X168 – CT guidance of biopsy
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
This service covers the use of Computed Tomography (CT) for guiding a biopsy procedure. It is listed in the Diagnostic Radiology section of the Schedule of Benefits on page under the 'Spine(s)' sub-heading for CT scans. As a diagnostic procedure, it is subject to the general requirements for referrals and medical record-keeping outlined in the General Preamble. Special visit premiums for non-elective diagnostic services and other premiums may apply if specific conditions are met.
When to Use
- Use X168 specifically for CT-guided percutaneous biopsy procedures where the imaging modality is the primary guidance tool.
- Select X168 when performing biopsies of spinal or paraspinal lesions that require CT precision, distinguishing it from ultrasound-guided procedures which fall under different codes.
Common Pitfalls
- Do not bill X168 in conjunction with diagnostic CT scan codes (e.g., X127, X128) for the same anatomical site during the same session, as the guidance is considered part of the procedure.
- Avoid billing X168 for procedures performed via fluoroscopy or ultrasound; ensure the imaging modality documented in the operative report matches the code definition.
Billing Tips
- Ensure the procedural report explicitly documents the use of CT guidance to satisfy audit requirements for this specific diagnostic radiology code.
- Apply the appropriate age-based premium (e.g., for patients under 16 years) to the procedural fee, as X168 is eligible for these percentage-based increases.
Effective: April 1, 2025
D. Diagnostic Radiology
DIAGNOSTIC RADIOLOGY
Diagnostic
Diagnostic Radiology, Clinical Procedures associated with Diagnostic Radiological Examinations
All insured services must be documented in appropriate records. The Act requires that the record 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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