X169 – Laminogram, planigram, tomogram
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
A diagnostic radiology examination, also known as tomography, creating a single plane of tissue in focus while blurring out the surrounding structures. This service includes a technical component (H) for performing the imaging and a professional component (P) for the interpretation.
According to the Schedule (), claims for diagnostic services with separate technical and professional components are submitted with suffixes. The technical component (H fee) is claimed with suffix B, and the professional component (P fee) is claimed with suffix C.
When to Use
- Use X169 when performing conventional tomography to isolate a specific plane of tissue, such as complex skeletal imaging where standard radiography provides insufficient clarity.
- Use this code for diagnostic imaging where the clinical requirement is to blur out overlying structures, distinguishing it from standard X-ray codes like X417.
Common Pitfalls
- Failing to use the correct suffix (B for technical, C for professional) will result in immediate claim rejection.
- Billing X169 in combination with restricted codes X172, X178, X184, or X185 will trigger an automatic audit or rejection due to overlapping service definitions.
- Submitting the technical component (suffix B) without maintaining the required quality assurance documentation for data acquisition and reporting is a significant audit risk.
Billing Tips
- Always ensure the professional component (suffix C) is billed by the radiologist interpreting the study, while the technical component (suffix B) is billed by the facility or physician responsible for the equipment and quality assurance.
Effective: April 1, 2025
D. Diagnostic Radiology
DIAGNOSTIC RADIOLOGY
Diagnostic
Diagnostic Radiology
The physician submitting a claim for the technical component is responsible for the complete quality assurance process for all elements of the technical component of the service, including data acquisition, reporting, and record keeping. The physician must be able to demonstrate the above upon request by the MOH.
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