E655 – Re-operation for failed vascular grafts
OHIP Surgical Assists Code — CARDIOVASCULAR SURGICAL PROCEDURES · Schedule of Benefits
A surgical procedure for the re-operation for failed vascular grafts, involving the repair or replacement of an existing prosthesis. This service is applicable only when performed more than one month after the original operation. This service is performed by a surgeon (suffix A). Anaesthesia services (suffix C) are payable on an Independent Consideration basis by comparing to a procedure with similar complexity as no base units are assigned (see ). Assistant services (suffix B) are not eligible for payment (see ).
When to Use
- Use E655 for the surgical revision or replacement of a vascular prosthesis that has failed, provided the index procedure occurred at least 30 days prior.
- Select this code for re-operation scenarios involving graft infection, pseudoaneurysm, or graft occlusion where the original graft requires surgical intervention.
Common Pitfalls
- Billing E655 for procedures performed within 30 days of the initial surgery, which will trigger an automatic rejection as it falls within the global surgical period.
- Attempting to bill for a surgical assistant (suffix B) will result in a claim rejection, as assistant services are explicitly ineligible for this code.
- Failure to submit for Independent Consideration (IC) for anaesthesia (suffix C) will result in zero payment for the anaesthetist, as no base units are assigned to this code.
Billing Tips
- When billing for anaesthesia (suffix C), you must provide a written request for Independent Consideration and include a comparison to a procedure of similar complexity to justify the unit value.
- Ensure the operative report clearly documents the date of the original graft placement to satisfy the 'greater than one month' requirement and avoid audit recovery.
Effective: April 1, 2025
Q. Cardiovascular Surgical Procedures
CARDIOVASCULAR SURGICAL PROCEDURES
Surgical
Cardiovascular Surgical Procedures
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