X225 – Knee including patella - five or more views
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
This is a diagnostic radiology procedure for the lower extremities involving a comprehensive examination of the knee, including the patella, through five or more X-ray views. As per , the service is composed of a technical component (H fee) and a professional component (P fee). The technical component covers the use of equipment and personnel, while the professional component covers the physician's interpretation and report.
When to Use
- Use X225 when a comprehensive knee series requires five or more distinct projections, such as AP, lateral, oblique, and specialized patellar views (e.g., Merchant or Sunrise views).
- Use this code for complex trauma or orthopedic assessments where standard knee series (X224) are insufficient to visualize the patellofemoral joint or complex fractures.
Common Pitfalls
- Billing X225 when only four views are performed; ensure the technical documentation explicitly confirms five or more views were acquired to avoid audit recovery.
- Attempting to bill X225 in conjunction with other special visit premiums for services rendered via PACS; these are strictly excluded as per GP105.
Billing Tips
- Ensure the technical report clearly lists the specific projections used to justify the 'five or more' requirement, as this is the primary documentation trigger for this specific code.
- If the patient is under 16, remember to apply the appropriate age-based premium percentage to the professional component, as X225 is eligible for these modifiers under Part K-Z rules.
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 service, including data acquisition, reporting, and record keeping, and must be able to demonstrate this upon request by the MOH. Source: :.
For payment of the trauma premium E420, the medical record must list the patient's Injury Severity Score (ISS). Source: :.
For special visit premiums for non-elective diagnostic services, the time at which the special visit takes place must be documented on the medical record. Source: :. Additionally, the request for interpretation must relate to a patient's condition requiring urgent interpretation that affects the patient's management. Source: :.
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