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R855
R855 – Common femoral/profunda femoris repair - as sole procedure
OHIP Radiology Code — CARDIOVASCULAR SURGICAL PROCEDURES · Schedule of Benefits
This is a surgical procedure for the repair of the common femoral and/or profunda femoris artery. Per the listing in the Schedule of Benefits, this service is designated to be performed as a sole procedure, which is a key payment condition. This procedure is classified under Cardiovascular Surgical Procedures. It has assigned base units for both surgical assistance and anaesthesia services.
When to Use
- Use R855 when performing an isolated repair of the common femoral or profunda femoris artery as the sole surgical intervention.
- Select this code for primary endarterectomy or patch angioplasty of the common femoral artery when no other vascular procedures are performed during the same operative session.
Common Pitfalls
- Billing R855 alongside other vascular procedures (such as R856 or R933) will trigger an automatic rejection because R855 is strictly designated as a sole procedure.
- Attempting to bill for a second surgical assistant without prior authorization will result in a payment denial, as R855 is not on the pre-approved list for multiple assistants.
Billing Tips
- Ensure the operative report clearly documents that the procedure was isolated to the common femoral or profunda femoris to justify the sole procedure designation.
- If the procedure is performed after hours, apply the appropriate E409 or E410 premium to the surgeon's fee, ensuring the claim reflects the non-elective nature of the surgery.
Provider Fee$559.20
Surgical Assistant Fee$125.10
Anaesthetist Fee$154.90
Non-Anaesthetist Fee$154.90
Effective: April 1, 2025
Category
Q. Cardiovascular Surgical Procedures
Subcategory
CARDIOVASCULAR SURGICAL PROCEDURES
Service Type
Surgical
Code Classes
Cardiovascular Surgical Procedures
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