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R797
R797 – Popliteal artery surgery
OHIP Radiology Code — CARDIOVASCULAR SURGICAL PROCEDURES · Schedule of Benefits
Performs an in-situ saphenous vein arterial bypass to the popliteal artery. This service is intended for procedures performed by one vascular surgeon. As a surgical service, this fee includes all constituent and common elements as outlined in the Schedule of Benefits (see -, for surgical assistant services, and for anaesthesiologist services).
When to Use
- Use R797 specifically for an in-situ saphenous vein arterial bypass procedure targeting the popliteal artery.
- Select R797 when the procedure is performed by a single vascular surgeon, as it is a comprehensive fee that includes all constituent surgical elements.
Common Pitfalls
- Billing R797 on the same day as R878 will result in an automatic rejection, as these codes are mutually exclusive.
- Failure to document the specific surgical technique (in-situ saphenous vein) can lead to audit recovery if the claim is flagged for review against other vascular bypass codes like R804.
- Attempting to bill constituent elements of the surgery separately is a common error; R797 is a global fee that encompasses the standard surgical components.
Billing Tips
- Ensure that if the procedure is performed after hours or on weekends, you append the appropriate E409 or E410 premium to the R797 claim to capture the 50% or 75% increase.
- If the patient meets the criteria for trauma (ISS > 15 for adults or > 12 for children), ensure the E420 trauma premium is submitted on the same claim as R797 to receive the 50% fee increase.
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