X111 – Small bowel examination
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
Radiological examination of the small bowel only. This service is intended to be claimed when it is the only examination performed during the patient's visit. This service has two components: a technical component (`X111H) representing the cost of the facility and equipment, and a professional component (X111P`) for the physician's interpretation. The technical component is not eligible for payment if rendered outside of a hospital.
When to Use
- Use X111 when performing a dedicated radiological examination of the small bowel as a standalone procedure.
- Use this code for small bowel follow-through studies where no other concurrent gastrointestinal imaging is performed during the same encounter.
Common Pitfalls
- Claiming the technical component (X111H) for services rendered in a private clinic or non-hospital setting, which is strictly prohibited.
- Attempting to bill X111 in conjunction with other diagnostic imaging codes for the same anatomical region, as X111 is intended for use only when it is the sole examination provided.
Billing Tips
- Ensure the professional component (X111P) and technical component (X111H) are billed separately as required by the hospital setting to ensure full reimbursement.
- Verify that the referring physician or nurse practitioner is clearly documented, as a formal referral is mandatory for this diagnostic service.
Effective: April 1, 2025
D. Diagnostic Radiology
DIAGNOSTIC RADIOLOGY
Diagnostic
Diagnostic Radiology
The medical record must establish that an insured service was provided, the service claimed is the service that was rendered, and the service was medically necessary.
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