X228 – Calcaneus - three or more views
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
A diagnostic radiological examination of the calcaneus (heel bone), consisting of three or more views. This service is comprised of a professional component (interpretation by a physician, billed as the 'P' fee) and a technical component (the actual performance of the x-ray, billed as the 'H' fee).
When to Use
- Use X228 when clinical suspicion of a calcaneal fracture requires a comprehensive series of three or more views to visualize the bone from multiple angles.
- Use X228 instead of X068 when the diagnostic protocol mandates a third view, such as a tangential or axial projection, to rule out subtle pathology.
Common Pitfalls
- Billing X228 when only two views were performed, which should be billed as X068 to avoid audit recovery for over-servicing.
- Attempting to bill the technical component (H-fee) for an office-based X-ray, which is ineligible for payment under the Health Insurance Act.
Billing Tips
- Ensure you append the correct suffix to your claim: use suffix C for the professional interpretation component and suffix B for the technical component when performed in a hospital setting.
Effective: April 1, 2025
D. Diagnostic Radiology
DIAGNOSTIC RADIOLOGY
Diagnostic
Diagnostic Radiology
For services referred by a Nurse Practitioner, the referral must be authorized under the Nursing Act or permitted under the Regulated Health Professions Act.
For services referred by an Oral and Maxillofacial Surgeon, the test must be in connection with a dental surgical procedure in a hospital.
This service is for an examination of the calcaneus with three or more views. For two views, see billing code X068.
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