R801 – Descending aorta with or without temporary shunt
OHIP Radiology Code — CARDIOVASCULAR SURGICAL PROCEDURES · Schedule of Benefits
This service involves the surgical repair or excision of an aneurysm located in the descending thoracic aorta, followed by the placement of a graft. The procedure may include the use of a temporary shunt as needed. Payment for surgical assistant (suffix B) and anaesthetist (suffix C) services are calculated based on basic units plus time units as detailed in the Schedule of Benefits (pages , ). The service is eligible for various premiums, including after-hours and age-based increases.
When to Use
- Use R801 for open surgical repair or excision of a descending thoracic aorta aneurysm, regardless of whether a temporary shunt is utilized.
- Select R801 specifically for open procedures; do not use this code for endovascular aneurysm repair (EVAR), which is billed under the codes specified in section Q13.
Common Pitfalls
- Failing to append the E667 add-on code when the descending thoracic aorta aneurysm is documented as ruptured, which results in missed revenue.
- Attempting to claim the E420 trauma premium in conjunction with after-hours premiums; these are mutually exclusive and the claim will be rejected if both are submitted for the same service.
- Neglecting to document the Injury Severity Score (ISS) in the medical record when claiming the E420 trauma premium, which is a mandatory requirement for audit compliance.
Billing Tips
- Ensure the surgical assistant and anaesthesiologist units are calculated based on the major procedure (R801) when multiple procedures are performed under the same anaesthetic.
- Remember that a second surgical assistant is payable for R801 without prior authorization; simply bill the second assistant's services using the same logic as the primary assistant.
Effective: April 1, 2025
Q. Cardiovascular Surgical Procedures
CARDIOVASCULAR SURGICAL PROCEDURES
Surgical
Cardiovascular Surgical Procedures
All insured services must be documented in appropriate medical records to 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.
Second assistant's services are payable and authorization is not required.
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