X194 – Additional coned views with or without magnification
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
X194 is for additional coned views, with or without magnification, billed per film. It is limited to two views per breast. This procedure can be used for individuals with identified signs or symptoms, for follow-up of established disease, or for individuals with identified risk factors according to clinical practice guidelines. This service has both a technical component (H fee) and a professional component (P fee).
When to Use
- Use X194 to bill for localized coned-down views performed to further characterize a suspicious finding identified on a standard screening mammogram (e.g., X190).
- Use X194 when performing magnification views to evaluate the morphology of microcalcifications or the margins of a mass detected during diagnostic imaging.
Common Pitfalls
- Billing more than two units of X194 per breast, as the Schedule of Benefits strictly limits this code to a maximum of two views per breast.
- Attempting to bill X194 as a standalone screening procedure; it must be linked to a diagnostic indication such as a palpable lump, focal pain, or follow-up of a known lesion.
- Failing to distinguish between the technical (H) and professional (P) components, which can lead to payment discrepancies if the claim is not submitted with the appropriate fee code suffix.
Billing Tips
- Ensure the clinical indication for the additional views is clearly documented in the radiology report to justify the necessity of the coned/magnification views beyond the standard diagnostic series.
- If a patient requires a different mammographic modality (e.g., tomosynthesis) on the same day, submit with the manual review indicator to ensure proper adjudication of the additional imaging.
Effective: April 1, 2025
D. Diagnostic Radiology
DIAGNOSTIC RADIOLOGY
Diagnostic
Diagnostic Radiology
The physician must maintain documentation that describes the process by which the physician monitors quality assurance in accordance with professional standards.
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