R841 – Obliteration of A.V. fistula
OHIP Radiology Code — CARDIOVASCULAR SURGICAL PROCEDURES · Schedule of Benefits
R841 is a cardiovascular surgical procedure for the obliteration of an arterio-venous (A.V.) fistula. It is listed in the Cardiovascular Surgical Procedures section of the Schedule of Benefits under the Veins and Anastomosis subheadings. The fee for this service can be augmented with age-related premiums for patients under 16, after-hours premiums for the surgeon and anaesthetist, and a trauma premium under specific circumstances. The anaesthesia component of this service is calculated using a combination of base and time units.
When to Use
- Use R841 for the surgical ligation or excision of a non-functioning or failing arteriovenous fistula (AVF) created for hemodialysis access.
- Use this code when performing a formal surgical obliteration of a fistula that has developed complications such as high-output heart failure, distal ischemia (steal syndrome), or persistent infection.
Common Pitfalls
- Do not bill R841 on the same day as R942, as these services are mutually exclusive and will trigger an automatic rejection.
- Avoid billing R841 for simple percutaneous interventions or endovascular closures, as this code is specific to open surgical obliteration.
- Failure to document the specific clinical indication (e.g., steal syndrome or infection) can lead to audit scrutiny regarding the medical necessity of the procedure.
Billing Tips
- Ensure that if an assistant is required, you do not bill for one automatically; you must submit a letter of justification to the Ministry for approval under M400B.
- If the procedure is performed on an emergency basis after hours, ensure you append the correct E409 or E410 premium to the R841 claim to capture the 50% or 75% increase.
Effective: April 1, 2025
Q. Cardiovascular Surgical Procedures
CARDIOVASCULAR SURGICAL PROCEDURES
Surgical
Cardiovascular Surgical Procedures
Where no basic unit is listed opposite the service in the column headed with 'Asst' and where 'nil' is not listed opposite the service in the column headed with 'Asst', the number of basic units is that listed opposite the service under the column headed with 'Anae'. This type of service is only eligible for payment upon authorization by a medical consultant following submission of a letter from the surgeon outlining the reason the assistant was required. Submit claims for this type of service using fee code M400B.
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