X211 – Sternoclavicular joints (bilateral) - four or more views
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
A radiological examination of the sternoclavicular joints, bilaterally, requiring four or more views. This service is a diagnostic procedure with both professional and technical components. Per , the technical component of a diagnostic service listed in a column headed with an 'H' (or with two fee amounts) and rendered outside of a hospital is not eligible for payment. The technical component is also not eligible for payment if rendered to a hospital in-patient or a patient who is admitted to the hospital within 24 hours of the service.
When to Use
- Use X211 when a dedicated bilateral sternoclavicular joint series is performed requiring four or more views to assess for dislocation, arthritis, or trauma.
- Select X211 instead of general chest or clavicle series codes when the clinical focus is specifically on the sternoclavicular articulation and the view count meets the four-view threshold.
Common Pitfalls
- Billing X211 for a standard clavicle or chest X-ray that happens to include the sternoclavicular joints, as this code requires a specific, dedicated multi-view protocol.
- Attempting to bill the technical component for services rendered in a private clinic or via teleradiology/PACS, which is strictly prohibited under GP11.
- Submitting X211 for fewer than four views, which will lead to audit discrepancies if the radiological report does not support the minimum view requirement.
Billing Tips
- Ensure the radiological report explicitly documents the four or more views performed to satisfy the documentation requirements for this specific code.
- When providing services in a hospital setting, verify that the patient's admission status does not trigger the 24-hour rule, which would disqualify the technical component fee.
Effective: April 1, 2025
D. Diagnostic Radiology
DIAGNOSTIC RADIOLOGY
Diagnostic
Diagnostic Radiology
The Act requires that the medical record 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. (:)
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. (:)
four or more views
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