E653 – Plus stripping
OHIP Surgical Assists Code — CARDIOVASCULAR SURGICAL PROCEDURES · Schedule of Benefits
An add-on surgical procedure for venous stripping, billed in conjunction with a primary varicose vein surgery (e.g., R842). Payment for this service is insured only when all of the following conditions, as detailed on :, are met: 1. There is incompetence (i.e. reflux) at the saphenofemoral junction or saphenopopliteal junction that is documented by Doppler or duplex ultrasound scanning; 2. The patient has failed a trial of conservative management of at least three months duration; and 3. The patient has at least one of several specified signs of chronic venous insufficiency or complications from varicosities.
When to Use
- Use E653 as an add-on to R842 when performing stripping of the long or short saphenous vein in patients with documented saphenofemoral or saphenopopliteal reflux.
- Apply this code when the primary procedure involves the surgical removal of varicose veins and the patient meets the strict criteria for chronic venous insufficiency, such as lipodermatosclerosis or stasis dermatitis.
Common Pitfalls
- Billing E653 as a standalone procedure will result in an automatic rejection, as it is strictly an add-on code requiring a primary surgical code like R842.
- Failure to explicitly document the three-month trial of conservative management, including the use of prescription gradient compression stockings, is a primary cause for audit recovery.
- Claiming E653 for cosmetic varicosities without documenting the required clinical complications (e.g., ulceration, recurrent thrombophlebitis, or significant hemorrhage) will lead to claim reversal.
Billing Tips
- Ensure your operative report explicitly references the pre-operative duplex ultrasound findings of reflux at the junction to satisfy the mandatory documentation requirement for E653.
- When billing E653 with a primary procedure, ensure the diagnosis code on the claim reflects the specific complication (e.g., venous ulcer or stasis dermatitis) to justify the medical necessity of the stripping.
Effective: April 1, 2025
Q. Cardiovascular Surgical Procedures
CARDIOVASCULAR SURGICAL PROCEDURES
Surgical
Cardiovascular Surgical Procedures
Documentation of incompetence (i.e. reflux) at the saphenofemoral junction or saphenopopliteal junction by Doppler or duplex ultrasound scanning.
Documentation of a failed trial of conservative management of at least three months duration.
Documentation of at least one of the qualifying signs of chronic venous insufficiency or complications from varicosities.
1. Conservative management includes analgesics and prescription gradient support compression stockings.
2. Significant hemorrhage refers to a hemorrhage related to varicose veins that requires iron therapy or transfusion.
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