R735 – Mitral replacement
OHIP Radiology Code — CARDIOVASCULAR SURGICAL PROCEDURES · Schedule of Benefits
Mitral replacement is a surgical procedure to replace a patient's mitral valve. This service is eligible for surgeon (A), assistant (B), and anaesthetist (C) fees. The assistant service has 18 base units, and the anaesthesia service has 28 base units, with additional time units calculated for the duration of the procedure. Specific payment rules apply for multivalvular replacements, as detailed in the notes on . This service is eligible for various premiums including those for age, after-hours, and trauma.
When to Use
- Use R735 for isolated mitral valve replacement procedures performed via open surgical approach.
- Use R735 in conjunction with the 85% rule for the secondary valve when performing a combined mitral and aortic valve replacement (e.g., R735 + 85% of R734).
Common Pitfalls
- Failing to document the Injury Severity Score (ISS) when attempting to bill the E420 trauma premium, which is a mandatory requirement for audit compliance.
- Incorrectly applying the 85% reduction rule for multivalvular procedures by applying it to the major valve instead of the secondary valve.
- Attempting to claim after-hours premiums (E400B/E401B) in addition to the E420 trauma premium, which is explicitly prohibited by the Schedule of Benefits.
Billing Tips
- Ensure the anaesthesiologist includes the appropriate ASA status modifier (E022C, E017C, or E016C) and the emergency modifier (E020C) if the surgery commences within 24 hours of booking.
- When a second surgical assistant is utilized, bill the service directly as it is pre-authorized for this procedure and does not require manual intervention.
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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