X128 – CT Spine - with and without IV contrast
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
This service provides a computed tomography (CT) scan of the spine, performed both without and subsequently with the administration of intravenous (IV) contrast material. It is listed in the Diagnostic Radiology section of the Schedule and represents a global fee that typically includes both the technical and professional components of the service. See related codes X415 for a CT of the spine without contrast and X416 for a CT with contrast only.
When to Use
- Use X128 when the clinical protocol specifically requires both non-contrast and post-contrast imaging to evaluate spinal pathology, such as suspected infection, neoplasm, or post-operative assessment.
- Choose X128 instead of X415 when the diagnostic question cannot be answered by non-contrast imaging alone, ensuring the medical record reflects the necessity of the dual-phase study.
Common Pitfalls
- Billing X128 when only a single-phase study was performed; if contrast was not administered, you must use X415, or if only contrast was used, use X416.
- Failing to document the specific clinical indication for the contrast administration, which is a common trigger for audit inquiries regarding the necessity of the 'with and without' protocol.
Billing Tips
- Ensure the technical component documentation clearly demonstrates that both non-contrast and contrast-enhanced sequences were acquired, as this is the primary requirement for the global fee.
Effective: April 1, 2025
D. Diagnostic Radiology
DIAGNOSTIC RADIOLOGY
Diagnostic
Diagnostic Radiology
All insured services must be documented in appropriate medical records to establish medical necessity and that the service billed was the service that was rendered. See for details.
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. See .
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