X230 – Toe - three or more views
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
This service provides for a diagnostic radiological examination of a patient's toe, consisting of three or more views. The professional component (P) is for the physician's interpretation and report. The technical component (H) covers the cost of the facility, equipment, and staff to perform the imaging, and is subject to specific payment rules when performed in a hospital setting as detailed in .
When to Use
- Use X230 when a minimum of three distinct radiographic views of a toe are performed and interpreted for diagnostic purposes.
- Use X230 for trauma or suspected fracture cases where standard two-view protocols (often covered under lower-intensity codes) are clinically insufficient to visualize the pathology.
Common Pitfalls
- Billing X230 when fewer than three views are captured; ensure the radiology report explicitly documents the number of views to support the claim during an audit.
- Attempting to claim the technical component (H) for hospital in-patients or out-patients admitted within 24 hours, which is strictly prohibited under GP11 rules.
- Double-billing X230 alongside other foot or toe imaging codes for the same anatomical site during the same encounter without clear clinical justification for separate procedures.
Billing Tips
- Always verify if the facility is a hospital setting before claiming the technical component (H), as the $14.90 fee is only payable for non-hospital, non-admitted patient services.
- Ensure the professional component (P) is billed only after the formal interpretation and report are completed and filed in the patient's record.
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.
All insured services must be documented in appropriate records to establish that the service was provided, was medically necessary, and is the service for which the account is submitted.
The fee listed as 'P' represents the professional component for the physician's interpretation and report. The fee is $9.05.
The fee listed as 'H' represents the technical component. The fee is $14.90. This component is not eligible for payment if the service is rendered to a hospital in-patient, or to an out-patient who is admitted to the hospital within 24 hours for the same condition. It is also not eligible for payment if rendered outside of a hospital (See ).
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