X104 – Oesophagus, stomach and duodenum - double contrast
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
A diagnostic radiology procedure for a double contrast study of the oesophagus, stomach, and duodenum, which includes a survey film if one is taken. This service is comprised of a technical component ('H' fee) and a professional component ('P' fee). Per :, the claim for the technical component is submitted using suffix 'B' and the claim for the professional component is submitted using suffix 'C'. The technical component is only eligible for payment if the service is rendered in a hospital.
When to Use
- Use X104 when performing a double contrast study of the upper gastrointestinal tract to evaluate mucosal detail in the oesophagus, stomach, and duodenum.
- Select X104 instead of X107 when the clinical requirement is a full double contrast examination rather than a single contrast or limited study.
Common Pitfalls
- Failing to submit the technical component (suffix B) and professional component (suffix C) as separate claims, which is mandatory for this code.
- Billing the technical component (suffix B) for services rendered in a private clinic, as it is strictly restricted to hospital settings.
- Attempting to bill X104 in conjunction with X107, which is a restricted code combination.
Billing Tips
- Ensure the technical component (suffix B) is omitted if the patient is admitted as an in-patient within 24 hours of the diagnostic service for the same condition.
Effective: April 1, 2025
D. Diagnostic Radiology
DIAGNOSTIC RADIOLOGY
Diagnostic
Diagnostic Radiology
All insured services must be documented in appropriate records that establish: 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. See :.
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