X188 – CT Head - with and without IV contrast
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
This service provides for a Computed Tomography (CT) scan of the head, which includes two separate scanning sequences: one performed before the administration of intravenous (IV) contrast material, and a second sequence performed after IV contrast has been administered. This dual-scan approach allows for a comprehensive assessment by comparing pre- and post-contrast images.
When to Use
- Use X188 when the clinical indication requires both pre- and post-contrast imaging, such as investigating suspected intracranial neoplasms or infectious processes like abscesses.
- Select X188 over X400 (non-contrast) or X401 (contrast-only) when the diagnostic protocol explicitly mandates the comparison of non-enhanced and enhanced sequences to differentiate pathology.
Common Pitfalls
- Billing X188 when only a single-phase scan was performed; ensure the documentation confirms both pre- and post-contrast sequences were completed.
- Attempting to add E874 to X188 for non-stroke indications; E874 is strictly restricted to acute stroke investigations within the therapeutic window.
Billing Tips
- If performing a CT perfusion study for acute stroke, ensure E874 is claimed alongside X188 to capture the additional work, provided the interpretation is rendered within the required therapeutic timeframe.
Effective: April 1, 2025
D. Diagnostic Radiology
DIAGNOSTIC RADIOLOGY
Diagnostic
Diagnostic Radiology
All insured services must be documented in the patient's medical record, establishing that the service was provided, is the service for which the account is submitted, and was medically necessary. Refer to () for general requirements.
Commentary regarding the add-on code E874: When a CT perfusion study is performed only with a non-contrast CT head scan, claim E874 and the non-contrast CT head service (e.g., X400, X402). The commentary notes it would not be appropriate to claim E874 with a contrast-enhanced only CT head service (e.g., X401, X405).
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