R757 – Resection coarctation - infant
OHIP Radiology Code — CARDIOVASCULAR SURGICAL PROCEDURES · Schedule of Benefits
Resection of coarctation of the aorta is a surgical procedure to repair a narrowing of the aorta. This fee code applies specifically to patients defined as infants, which is a person from 29 days up to, but not including, 2 years of age as per . The fee is for the surgeon's service (suffix A), with separate calculations for assistant (suffix B) and anaesthetist (suffix C) services based on basic and time units defined in the Schedule of Benefits.
When to Use
- Use R757 for surgical repair of aortic coarctation specifically in patients aged 29 days up to, but not including, 2 years.
- Select R757 for the primary surgeon (suffix A) when performing the resection procedure in an infant, ensuring the patient's age is verified against the 29-day to 2-year window.
Common Pitfalls
- Billing R757 for patients under 29 days of age, which falls outside the infant definition and will result in a rejection; use the appropriate neonatal code instead.
- Failing to apply the mandatory age-based percentage premiums (AGE_PREMIUM_LT1Y or AGE_PREMIUM_1_TO_2Y) which are required for surgical procedures on patients in these specific age brackets.
- Incorrectly billing R757 for a patient who has reached their 2nd birthday; once the patient is 2 years or older, this code is no longer valid.
Billing Tips
- Always append the correct age premium (25% for <1 year or 20% for 1-2 years) to your claim to ensure the full eligible fee is captured.
- If the procedure is performed after hours, ensure you select the appropriate E-series premium (E409/E410) rather than attempting to bill a standard office visit fee.
Effective: April 1, 2025
Q. Cardiovascular Surgical Procedures
CARDIOVASCULAR SURGICAL PROCEDURES
Surgical
Cardiovascular Surgical Procedures
Patient must be an infant (from 29 days up to, but not including, 2 years of age)
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