X223 – Femur including one joint - three or more views
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
A diagnostic radiological examination of the femur, including one adjacent joint (hip or knee), requiring three or more views. This service comprises a professional component ('P' fee) for the physician's interpretation and report, and a technical component ('H' fee) for the hospital's service of performing the x-ray.
When to Use
- Use X223 when the imaging request specifically mandates a femur series that includes either the hip or the knee joint with at least three radiographic views.
- Select X223 for post-operative orthopedic assessment of femoral hardware where the field of view must encompass the femur and one adjacent joint to confirm alignment or integrity.
Common Pitfalls
- Billing X223 when only two views are performed; the code strictly requires three or more views to be eligible for payment.
- Attempting to bill X223 in conjunction with separate joint codes (e.g., knee or hip series) for the same anatomical region, which constitutes unbundling.
- Submitting X223 for a femur-only study without the inclusion of the adjacent joint, which should instead be coded under a different diagnostic radiology code.
Billing Tips
- Ensure the radiology report explicitly documents the inclusion of the adjacent joint and the number of views to satisfy the audit requirements for the technical component.
- When billing for urgent after-hours interpretations, verify that the clinical documentation supports the 'urgent' nature of the request to justify the application of Special Visit Premiums.
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.
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