R866 – Gastric devascularization - as sole procedure
OHIP Radiology Code — CARDIOVASCULAR SURGICAL PROCEDURES · Schedule of Benefits
Gastric devascularization is a surgical intervention to control bleeding, typically from gastric varices, by ligating the blood vessels that supply the upper part of the stomach. This listing is for when the procedure is performed as the primary and sole surgical intervention during an operative session.
When to Use
- Use R866 when performing an isolated gastric devascularization to control acute hemorrhage from gastric varices.
- Use this code when the procedure is the primary surgical intervention and no other major surgical procedures are performed during the same operative session.
Common Pitfalls
- Billing R866 alongside other surgical procedures will trigger a rejection, as the code is strictly defined as a sole procedure.
- Failing to document the specific anatomical vessels ligated can lead to audit concerns regarding the clinical necessity of the procedure as a standalone intervention.
Billing Tips
- Ensure the claim is submitted without other surgical procedure codes to avoid the 'sole procedure' restriction violation.
- If the procedure is performed on an emergency basis after hours, ensure the appropriate non-elective premium (E409A or E410A) is appended to maximize the claim value.
Effective: April 1, 2025
Q. Cardiovascular Surgical Procedures
CARDIOVASCULAR SURGICAL PROCEDURES
Surgical
Cardiovascular Surgical Procedures
All insured services must be documented in appropriate records establishing that the service was provided, is the service for which the account is submitted, and was medically necessary.
For surgical assistant services, the start and stop times must be documented in the patient's permanent medical record if a replacement assistant is used.
as sole procedure
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