R798 – Carotid aneurysm - reconstruction or excision with graft
OHIP Radiology Code — CARDIOVASCULAR SURGICAL PROCEDURES · Schedule of Benefits
A surgical procedure listed in the Urogenital System section of the Schedule of Benefits. Payment is made for the surgeon (suffix A), assistant (suffix B), and anaesthetist (suffix C). The fee for assistants and anaesthetists is calculated based on a combination of basic units and time-based units as per the rules outlined in the General Preamble (, ). Various premiums may apply, including those for after-hours services, patient age, and specific anaesthetic considerations. Payment for a second assistant requires authorization from a medical consultant as per .
When to Use
- Use R798 for the definitive surgical repair of a carotid aneurysm involving the excision of the aneurysmal segment and interposition of a graft.
- Use this code for elective carotid reconstructions where the primary intent is the restoration of vessel integrity via grafting, distinguishing it from simple endarterectomy procedures.
Common Pitfalls
- Billing R798 alongside other carotid procedures without clear documentation of distinct surgical sites or separate incisions, which may trigger a duplicate service rejection.
- Attempting to bill for a second assistant (suffix B) without prior medical consultant authorization, as R798 does not carry automatic eligibility for a second assistant under GP90.
- Failing to include the Injury Severity Score (ISS) in the medical record when attempting to claim the E420 trauma premium, which is a mandatory audit requirement.
Billing Tips
- Ensure the operative report explicitly details the use of a graft, as the code specifically covers reconstruction or excision with graft; simple primary repair without a graft may not align with this fee.
Effective: April 1, 2025
Q. Cardiovascular Surgical Procedures
CARDIOVASCULAR SURGICAL PROCEDURES
Surgical
Urogenital and Urinary Surgical Procedures
All insured services must be documented in appropriate records that establish: 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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