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R838
R838 – I.V.C. - transvenous (umbrella)
OHIP Radiology Code — CARDIOVASCULAR SURGICAL PROCEDURES · Schedule of Benefits
This procedure involves the transvenous placement of an umbrella-like filter into the inferior vena cava. As a surgical procedure, it is eligible for claims by the surgeon (suffix A), assistant (suffix B), and anaesthesiologist (suffix C). The base units for the assistant are 6, and for anaesthesia are 10. Time units are calculated based on the duration of the service as per the rules in the General Preamble (- for assistants, - for anaesthetists).
When to Use
- Use R838 for the percutaneous transvenous placement of an IVC filter when anticoagulation is contraindicated or has failed in a patient with documented venous thromboembolism.
- Use R838 as the primary procedure code for the surgical component of the filter insertion, distinct from any associated diagnostic venography or ultrasound guidance.
Common Pitfalls
- Billing R838B for a second assistant without prior authorization from a medical consultant will result in automatic rejection, as R838 is not on the pre-approved list for multiple assistants.
- Failing to document the specific start and end times for the surgical assistant or anaesthesiologist, which are required to calculate the time-based units correctly beyond the base units.
- Attempting to claim E420 (Trauma Premium) alongside after-hours premiums (E409/E410); these are mutually exclusive and cannot be submitted on the same claim.
Billing Tips
- Ensure the surgical assistant submits R838B as the base unit code to trigger the correct calculation of time-based units, as the total fee is derived from the sum of base and time units multiplied by the unit fee.
- Verify that the anaesthesia claim includes the appropriate extra unit codes (e.g., E022C for ASA status) to maximize the anaesthetic fee, as R838 is a surgical procedure eligible for these modifiers.
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