R842 – Extra fascial and sub-fascial incompetent perforators by full fascial technique
OHIP Radiology Code — CARDIOVASCULAR SURGICAL PROCEDURES · Schedule of Benefits
Extra fascial and sub-fascial incompetent perforators by full fascial technique is a surgical procedure for varicose veins. This service is insured only when specific medical criteria are met. Insurance Conditions for Varicose Vein Surgery As outlined on page of the Schedule, surgical services for varicose veins are insured only when all of the following conditions are met: 1. Documented Incompetence: There must be incompetence (reflux) at the saphenofemoral junction or saphenopopliteal junction, documented by Doppler or duplex ultrasound scanning. 2. Failed Conservative Management: The patient must have failed a trial of conservative management lasting at least three months. Conservative management includes analgesics and prescription gradient support compression stockings. 3. Specific Clinical Conditions: The patient must have at least one of the conditions described in either category (a) or (b) below: a. One or more signs of chronic venous insufficiency: Eczema, Pigmentation, Lipodermatosclerosis, or Ulceration. b. Varicosities that result in one or more of the following: Ulceration secondary to venous stasis. One or more significant hemorrhages from a ruptured superficial varicosity (defined as a hemorrhage requiring iron therapy or transfusion). Two or more episodes of minor hemorrhage from a ruptured superficial varicosity. Recurrent superficial thrombophlebitis. Stasis dermatitis. Varicose eczema. Lipodermosclerosis. Unremitting edema or intractable pain interfering with activities of daily living and requiring chronic analgesic medication. This procedure has an anaesthesia value of 7 base units and a surgical assistant value of 6 base units, plus applicable time units for both.
When to Use
- Use R842 when performing sub-fascial ligation of incompetent perforators in patients who have failed a three-month trial of conservative management and demonstrate documented reflux at the saphenofemoral or saphenopopliteal junction.
- Use R842 specifically for patients presenting with objective signs of chronic venous insufficiency, such as lipodermatosclerosis, stasis dermatitis, or active ulceration, where the procedure is medically necessary to manage these complications.
Common Pitfalls
- Failing to document the specific three-month trial of conservative management, including the use of prescription gradient support compression stockings, is a frequent cause of audit recovery.
- Billing R842 without documented ultrasound evidence of reflux at the saphenofemoral or saphenopopliteal junction will lead to automatic rejection, as this is a mandatory requirement for all varicose vein surgical codes.
- Attempting to bill R842 for cosmetic improvement of asymptomatic varicosities without meeting the specific clinical criteria (e.g., recurrent thrombophlebitis or significant hemorrhage) is an ineligible service.
Billing Tips
- If performing a stripping procedure in the same operative session, ensure you add code E653 to your claim to receive the additional flat fee payment.
- Always ensure the specific clinical indication (e.g., 'recurrent superficial thrombophlebitis' or 'intractable pain interfering with ADLs') is clearly noted in the patient chart to support the medical necessity of the procedure.
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.
Documentation of a failed trial of conservative management of at least three months duration.
The patient has at least one of the conditions described in either a. or b. (One or more signs of chronic venous insufficiency: Eczema, Pigmentation, Lipodermatosclerosis, or Ulceration; OR Varicosities that result in one or more of the following: Ulceration secondary to venous stasis, One or more significant hemorrhages from a ruptured superficial varicosity, Two or more episodes of minor hemorrhage from a ruptured superficial varicosity, Recurrent superficial thrombophlebitis, Stasis dermatitis, Varicose eczema, Lipodermosclerosis, Unremitting edema or intractable pain interfering with activities of daily living and requiring chronic analgesic medication.)
1. Conservative management includes analgesics and prescription gradient support compression stockings.
2. Significant hemorrhage refers to a hemorrhage related to varicose veins that requires iron therapy or transfusion.
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