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R864
R864 – Repair of false aneurysm at groin anastomosis
OHIP Radiology Code — CARDIOVASCULAR SURGICAL PROCEDURES · Schedule of Benefits
This surgical procedure involves the repair of a false aneurysm located at the site of a previous vascular connection (anastomosis) in the groin area.
When to Use
- Use R864 specifically for the surgical repair of a pseudoaneurysm occurring at a previous vascular graft-to-artery anastomosis site in the groin.
- Use this code when the procedure involves the direct repair of the anastomotic site, distinguishing it from a primary femoral artery aneurysm repair (e.g., R860 or R861).
Common Pitfalls
- Billing R864 in conjunction with other vascular reconstruction codes (e.g., R855, R856) without proper documentation of separate incisions or distinct anatomical sites may trigger a rejection for unbundling.
- Failure to document the specific nature of the 'false' aneurysm (pseudoaneurysm) versus a true degenerative aneurysm can lead to audit discrepancies regarding the appropriateness of the R864 fee.
Billing Tips
- Ensure the operative report explicitly describes the anastomotic site involvement to justify the use of R864 over standard aneurysm repair codes.
- If the procedure is performed on an emergency basis, ensure the appropriate after-hours premium (E409 or E410) is appended to the claim, as R864 is a qualifying surgical procedure.
Provider Fee$893.20
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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