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R759
R759 – Congenital heart procedures
OHIP Radiology Code — CARDIOVASCULAR SURGICAL PROCEDURES · Schedule of Benefits
Congenital heart procedures - e.g. Blalock, Glenn, Potts, Waterston or Central. This is a surgical service listed in the Cardiovascular Surgical Procedures section of the Schedule of Benefits.
When to Use
- Use R759 specifically for systemic-to-pulmonary artery shunts such as Blalock-Taussig, Glenn, Potts, or Waterston procedures.
- Select R759 when performing central shunt procedures for palliation of cyanotic congenital heart disease in neonates or infants.
Common Pitfalls
- Do not bill R759 in combination with other major cardiac surgical codes if the procedure is considered an integral component of a more comprehensive repair, as this may trigger a claim rejection for unbundling.
- Failure to apply the mandatory age-based premiums (e.g., AGE_PREMIUM_UNDER_30_DAYS) will result in significant underpayment, as these are not automatically calculated by the system.
Billing Tips
- Always verify if the procedure qualifies for the 30% age premium for patients under 30 days, as most R759 cases involve neonatal patients where this is applicable.
- Ensure the operative report clearly details the specific shunt type performed, as this documentation is required to justify the use of R759 over other cardiovascular surgical codes.
Provider Fee$774.35
Surgical Assistant Fee$162.63
Anaesthetist Fee$309.80
Non-Anaesthetist Fee$309.80
Effective: April 1, 2025
Category
Q. Cardiovascular Surgical Procedures
Subcategory
CARDIOVASCULAR SURGICAL PROCEDURES
Service Type
Surgical
Code Classes
Cardiovascular Surgical Procedures
All insured services must be documented in appropriate records that establish: 1. an insured service was provided; 2. the service for which the account is submitted is the service that was rendered; and 3. the service was medically necessary.
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