R792 – Carotid endarterectomy, with or without bypass graft
OHIP Radiology Code — CARDIOVASCULAR SURGICAL PROCEDURES · Schedule of Benefits
This procedure involves the surgical removal of atherosclerotic plaque from the carotid artery to improve blood flow to the brain and reduce the risk of stroke. It may include the use of a bypass graft. Payment for surgical assistant (suffix B) and anaesthesiologist (suffix C) services are calculated based on basic units plus time units as described in the Schedule of Benefits.
When to Use
- Use R792 for the primary surgical removal of atherosclerotic plaque from the carotid artery, regardless of whether a bypass graft is utilized.
- Use R792 in conjunction with add-on code E665 specifically when a patch graft is incorporated into the carotid endarterectomy procedure.
Common Pitfalls
- Billing R792 with R815 on the same day will result in a rejection, as these services are mutually exclusive per the Schedule of Benefits.
- Attempting to bill for a hospital admission assessment is a common error; only the 'major pre-operative visit' (consultation or assessment) is eligible for payment when the decision to operate is finalized.
- Failing to document the Injury Severity Score (ISS) in the medical record will lead to the rejection of the E420 trauma premium, even if the clinical criteria for trauma are met.
Billing Tips
- Always append E665 to your claim for R792 when a patch graft is used to ensure you receive the additional $419.00 fee.
- If a second surgical assistant is required, you must obtain prior authorization from a medical consultant and submit a formal letter of justification, as R792 is not pre-approved for secondary assistance.
Effective: April 1, 2026
Q. Cardiovascular Surgical Procedures
CARDIOVASCULAR SURGICAL PROCEDURES
Surgical
Digestive System Surgical Procedures
All insured services must be documented in appropriate records. The Act requires that the record establish that: 1. an insured service was provided; 2. the service for which the account is submitted is the service that was rendered; and 3. the service was medically necessary.
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