X175 – Peripheral angiogram - bilateral
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
Unlisted diagnostic procedure. This service is divided into professional and technical components for billing purposes as per .
Billing Components:
- Technical Component: Claimed using the fee schedule code with suffix B (X175B). The fee corresponds to the assistant_fee in the master record.
- Professional Component: Claimed using the fee schedule code with suffix C (X175C). The fee corresponds to the anaesthetist_fee in the master record.
The general requirements for diagnostic services, including documentation and potential referral, apply as outlined in the General Preamble.
When to Use
- Use X175C for the professional interpretation of a bilateral peripheral angiogram when performed in a facility setting.
- Use X175B to bill for the technical component when you own or operate the equipment and are responsible for the quality assurance of the image acquisition.
Common Pitfalls
- Billing X175 as a single code without the B or C suffix will result in an automatic rejection as the system requires the split components.
- Attempting to bill X175B without maintaining the required documentation for technical quality assurance is a significant audit risk under GP8.
- Failing to include a valid referring physician or nurse practitioner ID on the claim will trigger a rejection, as this is a diagnostic service requiring a referral.
Billing Tips
- Ensure you are applying the correct age premium (e.g., for patients under 16) to both the B and C components if the patient meets the specific age criteria defined in GP64.
- Verify that the facility where the procedure occurred is registered to allow for the technical component (X175B) billing, as this is not applicable for all practice types.
Effective: April 1, 2025
D. Diagnostic Radiology
DIAGNOSTIC RADIOLOGY
Diagnostic
Diagnostic and Therapeutic Procedures, 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.
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.
For those diagnostic services which have both technical and professional components listed under one fee schedule code, the technical and professional components are claimed separately. 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.
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