X195 – Chest
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
A fluoroscopic examination of the chest, performed by a physician, which may or may not include the use of spot films. This service has a professional component ('P' fee) and a technical component ('H' fee). As per , the technical component is generally payable only when the service is rendered in a hospital to an out-patient or emergency department patient. The professional component relates to the physician's interpretation. Claims for the professional component should be submitted with a 'C' suffix, and claims for the technical component should be submitted with a 'B' suffix.
When to Use
- Use X195 when performing a real-time fluoroscopic examination of the chest, such as assessing diaphragmatic excursion or evaluating airway dynamics, which is distinct from a standard static chest X-ray.
- Use this code when the procedure involves the use of spot films during the fluoroscopic session to document specific findings.
Common Pitfalls
- Submitting the professional component (suffix C) and technical component (suffix B) as a single claim line will result in rejection; they must be billed as two separate line items.
- Billing the technical component (suffix B) for services performed in a private clinic or office setting is a common audit trigger, as it is generally restricted to hospital-based services.
- Failing to account for the 24-hour rule: the technical component is ineligible if the patient is admitted to the same hospital within 24 hours of the diagnostic service for the same condition.
Billing Tips
- Ensure the professional component (suffix C) is only billed by the physician who performed the interpretation, while the technical component (suffix B) is billed by the physician responsible for the quality assurance and data acquisition of the procedure.
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.
FLUOROSCOPY - BY PHYSICIAN WITH OR WITHOUT SPOT FILMS
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