What does Diagnostic radiology (33) bill under OHIP?

Diagnostic radiology services are split into professional and technical components:

• The professional component (P) covers clinical supervision, performance of non-separately billable procedures (e.g. contrast injections that are integral to the study), fluoroscopy, post-procedure monitoring, interpretation and reporting.

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• The technical component (H) covers preparing the patient, performing the diagnostic procedure, providing equipment, supplies, staff, records and communication with the radiologist and patient/patient’s representative.

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Claims are submitted as:

• Professional (P) = fee code with suffix C

• Technical (H) = fee code with suffix B

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Key points for Diagnostic radiology (33):

• Imaging services – X-ray, CT, MRI, ultrasound and interventional procedures, generally billed as a fixed fee (no anaesthesia-style “basic + time unit” formula).

• Radiology consultations & second opinions – A335/A365, A330/A332, C335/C365, C330/C332.

• Minor assessments – A331, A338 when procedures are cancelled or not done.

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• After-hours work – Non-elective diagnostic special-visit premiums (C102–C110, C105–C107) and urgent CT/MRI interpretation premiums (E406–E408).

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Which consultation codes can Diagnostic radiology bill?

Diagnostic radiology (33) has its own consultation and second-opinion listings, plus access to a special interventional consultation.

A335 – Diagnostic radiology consultation

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• The service includes the specific elements of diagnostic radiology professional component, or

• A radiologist is required to make a special visit (evening/night/weekend/holiday) to advise whether a diagnostic procedure should be done and the procedure is ultimately not done, or

• A radiologist is required to render an opinion prior to certain interventional procedures (J021, J025, J040, J041, J046, J048, J049, J050, J055, J056, J057, J058, J059, J063, J065, J066, N107, N118, N122, N125, S233, Z446, Z456, Z562, Z594) and all consultation conditions are met.

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• A diagnostic radiology consultation is not payable when radiographs from another facility are used only for comparison.

• A335 is not eligible for CT/MRI services – second-opinion codes A330/A332 are used instead.

A365 – Special interventional radiological consultation

A365 is billed when, due to the complexity/seriousness of the problem, the radiologist must spend ≥ 50 minutes with the patient in consultation, in the context of an interventional radiological problem. Time used for other billable procedures is excluded from the 50-minute minimum.

Radiology CT/MRI second-opinion consultations

These capture the “second-opinion” consult role for CT/MRI:

• A330 – Radiology second opinion of CT study, per study

• A332 – Radiology second opinion of MRI study, per study

Key rules:

• Not eligible when outside images are only for comparison with local CT/MRI images.

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• Maximum one of each (A330, A332) per study per patient per 30-day period.

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• CT/MRI “study” regions are precisely defined (head, neck, thorax, abdomen, pelvis, extremities [one or more], spine [one or more segments], plus breast(s) for MRI).

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• After-hours CT/MRI premiums E406–E408 are not eligible with A330/A332.

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In-patient (C-prefix) radiology consultations and second opinions

For in-patients, use C-prefix equivalents:

• C335 – Consultation (same conditions as A335).

• C365 – Special interventional radiological consultation (same conditions as A365).

• C330 – Radiology second opinion of CT study, per study (same conditions as A330).

• C332 – Radiology second opinion of MRI study, per study (same conditions as A332).

These are used for hospital in-patients when the consult/second-opinion criteria are met and the patient status is in-patient.

Which assessment or visit codes does Diagnostic radiology use?

Radiologists also bill minor assessments when they assess a patient but a planned procedure is not performed.

A331 – Minor assessment (planned procedure cancelled)

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A338 – Minor assessment (procedure deemed inadvisable)

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Both A331 and A338 have the same fee and are used instead of a consultation when the interaction is focused and the procedure is cancelled or not performed.

C335 – In-patient consultation

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Frequency / limitation highlights:

• A330/A332 are limited to one each per study per patient per 30 days and cannot be combined with E406–E408.

• A335 is not payable for CT/MRI services; use A330/A332 or C330/C332 for those modalities.

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• A331/A338 are only eligible when no diagnostic radiology procedure is rendered in that encounter.

How do Diagnostic radiology “components” and time-related premiums work?

Unlike Anaesthesia, Diagnostic radiology does not use “basic units + time units” for each study. Instead, each imaging service has:

• A fixed fee for the procedure,

• Divided into professional (P) and technical (H) components,

• Plus potential after-hours special visit or urgent interpretation premiums.

Professional vs technical components

From the Diagnostic Radiology preamble:

• Professional component (P) = clinical supervision, associated clinical tasks, interpretation, report.

• Technical component (H) = patient prep, performing the study, equipment and staff, supplying records.

• Professional is claimed as code + C suffix; technical as code + B suffix.

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Time-related premiums: urgent CT/MRI interpretation via PACS

The SoB adds specific after-hours urgent CT/MRI interpretation premiums for radiologists interpreting studies remotely via PACS:

• Physician must be physically in Ontario at a location other than the hospital where the patient is imaged, and interpret via PACS/DICOM-compliant workstation.

• Premiums (payable in addition to the CT/MRI service):

  • E406 – Evenings (17:00–24:00) Monday–Friday – $60.00.

  • E407 – Saturdays, Sundays or Holidays daytime/evening (07:00–24:00) – $75.00.

  • E408 – Nights (00:00–07:00) – (fee shown in table; same section as E406/E407).

• Important: E406–E408 are not payable with A330/A332 radiology CT/MRI second opinions.

