X108

PDF page 361 / D3

DIAGNOSTIC RADIOLOGY
 PREAMBLE
  14. Three or more views of the chest should not be done routinely and claimed when a chest
      examination is requested.
    15. Chest studies should not be routinely done and claimed in mammography cases.
    16. Fluoroscopy claims should not be submitted for any examination performed by the radiologist
        where fluoroscopy is generally regarded as an integral part of the examinations e.g.
        examinations of the GI tract, urinary tract, and special procedures.
    17. ‘Colon - air contrast’ may be claimed when performed according to generally accepted criteria.
        The colon should be scrupulously prepared. Five to eight full size views of the abdomen should
        be obtained after fluoroscopically controlled introduction of air and barium.
    18. ‘Oesophagus, stomach and duodenum - double contrast’ presupposes the introduction of gas,
        the use of antifoam agent and a suitable barium mixture.
    19. 'Pharynx and oesophagus - cine or videotape' (X106) should not be claimed routinely with X108
        and X109 but only when specifically indicated.
    20. Abdomen and chest studies should not be routinely done and claimed in gastrointestinal
        examinations.
    21. Abdomen and/or pelvis should not be routinely claimed in lumbar spine examination requests.
    22. A survey film of the abdomen is a single view. The ordering of additional films should be left to
        the discretion of the radiologist who should have the power to determine what examination is
        adequate for a specific patient. Obviously, if progress of a long tube is being followed, a survey
        film is sufficient. If, however, an intestinal obstruction is being followed, a single film is usually
        inadequate.
    23. No extra fee should be claimed for rapid sequence intravenous pyelogram (IVP).
    24. Nephrotomography is covered by the listings for IVP and planigram.
    25. Preoperative and Routine Chest X-rays
        a. The technical and professional fee components for chest x-ray, X090, X091 and X092 are
           not eligible for payment in the routine preoperative preparation or screening of a patient for
           non-cardiac, non-thoracic surgery, unless there is a clinical indication requiring a chest x-ray
           other than solely for preoperative preparation or screening of the patient.
        [Commentary:
        Examples of indications could include but are not limited to:
        1.suspected active airway or airspace disease
        2.workup of shortness of breath
        3.metastatic workup]
        b. The technical and professional fee components for chest x-ray, X090, X091 and X092 are
           only eligible for payment when rendered for a patient who has symptoms, signs or an
           indication supported by current clinical practice guidelines relevant to the individual patient’s
           circumstances.
         [Commentary:
         Routine chest x-rays for screening or for admission to hospital without clinical indication are not
         payable.]
    26. X-ray or CT studies of the lumbar spine should not be routinely ordered or rendered for low back
        pain without suspected or known pathology.

PDF page 369 / D11

DIAGNOSTIC RADIOLOGY
 GASTROINTESTINAL TRACT
                                                                                                       H      P
     Palatopharyngeal analysis
   X105 - cine or videotape ................................................................          29.50   40.25
     Pharynx and oesophagus
   X106 - cine or videotape ................................................................          29.50   40.25
   X107 Oesophagus when X103, X104, X108 or X109 not claimed...                                       26.70   32.80
     Oesophagus, stomach and duodenum
   X108 - including survey film, if taken .............................................               46.30   41.65
   X104 - double contrast, including survey film, if taken...................                         48.50   50.65
   X103 - double contrast, including survey film, if taken, and small
          bowel ..................................................................................    60.95   63.75
   X110 Hypotonic duodenogram.........................................................                39.35   35.95
   X109 Oesophagus, stomach and small bowel .................................                         59.10   54.35
     Small bowel only
   X111 - when only examination performed during patient’s visit.....                                 26.40   23.80
     Colon
   X112 - barium enema including survey film, if taken .....................                          48.40   32.10
   X113 - air contrast, primary or secondary, including survey films, if
           taken...................................................................................   61.30   54.35
     Gallbladder
   X114 - one or multiple day examinations.......................................                     29.95   12.65
   X120 - one or multiple day examinations with preliminary plain film                                39.80   12.65
   X116 T-tube cholangiogram .............................................................            21.70   10.80
   X117 Operative cholangiogram........................................................               21.70   12.10
   X123 Operative pancreatogram or ERCP........................................                       21.70    9.80

Master, record 6559. Record Layout PDF, page 1.

X10820260401999999990000000000000000579500000000000000000000000000000416500

Auxiliary master fields are preserved as raw scaled values. The linked layout calls them zero-filled, but this edition contains non-zero values. They are not presented as final dollar fees or PDF units.