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R916
R916 – Re-exploration of vascular graft and closure of lymph fistula in groin
OHIP Radiology Code — HAEMATIC AND LYMPHATIC SURGICAL PROCEDURES · Schedule of Benefits
A surgical procedure for the re-exploration of a vascular graft and closure of a lymph fistula in the groin. This service includes fee allowances for the surgeon (suffix A), assistant (suffix B), and anaesthetist (suffix C). Assistant services are calculated based on 7 basic units plus time units. Anaesthesia services are calculated based on 6 basic units plus time units.
When to Use
- Use R916 for the specific surgical re-exploration of a vascular graft site to address a persistent lymph fistula in the groin.
- Select R916 when the primary objective is the closure of a lymphatic leak following a previous vascular procedure in the groin region.
Common Pitfalls
- Billing R916 for a routine wound debridement or simple incision and drainage, which are not equivalent to the complexity of a graft re-exploration.
- Attempting to bill R916 in conjunction with other vascular graft procedures on the same site without clear documentation of distinct, separate surgical intent.
- Failure to document the specific presence of a lymph fistula, which is a mandatory clinical requirement for this code.
Billing Tips
- Ensure the operative report explicitly details the re-exploration of the graft and the specific technique used to close the lymph fistula to support the claim upon audit.
- Verify that the assistant and anaesthetist units are calculated separately using the 7-unit and 6-unit base rules respectively, rather than applying a flat percentage to the surgeon's fee.
Provider Fee$207.30
Surgical Assistant Fee$75.06
Anaesthetist Fee$92.94
Non-Anaesthetist Fee$92.94
Effective: April 1, 2025
Since Apr 2004, this fee has increased 0.0% vs 57.0% CPI inflation
Category
R. Haematic and Lymphatic Surgical Procedures
Subcategory
HAEMATIC AND LYMPHATIC SURGICAL PROCEDURES
Service Type
Surgical
Code Classes
Haematic and Lymphatic Surgical Procedures
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