X207 – Sacrum and/or coccyx - three or more views
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
A diagnostic radiology examination of the sacrum and/or coccyx, requiring the capture and interpretation of three or more views. As per the Schedule, this service is divided into a technical component (Fee H) and a professional component (Fee P). The technical component is not eligible for payment if rendered to a hospital in-patient, or to an out-patient who is admitted to the same hospital within 24 hours for the same condition (see ).
When to Use
- Use X207 when a patient presents with acute trauma to the sacrococcygeal region requiring a minimum of three distinct radiographic projections to rule out fracture.
- Use X207 for the diagnostic evaluation of chronic coccydynia where a detailed assessment of the sacral anatomy is required beyond the two-view protocol of X208.
Common Pitfalls
- Billing X207 when only two views are performed; if fewer than three views are captured, you must use X208 instead.
- Attempting to bill the technical component (H) for hospital in-patients or out-patients admitted within 24 hours, which triggers an automatic rejection under GP11 rules.
- Submitting X207 alongside X034 or X035 for the same anatomical region, which is considered unbundling and will lead to claim adjustment.
Billing Tips
- Ensure the requisition explicitly justifies the need for three or more views to support the medical necessity of the higher-intensity X207 code over X208.
- Always verify the patient's hospital admission status at the time of service to determine if only the professional component (P) is eligible for submission.
Effective: April 1, 2025
D. Diagnostic Radiology
DIAGNOSTIC RADIOLOGY
Diagnostic
Diagnostic Radiology
All insured services must be documented in appropriate records.
The record must establish that: 1. an insured service was provided; 2. the service for which the account is submitted is the service that was rendered; and 3. the service was medically necessary.
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