R839 – Internal iliac
OHIP Radiology Code — CARDIOVASCULAR SURGICAL PROCEDURES · Schedule of Benefits
Ligation of the internal iliac vein. This is a surgical procedure listed under Cardiovascular Surgical Procedures. When this service is for the treatment of varicose veins, it is only insured when specific criteria are met, including documented reflux, failure of conservative management, and the presence of significant symptoms or complications. Refer to the notes and requirements for the full list of conditions.
When to Use
- Use R839 for the surgical ligation of the internal iliac vein when clinically indicated for venous insufficiency or related pathology.
- Use this code when the patient meets the strict criteria for varicose vein treatment, specifically documented reflux at the saphenofemoral or saphenopopliteal junction via duplex ultrasound.
- Use R839 when the patient has failed at least three months of conservative management, including the use of prescription-grade compression stockings.
Common Pitfalls
- Billing R839 without explicit documentation of the required ultrasound findings (reflux at the saphenofemoral or saphenopopliteal junction) will result in automatic rejection.
- Failure to document the specific clinical condition from the approved list (e.g., lipodermatosclerosis, recurrent superficial thrombophlebitis, or intractable pain requiring chronic analgesics) is a primary audit risk.
- Billing R839 for cosmetic varicose vein treatment without evidence of the required chronic venous insufficiency signs or complications is non-insured and will be clawed back.
Billing Tips
- Ensure the patient's medical record explicitly states the duration and nature of the failed conservative management (e.g., '3 months of compression stockings and analgesics') to satisfy the Q19 requirements.
- If performing multiple procedures, ensure you identify the major procedure to correctly calculate the assistant and anaesthetist units, as R839 is not on the pre-approved list for multiple assistants.
Effective: April 1, 2025
Q. Cardiovascular Surgical Procedures
CARDIOVASCULAR SURGICAL PROCEDURES
Surgical
Cardiovascular Surgical Procedures
When performed for varicose veins, incompetence (i.e. reflux) at the saphenofemoral junction or saphenopopliteal junction must be documented by Doppler or duplex ultrasound scanning.
The following applies to surgical services (ligation/stripping) for the treatment of varicose veins involving the long and/or short saphenous vein(s): Surgical services are only insured when all of the following conditions are met: 1. There is incompetence (i.e. reflux) at the saphenofemoral junction or saphenopopliteal junction that is documented by Doppler or duplex ultrasound scanning; 2. The patient has failed a trial of conservative management of at least three months duration; and 3. The patient has at least one of the conditions described in either a. or b. below: a. One or more of the following signs of chronic venous insufficiency: i. Eczema; ii. Pigmentation; iii. Lipodermatosclerosis; iv. Ulceration b. Varicosities that result in one or more of the following: i. Ulceration secondary to venous stasis; ii. One or more significant hemorrhages from a ruptured superficial varicosity; iii. Two or more episodes of minor hemorrhage from a ruptured superficial varicosity; iv. Recurrent superficial thrombophlebitis; v. Stasis dermatitis; vi. Varicose eczema; vii. Lipodermosclerosis; viii. Unremitting edema or intractable pain interfering with activities of daily living and requiring chronic analgesic medication.
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