Z746 – Femoral
OHIP Psychiatric Code — CARDIOVASCULAR SURGICAL PROCEDURES · Schedule of Benefits
Ligation of the femoral vein. This is a cardiovascular surgical procedure typically performed under anaesthesia, with surgical assistance. When this service is performed for the treatment of varicose veins, it is only insured if 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; 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.
When to Use
- Use Z746 for the primary ligation of the femoral vein when treating symptomatic varicose veins that have failed a minimum three-month trial of conservative management.
- Use Z746 in conjunction with E653 when performing both ligation and stripping of the saphenous vein, provided the patient meets the specific chronic venous insufficiency or complication criteria.
Common Pitfalls
- Billing Z746 without explicit documentation of a three-month trial of conservative management, including the use of prescription gradient compression stockings, will lead to claim rejection or clawback upon audit.
- Failing to document objective evidence of reflux at the saphenofemoral or saphenopopliteal junction via Doppler or duplex ultrasound is a primary cause for denial of this procedure.
- Submitting Z746 for purely cosmetic varicose veins without documenting at least one of the required clinical complications, such as ulceration, recurrent thrombophlebitis, or significant hemorrhage, is an ineligible service.
Billing Tips
- Always append the E653 add-on code on the same claim as Z746 if stripping is performed, as these are intended to be billed together for comprehensive varicose vein management.
- Ensure the medical record clearly lists the specific complication (e.g., lipodermatosclerosis or stasis dermatitis) to satisfy the 'required patient conditions' criteria, as generic 'varicose veins' is insufficient for payment.
Effective: April 1, 2025
Q. Cardiovascular Surgical Procedures
CARDIOVASCULAR SURGICAL PROCEDURES
Surgical
Cardiovascular Surgical Procedures
When performed for varicose veins, the medical record must document incompetence (i.e. reflux) at the saphenofemoral junction or saphenopopliteal junction by Doppler or duplex ultrasound scanning.
When performed for varicose veins, the medical record must document that the patient has failed a trial of conservative management of at least three months duration. Conservative management includes analgesics and prescription gradient support compression stockings.
Surgical services (ligation/stripping) for the treatment of varicose veins involving the long 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.
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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