X130 – Intravenous pyelogram including preliminary film
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
Intravenous pyelogram (IVP) including a preliminary film. This procedure involves injecting a contrast medium into a vein and taking a series of x-rays of the kidneys, ureters, and bladder as the dye travels through the urinary tract. This service is comprised of a professional component (interpretation, 'P' fee) and a technical component (performing the procedure, 'H' fee).
When to Use
- Use X130 when performing a formal intravenous pyelogram to evaluate the urinary tract for obstruction, stones, or structural anomalies.
- Use this code specifically for the complete procedure including the preliminary scout film and subsequent contrast-enhanced imaging sequences.
Common Pitfalls
- Failing to use the correct suffix (B for technical, C for professional) will result in automatic rejection of the claim.
- Billing X130 in conjunction with other abdominal imaging codes like X120 or X121 is often flagged for unbundling if the services are considered part of the same diagnostic study.
- Submitting the technical component (suffix B) without maintaining the required quality assurance documentation for the imaging equipment and process is a significant audit risk.
Billing Tips
- Ensure the referral source is explicitly documented as a physician or nurse practitioner, as this is a mandatory requirement for diagnostic radiology claims.
- If the procedure is performed on an urgent, non-elective basis in a hospital setting, verify eligibility for the Non-Elective Diagnostic Special Visit Premium to maximize reimbursement.
Effective: April 1, 2025
D. Diagnostic Radiology
DIAGNOSTIC RADIOLOGY
Diagnostic
Diagnostic Radiology, Clinical Procedures associated with Diagnostic Radiological Examinations
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 maintains documentation that describes the process by which the physician monitors quality assurance in accordance with professional standards.
The claim for the technical component is submitted using the fee schedule code with the suffix B and the claim for the professional component is submitted using the fee schedule code with a suffix C.
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