R731 – Tricuspid valvuloplasty
OHIP Radiology Code — CARDIOVASCULAR SURGICAL PROCEDURES · Schedule of Benefits
Tricuspid valvuloplasty (R731) is a cardiovascular surgical procedure involving the repair or reconstruction of the tricuspid valve. The service is listed in the Cardiovascular Surgical Procedures section under the subheading for Valves. Payment is structured with separate considerations for the surgeon (suffix A), surgical assistant (suffix B), and anaesthesiologist (suffix C), with specific base units assigned for assistant and anaesthesia services. Assistant services are allotted 18 base units and anaesthesia services are allotted 28 base units, with additional time units calculated based on the duration of the procedure as per the rules outlined in the General Preamble.
When to Use
- Use R731 for isolated tricuspid valve repair or reconstruction procedures.
- Use R731 in conjunction with other valve codes (e.g., R724) for multivalvular procedures, applying the 85% reduction rule to the secondary valve fee.
Common Pitfalls
- Attempting to bill for a second surgical assistant without prior written authorization from a medical consultant, as R731 is not on the pre-approved list for second assistants.
- Failing to document the Injury Severity Score (ISS) in the medical record when attempting to claim the E420 trauma premium.
Billing Tips
- Ensure the surgical assistant claims the R731B premium for any assistance time exceeding the first 60 minutes, as this is specifically tied to the R731 base code structure.
- When performing multivalvular surgery, always designate the procedure with the highest fee as the primary code and apply the 85% reduction to the R731 fee to ensure correct processing.
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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