted to the same facility within 24 hours of the service is a violation of the 24-hour rule and will result in a clawback.
- Attempting to bill the technical component (suffix B) for services rendered outside of a hospital setting is ineligible for payment under the Health Insurance Act.
- Failing to append the correct suffix (B for technical, C for professional) will result in immediate rejection, as X092 must be split into these two distinct claims.
Billing Tips
- Ensure the professional component (X092C) is submitted by the interpreting physician, while the technical component (X092B) is only claimed by the facility or physician responsible for the quality assurance of the imaging equipment.
- When providing urgent interpretation in an emergency department setting between 00:00 and 07:00, ensure you meet the specific criteria for C107 if billing for additional patients seen during that same special visit.
Effective: April 1, 2025
D. Diagnostic Radiology
DIAGNOSTIC RADIOLOGY
Diagnostic
Diagnostic Radiology
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 the above upon request by the MOH.
The physician must maintain documentation that describes the process by which the physician monitors quality assurance in accordance with professional standards.
Miniature chest film for survey purposes only is not an insured benefit.
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