X131 – Cystourethrogram (non-catheter)
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
Cystourethrogram (non-catheter) is a diagnostic imaging procedure of the genitourinary tract, as listed in the Genitourinary Tract subsection of the Diagnostic Radiology section. The service fee is divided into a technical component (H fee) and a professional component (P fee). The technical component covers the performance of the imaging and is only payable when the service is rendered in a hospital. The professional component covers the physician's interpretation of the results. See for general rules on diagnostic services.
When to Use
- Use X131 for non-catheter cystourethrograms performed in a hospital setting to evaluate bladder and urethral anatomy.
- Select X131 when the procedure is diagnostic in nature and does not involve the insertion of a catheter for contrast administration.
Common Pitfalls
- Billing the technical component (H fee) for procedures performed outside of a hospital setting will result in automatic rejection.
- Submitting the technical component (H fee) for an inpatient or an outpatient who is admitted to the same hospital within 24 hours for the same condition is a violation of GP11 rules.
- Confusing the required suffixing: the technical component must be submitted with suffix B, while the professional component must use suffix C.
Billing Tips
- Ensure the technical component (suffix B) is only claimed when the service is rendered in a hospital, as it is ineligible otherwise per GP11.
- Always verify the patient's admission status within the 24-hour window to avoid improper billing of the technical component.
Effective: April 1, 2025
D. Diagnostic Radiology
DIAGNOSTIC RADIOLOGY
Diagnostic
Diagnostic Radiology
All insured services must be documented in the patient's medical record to establish medical necessity and that the service was rendered. See .
For the technical component, the physician must maintain documentation describing the quality assurance monitoring process in accordance with professional standards. See .
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