R738 – Aortic valve replacement
OHIP Radiology Code — CARDIOVASCULAR SURGICAL PROCEDURES · Schedule of Benefits
Aortic valve replacement is a surgical procedure to replace a diseased or damaged aortic valve. - Add-on code E647 is payable for an associated patch aortoplasty with pericardium or graft. - Add-on code E656 is payable for an associated aortic annuloplasty (reconstruction and enlargement of aortic annulus). - Note on multivalvular replacement: When multiple valves are replaced, the fee is calculated as the fee for the major valve replaced plus 85% of the fee for the additional valve or valves.
When to Use
- Use R738 as the primary code for a standard surgical aortic valve replacement (AVR) performed in a hospital setting.
- Use R738 in combination with E647 when a patch aortoplasty using pericardium or a graft is required to facilitate the valve replacement.
- Use R738 in combination with E656 when the surgical plan specifically includes reconstruction and enlargement of the aortic annulus.
Common Pitfalls
- Failing to apply the 85% reduction rule for the secondary valve when performing a multivalvular replacement (e.g., AVR plus mitral valve replacement).
- Attempting to bill E647 or E656 without R738, as these add-on codes are strictly dependent on the primary AVR procedure.
- Incorrectly coding the procedure as a standalone repair when the clinical documentation supports the more comprehensive R738 replacement code.
Billing Tips
- Always ensure the operative report clearly details the use of patches or annuloplasty techniques to justify the addition of E647 or E656.
- When performing multiple valve replacements, bill the highest-valued procedure at 100% and the subsequent valve(s) at 85% to avoid claim rejection.
Effective: April 1, 2025
Q. Cardiovascular Surgical Procedures
CARDIOVASCULAR SURGICAL PROCEDURES
Surgical
Cardiovascular Surgical Procedures
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