R815 – Arterioplasty with or without patch graft including microvascular anastomosis, arterial or venous
OHIP Radiology Code — CARDIOVASCULAR SURGICAL PROCEDURES · Schedule of Benefits
Total proctocolectomy with ileal reservoir (e.g. 'J' pouch). This is a major surgical procedure involving the removal of the colon (colectomy), rectum (proctectomy), and anus. This procedure is followed by the construction of an ileal reservoir, commonly known as a 'J' pouch, which is a reservoir created from the end of the small intestine (ileum) and connected to the anal canal to allow for fecal continence. This service is claimable by the surgeon (R815A), a surgical assistant (R815B), and an anaesthesiologist (R815C). Notably, a second assistant's service is eligible for payment for this procedure without requiring special authorization from a medical consultant, as specified on page of the Schedule of Benefits.
When to Use
- Use R815 for the definitive surgical creation of an ileal reservoir (J-pouch) following a total proctocolectomy.
- This code is the primary procedure code for the entire complex reconstruction, encompassing the proctectomy and the ileal reservoir construction.
Common Pitfalls
- Billing R815 alongside other colorectal resection codes is often rejected as the procedure is considered comprehensive; ensure no unbundling occurs.
- Failure to append the correct suffix (A, B, or C) for the surgeon, assistant, or anaesthesiologist will result in an automatic claim rejection.
- Assuming a second assistant requires manual pre-authorization; R815 is explicitly exempt from this requirement per GP90.
Billing Tips
- When billing for a second assistant, ensure the claim is submitted with the same procedure code R815B to trigger the automatic payment rule for the second assistant.
- Always verify if the procedure qualifies for age-based premiums or after-hours premiums (E409/E410) to maximize the procedural fee beyond the base $581.85.
Effective: April 1, 2025
Q. Cardiovascular Surgical Procedures
CARDIOVASCULAR SURGICAL PROCEDURES
Surgical
Digestive System Surgical Procedures, Surgical Assistants' Services, Anaesthesiologists' Services
When more than one assistant was required for a surgical procedure, unless the service is listed below, the second assistant's service is only eligible for payment following authorization by a medical consultant and requires submission of a letter from the surgeon outlining the reason the second assistant was required. R815 is a service where a second assistant's service is payable and authorization is not required.
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