R859 – Partial removal of infected aortic graft (one limb only)
OHIP Radiology Code — CARDIOVASCULAR SURGICAL PROCEDURES · Schedule of Benefits
Partial removal of an infected aortic graft, involving only one limb of the graft. This procedure is typically performed to manage complications of aortic graft surgery, such as infection. The service includes all common and specific elements of a surgical procedure, including pre-operative assessment, the surgical procedure itself, and post-operative care as defined in the Schedule of Benefits. Note: Arterial reconstruction is considered an extra procedure and is billed separately. An additional fee for suprarenal or supraceliac aortic cross-clamping (E986) may be applicable. Assistant and anaesthesia fees are calculated based on base units plus time units.
When to Use
- Use R859 when performing a partial excision of an infected aortic graft limited to a single limb, distinct from a total graft excision.
- Select this code when managing a localized graft infection where the contralateral limb and the main body of the graft remain intact and undisturbed.
Common Pitfalls
- Billing R859 alongside arterial reconstruction codes without recognizing that reconstruction is considered a separate, billable procedure.
- Failing to append E986 when suprarenal or supraceliac cross-clamping is utilized, as this is a distinct flat-fee add-on not included in the R859 base fee.
- Attempting to bill R859 for a total graft removal, which would require a different, more comprehensive procedural code.
Billing Tips
- Always verify if the clinical scenario meets the criteria for the E986 add-on, as it is specifically listed as eligible for use with R859.
- Ensure that any subsequent arterial reconstruction performed during the same operative session is billed as a separate line item to capture the full scope of the surgical work.
Effective: April 1, 2025
Q. Cardiovascular Surgical Procedures
CARDIOVASCULAR SURGICAL PROCEDURES
Surgical
Cardiovascular Surgical Procedures
* Arterial reconstruction extra.
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