X160 – Carotid angiogram by direct puncture - unilateral
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
This code is for a clinical procedure associated with diagnostic radiology. As a procedure within the 'Clinical Procedures associated with Diagnostic Radiological Examinations' section, it is subject to the general rules outlined in the through of the Schedule of Benefits. This includes eligibility for age-based premiums for certain patient populations as described in , after-hours procedure premiums (), and special visit premiums for non-elective diagnostic services ().
When to Use
- Use X160 specifically for a unilateral carotid angiogram performed via direct percutaneous puncture.
- Use this code for diagnostic procedures where the physician physically performs the arterial puncture and injection, distinct from catheter-based angiography.
Common Pitfalls
- Billing X160 for catheter-based angiography, which is typically covered under different interventional radiology codes.
- Attempting to bill X160 bilaterally; the code is explicitly defined as unilateral, and a second procedure on the contralateral side requires a separate claim with appropriate modifiers or indicators.
- Failing to link the procedure to a non-elective status when claiming after-hours premiums like E409 or E410, leading to automatic rejection.
Billing Tips
- Ensure the claim includes the appropriate age-based premium (GP64) if the patient is under 16, as this is often missed for pediatric diagnostic procedures.
- When performing this as a non-elective service in a hospital setting, prioritize the correct Special Visit Premium (C108-C110) over travel premiums to maximize the claim value, as they cannot be combined.
Effective: April 1, 2025
D. Diagnostic Radiology
DIAGNOSTIC RADIOLOGY
Procedure
Clinical Procedures associated with Diagnostic Radiological Examinations
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