X226 – Tibia and fibula - three or more views
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
This service is for a radiographic study of the tibia and fibula, which must include at least one adjacent joint (either the knee or the ankle). The procedure requires a minimum of three views to be taken. This service is listed under the Lower Extremities subsection of Diagnostic Radiology. For the two-view version of this procedure, see X066.
When to Use
- Use X226 when a full radiographic assessment of the tibia and fibula is required, specifically including at least three views and capturing one adjacent joint (knee or ankle).
- Select X226 over X066 when the clinical complexity necessitates a third view to adequately visualize a suspected fracture or pathology that two views cannot sufficiently demonstrate.
Common Pitfalls
- Billing X226 when only two views are performed; this is a direct violation of the code definition and will lead to audit recovery of funds.
- Failing to include at least one adjacent joint (knee or ankle) in the imaging, which renders the study incomplete and ineligible for X226 billing.
- Attempting to bill X226 in conjunction with separate knee or ankle series codes for the same limb, which constitutes unbundling.
Billing Tips
- Ensure your radiology report explicitly documents the inclusion of the required adjacent joint and the specific views taken to substantiate the three-view requirement.
- If the clinical request only necessitates two views, you must use X066; do not upcode to X226 to increase reimbursement.
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 physician has the necessary training and experience to personally render the technical component of the service.
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