X126 – CT Abdomen - with and without IV contrast
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
A Computed Tomography (CT) scan of the abdomen that includes an initial acquisition of images without intravenous (IV) contrast, followed by a second acquisition of images after the administration of IV contrast material. This dual-phase technique is used to enhance the visualization of blood vessels, organs, and other structures.
When to Use
- Use X126 when a clinical protocol requires both non-contrast and contrast-enhanced phases to differentiate between vascular and non-vascular abdominal structures, such as in the evaluation of suspected renal calculi or adrenal masses.
- Select X126 over single-phase codes when the diagnostic objective is to characterize lesion enhancement patterns, which cannot be achieved with a single acquisition.
Common Pitfalls
- Attempting to bill X126 concurrently with X234 (CT colonography) will result in a rejection, as these are mutually exclusive procedures.
- Failing to document the medical necessity for the dual-phase acquisition (both with and without contrast) is a common audit risk, as payers may question why a single-phase scan was insufficient.
Billing Tips
- Ensure that if you are interpreting the study via PACS from an off-site location, you bill the appropriate E-series premium (E406, E407, or E408) rather than attempting to add a travel premium, provided all criteria for urgent management are met.
Effective: April 1, 2025
D. Diagnostic Radiology
DIAGNOSTIC RADIOLOGY
Diagnostic
Diagnostic Radiology
All insured services must be documented in appropriate records. The medical record must 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.
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