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R856
R856 – Extended profundoplasty
OHIP Radiology Code — CARDIOVASCULAR SURGICAL PROCEDURES · Schedule of Benefits
An extended profundoplasty is a surgical procedure to repair and widen the deep femoral artery (profunda femoris). This procedure is performed to improve blood flow to the lower leg and is more extensive than a standard common femoral/profunda femoris repair (R855).
When to Use
- Use R856 when the procedure involves extensive reconstruction, such as a patch angioplasty or complex endarterectomy of the deep femoral artery, which exceeds the scope of a standard R855 repair.
- Select R856 for cases requiring significant mobilization or extension of the profunda femoris to facilitate distal revascularization or to address extensive atherosclerotic disease.
Common Pitfalls
- Billing R856 alongside R855 for the same vessel is considered unbundling and will result in claim rejection; the procedure must be coded based on the highest level of surgical complexity performed.
- Failure to document the specific extent of the profundoplasty (e.g., length of arteriotomy or use of patch material) often leads to audit adjustments when the claim is compared against the simpler R855 definition.
Billing Tips
- Ensure the operative report explicitly describes the 'extended' nature of the repair to justify the fee difference between R856 and R855 in the event of a post-payment review.
Provider Fee$818.80
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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