R730 – Mitral valvotomy - restenosis
OHIP Radiology Code — CARDIOVASCULAR SURGICAL PROCEDURES · Schedule of Benefits
Performs a mitral valvotomy on a patient with restenosis. This procedure involves re-opening a mitral valve that has previously undergone a valvotomy but has become stenotic again. As a surgical procedure, the service includes all specific elements of surgery as outlined in the Schedule of Benefits (see :99 for Assistant and :106 for Anaesthetist).
When to Use
- Use R730 specifically for a repeat mitral valvotomy procedure where the patient has developed symptomatic restenosis following a previous valvotomy.
- Do not use R730 for a primary mitral valvotomy; use the appropriate primary procedure code instead to ensure accurate claim processing.
Common Pitfalls
- Billing R730 for a mitral valve replacement or repair that is not a valvotomy will result in a rejection or audit recovery.
- Attempting to bill for a second surgical assistant without prior written authorization from a medical consultant will lead to automatic denial of the assistant's claim.
Billing Tips
- If performing a multivalvular procedure, bill the major valve as the primary code and apply the 85% fee reduction rule to the additional valve codes to comply with Schedule of Benefits payment adjustments.
- Ensure the operative report explicitly documents the history of the previous valvotomy and the findings of restenosis to support the use of this specific code over other mitral valve procedures.
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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