X137 – Cystogram (catheter)
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
Cystogram (catheter) is a diagnostic radiology procedure for examining the urinary bladder. This service involves introducing a contrast agent into the bladder through a catheter to obtain images. This fee code has a technical component (Fee (H): 23.85) and a professional component (Fee (P): 8.40). Per , the technical component should be claimed with suffix B and the professional component with suffix C.
When to Use
- Use X137 when performing a retrograde cystogram via a catheter to evaluate for bladder rupture, vesicoureteral reflux, or bladder outlet obstruction.
- Select X137 specifically for catheter-based contrast studies; do not use for voiding cystourethrograms (VCUG) if a specific VCUG code is more appropriate for the clinical intent.
Common Pitfalls
- Failing to split the billing into the technical component (suffix B) and professional component (suffix C) will result in payment errors.
- Billing the technical component (suffix B) for a patient who is admitted to the hospital within 24 hours of the procedure for the same condition is prohibited under OHIP payment adjustment rules.
- Attempting to bill X137 for non-catheterized bladder imaging or ultrasound-based studies, which require different diagnostic codes.
Billing Tips
- Always ensure the referral source is documented, as X137 requires a valid referral from a physician or nurse practitioner to be considered an insured service.
- When providing urgent after-hours services in a hospital, ensure you select the correct special visit premium (e.g., C102, C103, or C104) to accompany the professional component (suffix C) of X137.
Effective: April 1, 2025
D. Diagnostic Radiology
DIAGNOSTIC RADIOLOGY
Diagnostic
Diagnostic Radiology
All insured services must be documented in appropriate records. The record must establish that: an insured service was provided; the service for which the account is submitted is the service that was rendered; and the service was medically necessary.
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