R726 – Tricuspid valvotomy
OHIP Radiology Code — CARDIOVASCULAR SURGICAL PROCEDURES · Schedule of Benefits
Tricuspid valvotomy is a surgical procedure involving an incision into the tricuspid valve of the heart, typically performed to correct stenosis (narrowing) of the valve. The service fee is for the surgeon's work (<suffix>A</suffix>). Assistant (<suffix>B</suffix>) and anaesthesia (<suffix>C</suffix>) services are calculated separately. Assistant services are valued at 18 base units plus time units as defined on pages -, and anaesthesia services are valued at 20 base units plus time units as defined on pages -. As per , a second assistant's service is payable for this procedure without requiring special authorization.
When to Use
- Use R726 for a primary surgical incision into the tricuspid valve to address stenosis.
- Use R726 in conjunction with other valve codes (e.g., R724, R725) when performing multivalvular procedures, applying the 85% reduction rule to the secondary valve fee.
Common Pitfalls
- Failing to document the Injury Severity Score (ISS) when attempting to claim the E420 trauma premium, which is a mandatory requirement for audit compliance.
- Incorrectly applying after-hours premiums (E409/E410) to elective procedures that were not delayed by an emergency, leading to automatic claim rejection.
- Attempting to claim special visit premiums (e.g., C998B, C999B) simultaneously with after-hours premiums (E400B, E401B), which is prohibited by the Schedule of Benefits.
Billing Tips
- Always bill the highest-valued procedure as the primary code and apply the 85% adjustment to the secondary valve procedure to ensure correct payment for multivalvular cases.
- Ensure the second assistant is billed under the same claim as the primary surgeon to utilize the automatic authorization for a second assistant on this procedure.
Effective: April 1, 2026
Q. Cardiovascular Surgical Procedures
CARDIOVASCULAR SURGICAL PROCEDURES
Surgical
Cardiovascular Surgical Procedures
Multivalvular replacement - the fee will be that for the major valve replaced plus 85% of the fee for the additional valve or valves.
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