X176 – Sialogram
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
A sialogram is a diagnostic radiology examination of the salivary ducts and glands. This procedure involves the injection of a contrast material into a salivary duct, followed by X-ray imaging. According to the Schedule of Benefits, this service is comprised of two components: - Technical Component (H): The fee for the technical aspect of the procedure, performed in a facility. The Schedule lists this as $29.80. - Professional Component (P): The fee for the physician's interpretation and report. The Schedule lists this as $11.35. As per , the claim for the technical component is submitted with suffix B and the professional component with suffix C. The technical component (H fee) is not eligible for payment if the service is rendered outside a hospital.
When to Use
- Use X176 when performing a diagnostic contrast study of the salivary ducts to investigate suspected sialolithiasis or chronic sialadenitis.
- Use this code for the professional interpretation (suffix C) and technical component (suffix B) when the procedure is performed within a hospital setting.
Common Pitfalls
- Billing the technical component (suffix B) for procedures performed in a private clinic or office, which will result in an automatic rejection.
- Failing to submit the professional component (suffix C) separately, as the total fee is split into two distinct billing submissions.
- Attempting to bill X176 without a valid referral from a physician, nurse practitioner, or oral maxillofacial surgeon, as per GP111.
Billing Tips
- Ensure the technical component is submitted with suffix B and the professional component with suffix C to avoid payment processing errors.
- If the sialogram is performed urgently in an acute care hospital setting between 00:00 and 07:00, consider adding the C107 premium if the criteria for urgent management are met.
Effective: April 1, 2025
D. Diagnostic Radiology
DIAGNOSTIC RADIOLOGY
Diagnostic
Diagnostic Radiology
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