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R822
R822 – Porto-caval anastomosis
OHIP Radiology Code — CARDIOVASCULAR SURGICAL PROCEDURES · Schedule of Benefits
Porto-caval anastomosis is a major cardiovascular surgical procedure. It involves the creation of a direct connection (anastomosis) between the high-pressure portal vein and the low-pressure inferior vena cava. This shunt diverts portal blood flow, reducing pressure in the portal venous system, which is a primary treatment for complications of portal hypertension, such as esophageal variceal bleeding.
When to Use
- Use R822 for the definitive surgical creation of a direct portocaval shunt to manage portal hypertension complications, such as refractory esophageal variceal hemorrhage.
- Select R822 when performing an open surgical anastomosis between the portal vein and the inferior vena cava, distinct from endovascular procedures like TIPS (which are billed under different diagnostic/interventional codes).
Common Pitfalls
- Do not bill R822 in conjunction with other major vascular reconstructions unless they are distinct, separate procedures; otherwise, the claim may be flagged for unbundling.
- Failure to document the specific anatomical approach and the clinical necessity for the shunt can lead to audit recovery, as this is a high-value surgical procedure.
Billing Tips
- Ensure that if the procedure is performed on an emergency basis after hours, you append the appropriate E409 or E410 premium to the R822 base fee to capture the full value of the service.
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