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X496
X496 – Multislice sequence - complex spine
OHIP Laboratory Code — MAGNETIC RESONANCE IMAGING (MRI) · Schedule of Benefits
A multislice sequence Magnetic Resonance Imaging (MRI) procedure for the complex spine, which involves imaging two or more non-adjoining segments. This code represents the primary scan. Repeat scans of another plane or using a different pulse sequence for the same study should be billed using X498 (maximum of 3 repeats).
When to Use
- Use X496 when performing a primary MRI scan that covers two or more non-adjoining spinal segments, such as a cervical and lumbar spine study.
- Use X496 as the base code for the initial complex spine sequence, ensuring that subsequent planes or pulse sequences for the same study are billed separately using X498.
Common Pitfalls
- Billing X496 for a single spinal segment or adjoining segments, which does not meet the definition of a complex spine study.
- Failing to use X498 for repeat scans or additional pulse sequences, leading to under-billing of the total study complexity.
- Attempting to bill X496 multiple times for the same patient encounter instead of utilizing the primary code plus the appropriate number of X498 repeat codes.
Billing Tips
- Always pair X496 with the correct number of X498 codes (up to a maximum of 3) to accurately reflect the total number of pulse sequences or planes performed during the complex spine examination.
- If gadolinium is administered during the complex spine study, ensure X487 is added to the claim to capture the additional fee for contrast use.
Provider Fee$0.00
Non-Anaesthetist Fee$101.65
Effective: April 1, 2025
Category
F. Magnetic Resonance Imaging (MRI)
Subcategory
MAGNETIC RESONANCE IMAGING (MRI)
Service Type
Diagnostic
Code Classes
Magnetic Resonance Imaging (MRI), Diagnostic Radiology
Referral RequiredFrom: Physician, NursePractitioner, OralMaxillofacialSurgeon
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