R837 – Multiple ligation and avulsion
OHIP Radiology Code — CARDIOVASCULAR SURGICAL PROCEDURES · Schedule of Benefits
Multiple ligation and avulsion is a surgical procedure for treating varicose veins. To be an insured service, it must meet specific criteria, including documented incompetence at the saphenofemoral or saphenopopliteal junction via Doppler or duplex ultrasound, a trial of conservative management for at least three months that has failed, and the presence of specific signs of chronic venous insufficiency or significant symptoms from the varicosities as outlined in the Schedule of Benefits.
When to Use
- Use R837 when performing surgical ligation and avulsion for patients with documented saphenofemoral or saphenopopliteal reflux who have failed a minimum of three months of conservative management including compression stockings.
- Use R837 for patients presenting with objective signs of chronic venous insufficiency such as lipodermatosclerosis, stasis dermatitis, or active ulceration secondary to venous stasis.
Common Pitfalls
- Billing R837 without explicit documentation of a three-month trial of conservative management, which is a mandatory requirement for the service to be considered insured.
- Failing to document the specific ultrasound findings of reflux at the saphenofemoral or saphenopopliteal junction, as this is the primary diagnostic requirement for audit compliance.
- Billing R837 for purely cosmetic varicose veins, which are explicitly excluded from OHIP coverage under the Schedule of Benefits.
Billing Tips
- Ensure the medical record contains a clear statement of the failed conservative management trial and the specific ultrasound report confirming junctional incompetence to prevent claim rejection or clawbacks.
Effective: April 1, 2025
Q. Cardiovascular Surgical Procedures
CARDIOVASCULAR SURGICAL PROCEDURES
Surgical
Cardiovascular Surgical Procedures
Incompetence (i.e. reflux) at the saphenofemoral junction or saphenopopliteal junction must be documented by Doppler or duplex ultrasound scanning.
Conservative management includes analgesics and prescription gradient support compression stockings.
Significant hemorrhage refers to a hemorrhage related to varicose veins that requires iron therapy or transfusion.
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