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X164
X164 – Discogram(s) - one or more levels
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
A discogram is an imaging test used to evaluate back pain. This service involves the injection of contrast dye into one or more intervertebral disc spaces under fluoroscopic guidance to assess the disc's integrity and determine if it is a source of pain. The fee for X164 covers the procedure for one or more disc levels.
When to Use
- Use X164 when performing a discogram under fluoroscopic guidance to evaluate discogenic pain, regardless of the number of levels injected.
- Select X164 specifically for the diagnostic procedure; do not use it for therapeutic spinal injections such as those covered under X151 or X163.
Common Pitfalls
- Attempting to bill X164 per level is incorrect; the code is global for one or more levels and will be rejected if submitted with multiple units.
- Billing X164 in conjunction with other diagnostic imaging codes for the same anatomical site during the same session often triggers manual review or rejection due to bundling rules.
Billing Tips
- Ensure the referral source is clearly documented as per GP111 requirements to avoid audit-related clawbacks on this diagnostic procedure.
- If the procedure is performed as an urgent, non-elective hospital service, verify eligibility for applicable Special Visit Premiums (e.g., C109, C108, C110) to maximize the claim value.
Provider Fee$0.00
Surgical Assistant Fee$32.95
Non-Anaesthetist Fee$23.00
Effective: April 1, 2025
Category
D. Diagnostic Radiology
Subcategory
DIAGNOSTIC RADIOLOGY
Service Type
Diagnostic
Code Classes
Diagnostic Radiology
Referral RequiredFrom: Physician, NursePractitioner, OralMaxillofacialSurgeon
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