Z745 – Saphenous vein ligation/stripping
OHIP Psychiatric Code — CARDIOVASCULAR SURGICAL PROCEDURES · Schedule of Benefits
Surgical service (ligation/stripping) for the treatment of varicose veins involving the long and/or short saphenous vein(s). This service is 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: - 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 Z745 when performing ligation and stripping for symptomatic varicose veins where duplex ultrasound confirms reflux at the saphenofemoral or saphenopopliteal junction.
- Use this code specifically for patients who have failed a documented 3-month trial of conservative management, such as prescription compression stockings and analgesics.
Common Pitfalls
- Billing Z745 for cosmetic varicose vein treatment is a common audit trigger; the Ministry strictly requires documentation of clinical complications like ulceration, recurrent thrombophlebitis, or intractable pain.
- Failing to document the specific ultrasound findings of reflux at the saphenofemoral or saphenopopliteal junction will lead to automatic claim rejection or recovery upon audit.
- Attempting to bill Z745 alongside sclerotherapy codes (e.g., R868) for the same limb is often flagged as unbundling or inappropriate billing for a single surgical session.
Billing Tips
- Ensure your operative note explicitly lists the specific clinical indicator from the OHIP Schedule (e.g., 'recurrent superficial thrombophlebitis') to justify the medical necessity of the procedure.
- If the patient requires surgical intervention due to hemorrhage, clearly document whether it was a single 'significant' event requiring iron/transfusion or two 'minor' episodes to satisfy the specific 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 must be documented by Doppler or duplex ultrasound scanning.
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.
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