R869 – Stripping of short saphenous vein with popliteal dissection
OHIP Radiology Code — CARDIOVASCULAR SURGICAL PROCEDURES · Schedule of Benefits
Stripping of short saphenous vein with popliteal dissection. Surgical services (ligation/stripping) for the treatment of varicose veins involving the long saphenous and/or short saphenous vein(s) are only insured when all of the following conditions are met: 1. There is incompetence (i.e. reflux) at the saphenofemoral junction or saphenopopliteal junction that is documented by Doppler or duplex ultrasound scanning; 2. The patient has failed a trial of conservative management of at least three months duration; and 3. 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: i. Eczema; ii. Pigmentation; iii. Lipodermatosclerosis; iv. Ulceration b. Varicosities that result in one or more of the following: i. Ulceration secondary to venous stasis; ii. One or more significant hemorrhages from a ruptured superficial varicosity; iii. Two or more episodes of minor hemorrhage from a ruptured superficial varicosity; iv. Recurrent superficial thrombophlebitis; v. Stasis dermatitis; vi. Varicose eczema; vii. Lipodermosclerosis; viii. Unremitting edema or intractable pain interfering with activities of daily living and requiring chronic analgesic medication. Note: 1. Conservative management includes analgesics and prescription gradient support compression stockings. 2. Significant hemorrhage refers to a hemorrhage related to varicose veins that requires iron therapy or transfusion.
When to Use
- Use R869 when performing a formal stripping of the short saphenous vein specifically involving popliteal dissection, distinct from the long saphenous vein procedures covered under R868.
- Use this code only after a minimum of three months of documented conservative management, such as prescription-grade compression stockings, has failed to resolve the patient's symptoms.
- Select R869 when the patient presents with objective evidence of saphenopopliteal junction incompetence via duplex ultrasound and meets the specific clinical criteria for chronic venous insufficiency, such as lipodermatosclerosis or ulceration.
Common Pitfalls
- Billing R869 without explicit documentation of a three-month trial of conservative management, which is a mandatory requirement for OHIP coverage of varicose vein surgery.
- Failing to document the specific anatomical site of incompetence (saphenopopliteal junction) via ultrasound, which is a prerequisite for audit compliance.
- Attempting to bill R869 for cosmetic varicosities; the procedure must be linked to medically necessary conditions like recurrent superficial thrombophlebitis or intractable pain interfering with daily living.
Billing Tips
- Ensure the ultrasound report confirming saphenopopliteal reflux is readily available in the patient record, as this is the primary documentation required to justify the medical necessity of the procedure.
- If the procedure is performed for intractable pain, ensure the chart clearly notes the patient's reliance on chronic analgesic medication to support the clinical necessity criteria.
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 that is documented by Doppler or duplex ultrasound scanning.
Surgical assistant basic units: 6.
Anaesthesia basic units: 7.
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