R933 – Axillo-femoral, femoro-femoral or axillo-axillary graft
OHIP Radiology Code — CARDIOVASCULAR SURGICAL PROCEDURES · Schedule of Benefits
This service covers the surgical creation of an axillo-femoral, femoro-femoral, or axillo-axillary bypass graft. Payment includes the surgeon's fee, and separate fees for a surgical assistant (suffix B) and anaesthesiologist (suffix C) if required. Assistant and anaesthesia fees are calculated based on basic units plus time-based units as defined in the Schedule of Benefits on pages - (-) and - (-). The procedure is eligible for various premiums, including those for age, after-hours service, and trauma, subject to their specific requirements.
When to Use
- Use R933 for the creation of an extra-anatomical bypass graft (axillo-femoral, femoro-femoral, or axillo-axillary) when standard aorto-iliac reconstruction is contraindicated or anatomically unsuitable.
- Select R933 when performing a secondary revascularization procedure in patients with prior failed aortic grafts or extensive retroperitoneal scarring that precludes a standard approach.
Common Pitfalls
- Billing R933 in conjunction with other major arterial reconstructions (e.g., R855 or R856) without clear documentation of separate anatomical sites or distinct surgical indications, which often triggers manual review or rejection.
- Failure to document the specific graft configuration (axillo-femoral vs. femoro-femoral) in the operative report, which is required to substantiate the use of this specific code over other vascular bypass codes.
- Incorrectly billing R933 when the procedure is limited to a simple thrombectomy or revision of an existing graft, which should be billed under appropriate revision codes rather than the primary bypass code.
Billing Tips
- Ensure the operative report explicitly details the proximal and distal anastomoses, as this is the primary evidence used by the Ministry to validate the R933 claim against the Schedule of Benefits.
- If the procedure is performed on an emergency basis, ensure the non-elective status is clearly indicated to support the application of after-hours premiums (E409/E410) or special visit premiums (C-series) for the surgical assistant and anaesthesiologist.
Effective: April 1, 2025
Q. Cardiovascular Surgical Procedures
CARDIOVASCULAR SURGICAL PROCEDURES
Surgical
Cardiovascular Surgical Procedures
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