R809 – Femoral-popliteal endarterectomy
OHIP Radiology Code — CARDIOVASCULAR SURGICAL PROCEDURES · Schedule of Benefits
Femoral-popliteal endarterectomy is a surgical procedure to remove atheromatous plaque material from the femoral and popliteal arteries. This service is billable by the surgeon (suffix A), surgical assistant (suffix B), and anaesthesiologist (suffix C). - The surgeon's fee (A) is for the procedure itself. - The assistant's fee (B) is calculated based on 10 base units plus time units as described in . - The anaesthesiologist's fee (C) is calculated based on 10 base units plus time units as described in .
When to Use
- Use R809 for the primary surgical removal of atheromatous plaque specifically involving the femoral and popliteal arterial segments.
- Select R809 when performing an endarterectomy; do not use this code for bypass grafting procedures, which require different procedural codes.
- Use this code for the index procedure; if a secondary, distinct vascular procedure is performed on a different vessel during the same session, ensure it is billed separately according to the Schedule of Benefits.
Common Pitfalls
- Billing R809 in conjunction with R878 is prohibited as they are restricted codes; ensure your claim does not include both to avoid automatic rejection.
- Failure to document the specific arterial segments treated can lead to audit scrutiny regarding the appropriateness of the R809 fee versus other vascular codes.
- Assuming a second assistant is automatically payable; R809 is not on the list for automatic second assistant payment, requiring prior authorization and a letter of justification.
Billing Tips
- Ensure surgical assistants (suffix B) and anaesthesiologists (suffix C) correctly apply the relevant after-hours or trauma premiums (E400 series or E420) to their respective base units to maximize eligible revenue.
- When billing for anaesthesia (suffix C), remember to append applicable extra units for ASA physical status or emergency status (e.g., E020C) to the base units to reflect the complexity of the case.
Effective: April 1, 2025
Q. Cardiovascular Surgical Procedures
CARDIOVASCULAR SURGICAL PROCEDURES
Surgical
Cardiovascular Surgical Procedures
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