X204C – Thoracic Spine - Three or More - Professional Component
OHIP Laboratory Code — Spine and Pelvis · Schedule of Benefits
Professional component (P fee) for the interpretation and reporting of a radiological examination of the thoracic spine, requiring a minimum of three views. As per , the professional component is claimed separately using suffix C. It includes the interpretation of the results and providing a report.
When to Use
- Use X204C when providing the professional interpretation for a thoracic spine series that includes at least three distinct radiographic views.
- Use this code specifically for the professional component (P-fee) when the technical component (H-fee) is being billed separately by the facility.
Common Pitfalls
- Billing X204C when fewer than three views are performed, which will result in a rejection or audit recovery.
- Submitting the claim without the 'C' suffix, as the system will not correctly process the professional component fee.
- Attempting to bill X204C alongside X204B, as these codes are mutually exclusive for the same examination.
Billing Tips
- Ensure the referring physician or nurse practitioner information is accurately captured, as this is a mandatory requirement for diagnostic imaging claims.
- Verify that the total number of views is clearly documented in the radiology report to support the 'three or more' requirement in the event of a post-payment audit.
Effective: January 1, 2025
Diagnostic Radiology
Spine and Pelvis
Diagnostic
Diagnostic Radiology
Diagnostic procedures referred by a Nurse Practitioner are only insured when rendered in an ICHSC or a hospital.
Diagnostic procedures referred by an Oral and Maxillofacial Surgeon are only insured when rendered in a hospital in connection with a dental surgical procedure.
A minimum of three views is required for this service to be eligible for payment.
Claimed with suffix C for the professional component.
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