X106 – Pharynx and oesophagus - cine or videotape
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
A diagnostic radiology procedure involving cine or videotape analysis of the pharynx and oesophagus. This service comprises two parts: - Professional Component (`P` Fee): The physician's work in interpreting the study and providing a report. This is billed by the physician. - Technical Component (`H` Fee): The cost of equipment, supplies, and staff to perform the imaging. Per of the Schedule of Benefits, the technical component of a diagnostic service listed with an 'H' fee is not eligible for payment if rendered outside of a hospital. It is also not payable if the patient is admitted to the hospital within 24 hours for the same condition. This service includes all common elements as defined in -.
When to Use
- Use X106 for the professional interpretation of a videofluoroscopic swallow study (VFSS) performed in a hospital setting.
- Use this code when documenting the dynamic assessment of pharyngeal and esophageal motility via cine or videotape, distinct from static radiographic studies like X103 or X104.
Common Pitfalls
- Billing the 'H' (technical) component for studies performed in a private clinic or office setting, which is strictly prohibited under GP11.
- Attempting to bill X106 when the patient is admitted to the hospital within 24 hours for the same condition, as the service is considered part of the hospital's global funding.
- Failing to maintain the required quality assurance documentation for the technical component, which leaves the physician vulnerable during an MOH audit.
Billing Tips
- Ensure the professional component is billed only for the interpretation and reporting; verify that the hospital facility is billing the technical component separately if applicable.
- When providing urgent, non-elective interpretations after hours, pair X106 with the appropriate C-series travel and 'first person seen' premiums (e.g., C104 and C110) to maximize reimbursement for hospital-based services.
Effective: April 1, 2025
D. Diagnostic Radiology
DIAGNOSTIC RADIOLOGY
Diagnostic
Diagnostic Radiology
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.
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