X413 – Computed tomography - Extremities - with IV contrast
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
This service is for a Computed Tomography (CT) scan of one or more extremities, which includes the use of intravenous (IV) contrast. It is a diagnostic radiology procedure.
When to Use
- Use X413 for CT imaging of the upper or lower extremities when IV contrast is clinically indicated to enhance vascular or soft tissue detail.
- Select X413 over X412 when the protocol specifically requires the administration of IV contrast for diagnostic accuracy.
- Apply this code for extremity CT studies performed in a hospital setting where the physician holds the technical component responsibility.
Common Pitfalls
- Failing to append the correct suffix (B for technical, C for professional) will result in automatic claim rejection.
- Billing X413 for a non-contrast study is a common audit trigger; ensure the contrast administration is clearly documented in the radiology report.
- Attempting to bill X413 alongside other extremity imaging codes without clear clinical justification for separate procedures can lead to recovery of funds.
Billing Tips
- Always ensure the technical component (X413B) and professional component (X413C) are submitted as separate line items to reflect the split-billing requirement.
- Verify that the referral source is documented as a physician, nurse practitioner, midwife, or oral maxillofacial surgeon to satisfy the mandatory referral requirement.
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.
The physician must have the necessary training and experience to personally render the technical component of the service.
The physician maintains documentation that describes the process by which the physician monitors quality assurance in accordance with professional standards.
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