All codes
R804
R804 – Tibial artery surgery
OHIP Radiology Code — CARDIOVASCULAR SURGICAL PROCEDURES · Schedule of Benefits
An in-situ saphenous vein arterial bypass to a tibial artery, performed by one vascular surgeon. This code is used when one surgeon performs the procedure. This code is listed in the Cardiovascular Surgical Procedures section.
When to Use
- Use R804 for an in-situ saphenous vein arterial bypass specifically to a tibial artery when performed by a single surgeon.
- Use this code for primary revascularization procedures where the saphenous vein is left in its anatomical position and arterialized for distal bypass.
Common Pitfalls
- Billing R804 in conjunction with R766 or R767 will trigger an automatic rejection as these codes are mutually exclusive.
- Attempting to bill R804 for bypass procedures involving prosthetic grafts or non-tibial targets will lead to audit scrutiny and potential recovery of funds.
Billing Tips
- Ensure the operative report explicitly details the in-situ technique, as this is the defining clinical requirement for the R804 fee.
- If the procedure is performed after hours or involves trauma, ensure the appropriate premium codes (E409, E410, or E420) are appended to the same claim to maximize the procedural reimbursement.
Provider Fee$1,643.00
Surgical Assistant Fee$125.10
Anaesthetist Fee$263.33
Non-Anaesthetist Fee$263.33
Effective: April 1, 2025
Since Apr 2004, this fee has increased 10.2% vs 57.0% CPI inflation
Category
Q. Cardiovascular Surgical Procedures
Subcategory
CARDIOVASCULAR SURGICAL PROCEDURES
Service Type
Surgical
Code Classes
Cardiovascular Surgical Procedures
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