X149 – Subsequent test - one site
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
Subsequent Bone Mineral Density (BMD) measurement by dual-energy X-ray absorptiometry (DXA) for one site on a high-risk patient. This service is for the prevention and management of osteoporosis or osteopenia. Definition of High-Risk Patient: For the purpose of subsequent testing, patient risk is defined using the fracture risk assessment tool (FRAX) or equivalent major osteoporotic fracture assessment tool. Levels of patient risk are defined as: “high risk patient” means a patient with an estimated risk > 15%. Required Elements of Service: BMD measurement by DXA is an insured service only when all the following conditions have been met: 1. the service is rendered for the prevention and management of osteoporosis or osteopenia; 2. when more than one site is measured, the sites include both hip and spine and where measurement of both hip and spine is not technically feasible the site measured consists of either hip or spine. [Commentary: Measurement of hip and spine would be considered not technically feasible due to prosthesis or deformity.]
When to Use
- Use X149 for a subsequent DXA scan when the patient's FRAX score confirms a major osteoporotic fracture risk > 15% and they have previously undergone a baseline BMD test.
- Use X149 when technical limitations, such as a hip prosthesis or spinal deformity, prevent the measurement of both hip and spine, restricting the scan to a single site.
Common Pitfalls
- Billing X149 more frequently than once every 36 months will trigger an automatic rejection, as the Ministry enforces strict interval limitations for subsequent high-risk testing.
- Submitting X149 for patients with a FRAX score ≤ 15% is a common audit trigger; ensure the high-risk status is documented in the patient's chart prior to the referral.
- Billing X149 when both hip and spine are technically feasible is incorrect; in those cases, you must use X155 for the dual-site measurement.
Billing Tips
- Always verify the patient's last BMD date in the EMR to ensure the 36-month window has elapsed before ordering X149, as the system will reject claims that overlap with previous X142, X148, or X155 services.
Effective: April 1, 2025
D. Diagnostic Radiology
DIAGNOSTIC RADIOLOGY
Diagnostic
Diagnostic Radiology
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