X196 – Skeleton
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
Fluoroscopy of the skeleton performed by a physician, with or without the use of spot films. This service is divided into a professional component ('P') and a technical component ('H'). The technical component is generally not payable when rendered outside of a hospital setting. See payment rules on for details on technical component eligibility.
When to Use
- Use X196 when performing active fluoroscopic guidance for skeletal procedures, such as joint aspirations or injections, where the physician is directly manipulating the fluoroscope.
- Use X196 for diagnostic skeletal fluoroscopic examinations that require real-time visualization of bony structures, distinguishing it from static radiography codes like X189.
Common Pitfalls
- Billing the technical component ('H') for services performed in a private office or clinic setting, which is generally ineligible for payment under GP11 rules.
- Failing to differentiate between the professional component ('P') and technical component ('H') on the claim, leading to automatic rejections or audit flags.
- Attempting to bill X196 alongside other diagnostic imaging codes for the same anatomical site without clear documentation of distinct clinical necessity.
Billing Tips
- Ensure the claim includes the appropriate suffix ('P' or 'H') to avoid rejection, as the Ministry requires explicit identification of the component rendered.
- Always append the relevant age-based premium (e.g., AGE_PREMIUM_5Y_16Y) if the patient qualifies, as these are specifically eligible for diagnostic radiological examinations like X196.
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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