X212 – Shoulder - three or more views
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
A diagnostic radiology service involving three or more x-ray views of the shoulder. This service is comprised of a professional component (interpretation and report) and a technical component (performing the x-ray).
When to Use
- Use X212 when the clinical requirement necessitates a comprehensive assessment of the shoulder girdle, such as evaluating for complex fractures or chronic instability requiring three or more distinct radiographic projections.
- Select X212 over X048 when the imaging protocol specifically dictates three or more views to achieve diagnostic clarity, as X048 is restricted to fewer than three views.
Common Pitfalls
- Billing X212 when only two views were performed is a common audit trigger; ensure the number of views documented matches the code requirements.
- Attempting to bill X212 in conjunction with other shoulder imaging codes for the same diagnostic session is prohibited and will result in claim rejection.
Billing Tips
- Ensure the professional component is supported by a formal, dated report that explicitly lists the three or more views performed to satisfy the technical component documentation requirements.
Effective: April 1, 2025
D. Diagnostic Radiology
DIAGNOSTIC RADIOLOGY
Diagnostic
Diagnostic Radiology
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 this upon request by the MOH.
All insured services must be documented in appropriate records to establish that an insured service was provided, the service claimed is the service that was rendered, and the service was medically necessary.
The fee listed in the Schedule (25.60 / 11.60) represents the total fee and the professional component fee, respectively. The technical component is the difference between these two values.
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