R796 – Carotid body tumor or aneurysm repair
OHIP Radiology Code — CARDIOVASCULAR SURGICAL PROCEDURES · Schedule of Benefits
This code represents a surgical procedure listed in the Digestive System section of the Schedule of Benefits. The surgeon bills this code with suffix A. Assistant services are claimed with suffix B and anaesthesia services with suffix C. Assistant and anaesthesia fees are calculated using basic units plus time-based units as per the rules in the General Preamble (, ). Various premiums may apply, including age-based premiums for specific age groups (), after-hours premiums for non-elective procedures (E409/E410, E400B/E401B, E400C/E401C), special visit premiums (, ), and the trauma premium (E420) ().
When to Use
- Use R796 for the surgical excision of a carotid body tumor (chemodectoma).
- Use R796 for the surgical repair of a carotid artery aneurysm.
Common Pitfalls
- Billing R796 alongside other vascular procedures on the same vessel may trigger a 'multiple procedure' reduction or rejection; ensure you are not unbundling components of the repair.
- Failure to document the Injury Severity Score (ISS) in the patient record will result in the automatic rejection of the E420 trauma premium even if the procedure was trauma-related.
Billing Tips
- Always verify the start time of the procedure to ensure after-hours premiums (E409/E410) are claimed correctly based on the commencement time, not the completion time.
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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