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X163 – Dacrocystogram

OHIP Diagnostic Radiology 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 ().
Referral requiredFrom: Physician, NursePractitioner, OralMaxillofacialSurgeon
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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