R720 – Total repair Tetralogy of Fallot
OHIP Radiology Code — CARDIOVASCULAR SURGICAL PROCEDURES · Schedule of Benefits
Total repair of Tetralogy of Fallot is an insured surgical service listed under Cardiovascular Surgical Procedures. The fee listed is for the primary surgeon (suffix A). The amount payable for a surgical assistant (suffix B) and an anaesthesiologist (suffix C) is calculated using a unit-based system. This includes base units specific to the procedure (R720) plus time units. The procedure is applicable whether or not the patient has had a previous arterial shunt.
When to Use
- Use R720 for the definitive surgical correction of Tetralogy of Fallot, regardless of whether the patient previously underwent a palliative systemic-to-pulmonary artery shunt.
- Use this code for the primary surgeon (suffix A) when performing the total repair; do not use it for secondary procedures or partial repairs which may fall under other R-series cardiovascular codes.
Common Pitfalls
- Failure to apply the appropriate age premium (e.g., 30% for patients < 30 days) on the primary surgeon's claim, as these are not automatically calculated by the system.
- Incorrectly billing for a second surgical assistant without prior authorization and a supporting letter from the surgeon, which is a mandatory requirement for payment of a second assistant.
Billing Tips
- Ensure that when multiple procedures are performed during the same anaesthetic, the assistant and anaesthesiologist units are based solely on the major procedure (R720) to avoid claim rejection.
- For anaesthesiologists, remember to append the relevant extra units (e.g., E022C for ASA III or E019C for age-based adjustments) to the base units to maximize the total anaesthetic fee.
Effective: April 1, 2026
Q. Cardiovascular Surgical Procedures
CARDIOVASCULAR SURGICAL PROCEDURES
Surgical
Cardiovascular Surgical Procedures
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