X224 – Knee including patella - three or four views
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
Knee including patella, three or four views. This is a diagnostic radiology procedure that is comprised of a technical component (the 'H' fee, claimed with suffix B) and a professional component (the 'P' fee, claimed with suffix C). The technical component covers the performance of the imaging, while the professional component covers the interpretation and report by a specialist.
When to Use
- Use X224 for standard knee imaging that includes the patella, specifically when 3 or 4 views are obtained to evaluate for fracture, dislocation, or degenerative changes.
- Choose X224 over X065 when the clinical protocol requires specific patellar views in addition to standard AP and lateral knee projections.
Common Pitfalls
- Failing to split the claim into suffix B for the technical component and suffix C for the professional component, which will result in an automatic rejection.
- Billing X224 for a single or two-view knee series, which should instead be coded under the appropriate lower-view diagnostic code.
- Attempting to bill the professional component (suffix C) for remote interpretations performed via PACS, as this is ineligible for the associated travel or special visit premiums.
Billing Tips
- Ensure the technical component (suffix B) is only claimed by the facility or physician who maintains the quality assurance and record-keeping requirements for the imaging equipment.
- When billing for urgent, non-elective hospital interpretations, ensure the patient's condition and the necessity for urgent management are clearly documented to support the use of C-series 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 the above upon request by the MOH.
The fee for X224 is split into a technical component ('H' fee: $9.90) and a professional component ('P' fee: $13.00).
For diagnostic services which have both technical and professional components listed under one fee schedule code, the technical and professional components are claimed separately. The claim for the technical component is submitted using the fee schedule code with the suffix B and the claim for the professional component is submitted using the fee schedule code with a suffix C.
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