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R716
R716 – Endocardial cushion and valve defect closure
OHIP Radiology Code — CARDIOVASCULAR SURGICAL PROCEDURES · Schedule of Benefits
Closure of an atrial septal defect involving an endocardial cushion and valve defect. This is a major cardiovascular surgical procedure. The fee is calculated based on surgical, anaesthetic, and assistant units. As a surgical service, it includes pre-operative and post-operative care as defined in the Schedule. See and for specific elements included in surgical assistant and anaesthesiologist services respectively.
When to Use
- Use R716 specifically for the surgical closure of an atrial septal defect that involves both the endocardial cushion and the associated valve apparatus.
- Select R716 over R715 when the operative report confirms the involvement of the endocardial cushion, as R715 is intended for simpler atrial septal defect closures.
Common Pitfalls
- Billing for a second surgical assistant without prior authorization; R716 is not on the pre-approved list, and claims will be rejected without a supporting letter from the surgeon.
- Failing to apply the correct age-based premium, which can range from 10% to 30% depending on the patient's age at the time of the procedure.
Billing Tips
- Ensure the operative report explicitly details the endocardial cushion involvement to support the use of R716 over less complex cardiovascular codes during a potential audit.
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