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Non-elective diagnostic special visit premiums (C102–C110, C105–C107)

These are special visit premiums when a radiologist attends hospital after hours to perform or interpret urgent diagnostic services:

• Apply to non-elective diagnostic services (Diagnostic Radiology, Nuclear Medicine, MRI, Ultrasound, etc.) for in-patients, out-patients or ED patients.

• Payable when the radiologist makes a special visit to the hospital to interpret results, perform a procedure, render a consultation, or conclude that a procedure is not indicated.

• Not payable for services rendered outside hospital (e.g. via PACS from home), and only one “person seen” premium per patient per special visit.

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Premium table:

• Travel premiums: C102 / C103 / C104 (evening, weekend, night travel).

• First person seen: C109 (evenings), C108 (weekends/holidays daytime–evening), C110 (nights).

• Additional person(s) seen: C105/C106/C107.

After-hours procedure premiums E409/E410/E412/E413

General after-hours procedure premiums may be relevant to radiologists when they are the proceduralist for a qualifying invasive diagnostic procedure:

• E412/E413 – For Emergency Department physicians (H-prefix services); increase procedural fee by 20% (evenings/weekends) or 40% (nights).

• E409/E410 – For non-ED physicians (including radiologists when they are the proceduralist); increase procedural fee by 50% (evenings/weekends) or 75% (nights).

They apply to non-elective procedures and delayed elective procedures meeting the GP104 criteria and are separate from the diagnostic special-visit premiums and E406–E408 CT/MRI PACS premiums.

Which Diagnostic radiology procedures and fee groups are most important?

Radiologists in Ontario typically provide:

• Plain radiography (X-ray) – multiple body regions (chest, abdomen, extremities, spine) with P/H fees.

• CT and MRI – including urgent PACS interpretation, second opinions (A330/A332, C330/C332), and after-hours premiums E406–E408.

• Ultrasound and nuclear medicine – within Diagnostic Radiology and Nuclear Medicine sections, eligible for non-elective diagnostic special visit premiums when urgent.

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• Interventional radiology procedures – where A365/C365 consultations may apply, plus potential use of E409/E410 if the radiologist is the proceduralist for a qualifying intervention.

Typical Diagnostic radiology (33) billing touch-points:

• CT/MRI second opinions (A330/A332, C330/C332).

• Minor assessments when a planned procedure is cancelled or not done (A331/A338).

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• Consultations for complex interventional cases (A335/A365, C335/C365).

• After-hours urgent CT/MRI interpretations via PACS (E406–E408).

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• Non-elective diagnostic special visit premiums for in-hospital urgent imaging (C102–C110, C105–C107).

Which premiums and add-ons apply to Diagnostic radiology?

For Diagnostic radiology (33), the important add-ons are:

1. Diagnostic special visit premiums – C102–C110, C105–C107 for non-elective diagnostic work in hospital.

2. Urgent CT/MRI interpretation premiums – E406, E407, E408 for PACS-based urgent reporting.

3. After-hours procedure premiums – E409/E410/E412/E413 where a radiologist is the proceduralist for a qualifying non-elective procedure.

Remember:

• Non-elective diagnostic special visit premiums are not payable for services rendered outside hospital (e.g. remote PACS from home).

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• Only one special visit person-seen premium per patient per special visit, regardless of how many eligible services are done.

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• E406–E408 are not payable with A330/A332 second-opinion codes.

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Common Diagnostic radiology (33) billing scenarios

Scenario 1 – Urgent CT head at night with PACS interpretation

Situation
At 01:30 (weeknight), a patient with suspected intracranial bleed undergoes CT head at Hospital A. A radiologist at Hospital B (physically in Ontario) interprets the CT via PACS.

Possible billing

• CT head professional component (CT code + C suffix).

• CT head technical component (if billed by Hospital A, CT code + B suffix).

• E408 – Night urgent CT/MRI interpretation via PACS in addition to the CT service.

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Why it’s allowed

• Radiologist is physically in Ontario, interpreting via PACS from another site, matching E406–E408 conditions.

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• E408 is payable in addition to the CT fee; A330 is not used because this is an urgent primary interpretation, not a second opinion.

Scenario 2 – Planned fluoroscopic procedure cancelled after radiology assessment

Situation
A patient is scheduled for a fluoroscopic diagnostic study. The radiologist reviews the patient on a non-emergent basis, determines the procedure cannot safely proceed due to cooperation and access issues, and no other radiology procedure is done.

Possible billing

• A331 – Minor assessment (planned diagnostic radiology procedure cancelled due to procedural difficulties and patient cooperation, with no other radiology performed).

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Why it’s allowed

• The SoB definition of A331 is exactly this scenario: non-emergent evaluation leading to cancellation/deferral of a planned diagnostic radiology procedure with no other radiology rendered.

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Scenario 3 – CT second opinion with minor assessment, not urgent

Situation
A radiologist at Site A has already reported a CT abdomen. The referring surgeon wants a second opinion from a radiologist at Site B; the patient is subsequently seen in clinic and the planned repeat CT is deemed unnecessary.

Possible billing (Site B radiologist)

• A330 – Radiology second opinion of CT study, per study – if all second-opinion criteria are met and the CT images are from a different institution.

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• A338 – Minor assessment – if the radiologist also sees the patient in a non-emergent setting and decides the proposed repeat diagnostic procedure is not indicated and is not done.

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Why it’s allowed

• A330 covers the remote second opinion of CT images from another institution.

• A338 applies when the radiologist evaluates the patient about advisability of a diagnostic radiological procedure which eventually is not done.

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• E406–E408 are not payable because this is not urgent after-hours PACS interpretation.