X136 – Vasogram
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
A vasogram is a diagnostic radiology procedure listed under the Genitourinary Tract section. The service is comprised of two components which are claimed separately:
- A technical component (Fee (H)), claimed with suffix B.
- A professional component (Fee (P)), claimed with suffix C.
This billing structure is detailed in the General Preamble (:). The technical component (H) is only eligible for payment when the service is rendered in a hospital setting and is not payable if rendered outside of a hospital (:).
When to Use
- Use X136 for diagnostic vasography when performed in a hospital setting to investigate male infertility or suspected ductal obstruction.
- Use this code when the procedure is performed as a standalone diagnostic radiological examination, distinct from therapeutic surgical interventions like vasectomy reversal.
Common Pitfalls
- Claiming the technical component (suffix B) for procedures performed in a private clinic or office setting, which is strictly prohibited under GP11.
- Failing to bill the professional component (suffix C) and technical component (suffix B) as separate line items, leading to incomplete reimbursement.
- Attempting to bill X136 in conjunction with surgical procedure codes for vasectomy or reconstruction, which may trigger audit flags for unbundling.
Billing Tips
- Ensure the technical component (suffix B) is only submitted when the hospital's equipment is utilized, as per the General Preamble.
- Apply the appropriate age-based premiums (e.g., for pediatric patients) and after-hours procedural premiums (E409/E410) to the professional component (suffix C) when criteria are met.
Effective: April 1, 2025
D. Diagnostic Radiology
DIAGNOSTIC RADIOLOGY
Diagnostic
Diagnostic Radiology
All insured services must be documented in appropriate records to 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. (Source: :)
Male
This service has a technical component (Fee (H): $17.95) and a professional component (Fee (P): $6.80). Claims for the technical component are submitted with suffix B, and for the professional component with suffix C (:).
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