X402 – Complex head - without IV contrast
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
A complex computed tomography (CT) scan of the head, performed without intravenous contrast. The definition of 'Complex head' is detailed in the Diagnostic Radiology Preamble, paragraph 9.
When to Use
- Use X402 when the CT head protocol requires specialized imaging parameters for complex pathology such as orbital, petrous temporal bone, or pituitary fossa investigations as defined in the Diagnostic Radiology Preamble.
- Select X402 instead of the standard X400 when the clinical indication necessitates high-resolution thin-section imaging or multi-planar reconstructions that meet the 'Complex' criteria.
Common Pitfalls
- Billing X402 for routine non-contrast head CTs that do not meet the specific anatomical or technical complexity requirements outlined in paragraph 9 of the Diagnostic Radiology Preamble will result in audit recovery.
- Attempting to bill X402 in conjunction with contrast-enhanced codes like X401 or X405 is a billing error, as X402 is strictly for non-contrast studies.
Billing Tips
- When performing an acute stroke investigation, ensure E874 is appended to X402 if a perfusion study is conducted, provided the interpretation is rendered immediately to guide therapeutic decisions.
Effective: April 1, 2025
D. Diagnostic Radiology
DIAGNOSTIC RADIOLOGY
Diagnostic
Diagnostic Radiology
All insured services must be documented in the medical record to establish that an insured service was provided, the service claimed is the service rendered, and the service was medically necessary as per .
The criteria for a 'Complex head' CT must be met, as defined in the Diagnostic Radiology Preamble, paragraph 9.
Complex head (see Diagnostic Radiology Preamble, paragraph 9).
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