X197 – Abdomen
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
X197 is a diagnostic imaging service for fluoroscopy of the abdomen, performed by a physician, with or without the use of spot films. The service is divided into two payable components: - H Fee (Technical Component): Covers the use of the equipment, premises, supplies, and technical personnel. - P Fee (Professional Component): Covers the physician's professional service, including the interpretation of the images and preparation of a report. As with all insured services, this fee includes the common and specific elements of service as outlined in the Schedule of Benefits (see -).
When to Use
- Use X197 for fluoroscopic examination of the abdomen where real-time imaging is required, distinguishing it from static plain-film abdominal radiography (X195 or X196).
- Select X197 when performing contrast-enhanced fluoroscopic studies of the gastrointestinal tract that specifically require abdominal visualization beyond standard localized imaging.
Common Pitfalls
- Billing the technical component (H) for hospital in-patients or patients admitted within 24 hours of the service is a common audit trigger and will be rejected.
- Attempting to bill X197 alongside other abdominal imaging codes (e.g., X195) for the same clinical indication without clear evidence of distinct, medically necessary procedures will lead to claim denials.
Billing Tips
- Ensure the professional component (P) is billed by the interpreting physician, while the technical component (H) is only claimed when the equipment and facility costs are not already covered by the hospital global budget.
Effective: April 1, 2025
D. Diagnostic Radiology
DIAGNOSTIC RADIOLOGY
Diagnostic
Diagnostic Radiology
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