X204 – Thoracic spine - three or more views
OHIP Laboratory Code · Schedule of Benefits
Diagnostic radiology of the thoracic spine consisting of three or more views.
When to Use
- Use X204 when clinical suspicion of fracture, malignancy, or severe deformity necessitates a minimum of three distinct projections of the thoracic spine.
- Use X204 when the initial two-view study (X027) is insufficient to rule out pathology, provided the additional views are clinically justified by the radiologist.
Common Pitfalls
- Billing X204 when only two views were performed, which constitutes an overbilling error; if fewer than three views are completed, the fee must be reduced by 25%.
- Attempting to bill X204 and X027 on the same patient for the same anatomical region, as these are mutually exclusive codes.
- Failing to account for the 24-hour admission rule (X204B) when performing the technical component in a hospital setting, leading to automatic claim rejection.
Billing Tips
- Ensure the interpretive report explicitly documents the findings of all three views to support the professional component (Suffix C) claim.
- When performing services in an Integrated Community Health Services Centre (ICHSC), bill only the professional component (Suffix C) to OHIP, as the technical component is handled separately.
Effective: April 1, 2026
Diagnostic Radiology
Diagnostic
The professional component (Suffix C) requires the physician to personally perform the interpretation of the results.
A written, signed, and dated interpretive report must be prepared and transmitted to the referring provider.
Conventional films of the spine should not be routinely done and claimed for before myelography.
Abdomen and/or pelvis should not be routinely claimed in lumbar spine examination requests.
If insured diagnostic radiology procedures yield abnormal findings or if they would yield information which in the opinion of the radiologist would be insufficient governed by the needs of the patient and the requirements of the referring provider or practitioner, the radiologist may add further views and claim for them (if listed).
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