R728 – Tricuspid valve replacement
OHIP Radiology Code — CARDIOVASCULAR SURGICAL PROCEDURES · Schedule of Benefits
Tricuspid valve replacement is a major cardiovascular surgical procedure. The service includes all constituent and common elements of an insured service. The fee is payable to the surgeon (A suffix), surgical assistant (B suffix), and anaesthesiologist (C suffix), with fees for assistants and anaesthesiologists calculated based on a combination of base and time units as outlined in the Schedule of Benefits (see pages -). A second assistant's services are payable for this procedure without special authorization ().
When to Use
- Use R728 as the primary procedure code for a standalone tricuspid valve replacement surgery.
- Use R728 in combination with other valve codes (e.g., R724, R725) for multivalvular replacement, applying the 85% reduction rule to the secondary valve procedures.
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 intervening surgical emergency.
Billing Tips
- Ensure the second surgical assistant is billed correctly as this procedure explicitly allows for a second assistant without requiring prior medical consultant authorization.
Effective: April 1, 2025
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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