R844 – Recurrent varicose veins - multiple ligation and/or stripping
OHIP Radiology Code — CARDIOVASCULAR SURGICAL PROCEDURES · Schedule of Benefits
Recurrent varicose veins - multiple ligation and/or stripping. As per , surgical services (ligation/stripping) for the treatment of varicose veins involving the long saphenous and/or short saphenous vein(s) 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: - Eczema - Pigmentation - Lipodermatosclerosis - 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; - 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.
When to Use
- Use R844 when performing ligation and stripping for recurrent varicose veins where the patient has documented saphenofemoral or saphenopopliteal junction incompetence via duplex ultrasound.
- Use this code for patients who have failed at least three months of conservative management (analgesics and prescription compression stockings) and present with objective signs like lipodermatosclerosis or venous ulceration.
Common Pitfalls
- Billing R844 without explicit documentation of the three-month conservative management trial is a primary cause for audit recovery.
- Claiming R844 for purely cosmetic varicosities without meeting the specific clinical criteria (e.g., hemorrhage, ulceration, or unremitting pain) will result in rejection.
- Failing to document the specific ultrasound findings confirming reflux at the junction level, as this is a mandatory requirement under Section Q19.
Billing Tips
- Ensure the medical record explicitly links the surgical necessity to the failed conservative management trial and the specific complication (e.g., recurrent superficial thrombophlebitis) to satisfy OHIP's strict coverage criteria.
- If performing bilateral procedures, ensure the claim reflects the correct multiple procedure rules, as R844 is subject to standard surgical fee reductions for secondary procedures.
Effective: April 1, 2025
Q. Cardiovascular Surgical Procedures
CARDIOVASCULAR SURGICAL PROCEDURES
Surgical
Cardiovascular Surgical Procedures
Documentation of incompetence (i.e. reflux) at the saphenofemoral junction or saphenopopliteal junction by Doppler or duplex ultrasound scanning.
Documentation of a trial of conservative management of at least three months duration.
Documentation of at least one of the required signs of chronic venous insufficiency or complications from varicosities.
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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