X163 – Dacrocystogram
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
A dacrocystogram is a miscellaneous diagnostic radiology examination. It involves injecting a contrast medium into the tear duct system followed by X-ray imaging to assess for blockages or other abnormalities. The payment for X163 is split into a technical component (H-fee) and a professional component (P-fee). According to the Schedule of Benefits, the claim for the technical component is submitted using the fee schedule code with the suffix B and the claim for the professional component is submitted using the fee schedule code with a suffix C ().
When to Use
- Use X163 for diagnostic imaging of the nasolacrimal duct system following contrast injection to identify anatomical obstructions or stenosis.
- Select this code when performing a formal dacrocystogram in a radiology department, ensuring the service is distinguished from minor office-based procedures.
Common Pitfalls
- Failing to split the claim into the technical (suffix B) and professional (suffix C) components will result in an automatic rejection.
- Billing X163 for a patient who is admitted to the hospital within 24 hours of the service for the same condition violates the technical component payment rules.
Billing Tips
- Always verify that the referral source is a physician, nurse practitioner, or oral maxillofacial surgeon, as per GP16 and GP111 requirements.
Effective: April 1, 2025
D. Diagnostic Radiology
DIAGNOSTIC RADIOLOGY
Diagnostic
Diagnostic Radiology
All insured services must be documented in appropriate records that 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.
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