R846 – Micro lympho-lympho or lymphovenous anastomosis
OHIP Radiology Code — HAEMATIC AND LYMPHATIC SURGICAL PROCEDURES · Schedule of Benefits
Micro lympho-lympho or lymphovenous anastomosis is a surgical procedure performed under the Haematic and Lymphatic system category. It involves the intricate connection of lymphatic channels to either other lymphatic channels or to small veins, typically using microsurgical techniques.
When to Use
- Use R846 for microsurgical lymphatic reconstruction, such as lymphovenous bypass (LVB) for the treatment of secondary lymphedema.
- Use this code when performing supermicrosurgical anastomosis of lymphatic vessels to small venules, distinct from general vascular repair codes.
Common Pitfalls
- Avoid billing R846 in conjunction with general vascular anastomosis codes, as this is a specialized procedure for the lymphatic system and may be flagged for unbundling.
- Failure to document the microsurgical nature of the anastomosis can lead to audit scrutiny, as the fee reflects the complexity of lymphatic-specific micro-dissection.
Billing Tips
- Ensure the surgical assistant and anaesthesiologist fees are calculated using the 7 basic units plus time units as specified in the Schedule, rather than relying on a flat fee.
- If performing multiple anastomoses during the same operative session, verify if the Schedule allows for multiple procedure billing or if a single global fee applies to the reconstruction.
Effective: April 1, 2025
R. Haematic and Lymphatic Surgical Procedures
HAEMATIC AND LYMPHATIC SURGICAL PROCEDURES
Surgical
Haematic and Lymphatic Surgical Procedures
The fee for a surgical assistant (suffix B) is calculated based on 7 basic units plus time units as per the Schedule (, ). The assistant unit fee is $12.51.
The fee for an anaesthesiologist (suffix C) is calculated based on 7 basic units plus time units as per the Schedule (, ). The anaesthesiologist unit fee is $15.49. Additional extra units may apply based on patient factors such as age, BMI, and medical condition ().
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