R868 – High ligation and stripping of long saphenous vein with groin dissection
OHIP Radiology Code — CARDIOVASCULAR SURGICAL PROCEDURES · Schedule of Benefits
High ligation and stripping of the long saphenous vein with groin dissection. This surgical service for the treatment of varicose veins involving the long saphenous vein is only insured when all of the following conditions are met: - There is incompetence (i.e. reflux) at the saphenofemoral junction or saphenopopliteal junction that is documented by Doppler or duplex ultrasound scanning. - The patient has failed a trial of conservative management of at least three months duration. - The patient has at least one of the conditions described in either a. or b. below: - a. One or more of the following signs of chronic venous insufficiency: - Eczema - Pigmentation - Lipodermatosclerosis - Ulceration - b. Varicosities that result in one or more of the following: - Ulceration secondary to venous stasis - One or more significant hemorrhages from a ruptured superficial varicosity - Two or more episodes of minor hemorrhage from a ruptured superficial varicosity - Recurrent superficial thrombophlebitis - Stasis dermatitis - Varicose eczema - Lipodermosclerosis - Unremitting edema or intractable pain interfering with activities of daily living and requiring chronic analgesic medication.
When to Use
- Use R868 for patients with documented saphenofemoral junction reflux who have failed at least three months of conservative management, specifically when presenting with active ulceration or lipodermatosclerosis.
- Use R868 when a patient presents with recurrent superficial thrombophlebitis or significant hemorrhage from a ruptured varicosity, provided the required ultrasound confirmation of junctional incompetence is on file.
Common Pitfalls
- Billing R868 without explicit documentation of a three-month trial of conservative management, such as compression stockings and analgesics, is a frequent cause of audit recovery.
- Failure to document the specific ultrasound findings of saphenofemoral or saphenopopliteal junction reflux will lead to automatic rejection or clawback upon review.
- Confusing R868 with R869; ensure the procedure performed strictly involves high ligation and stripping, as R869 covers different venous interventions.
Billing Tips
- Ensure your operative report clearly links the surgical findings to the specific qualifying condition (e.g., 'stasis dermatitis' or 'intractable pain') to satisfy the mandatory patient condition requirements.
- If performing the procedure after hours, ensure the start time is clearly noted in the chart to support the application of E409 or E410 premiums, as these are frequently audited for accuracy.
Effective: April 1, 2025
Q. Cardiovascular Surgical Procedures
CARDIOVASCULAR SURGICAL PROCEDURES
Surgical
Cardiovascular Surgical Procedures
Incompetence (i.e. reflux) at the saphenofemoral junction or saphenopopliteal junction must be documented by Doppler or duplex ultrasound scanning.
The medical record must document that the patient has failed a trial of conservative management of at least three months duration.
The medical record must document the presence of at least one of the qualifying signs of chronic venous insufficiency or complications from varicosities listed under required patient conditions.
Conservative management includes analgesics and prescription gradient support compression stockings.
Significant hemorrhage refers to a hemorrhage related to varicose veins that requires iron therapy or transfusion.
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