R763 – Creation of ASD by balloon septostomy
OHIP Radiology Code — CARDIOVASCULAR SURGICAL PROCEDURES · Schedule of Benefits
Listed under Cardiovascular Surgical Procedures, R763 is for the creation of an atrial septal defect (ASD) by balloon septostomy. The fee for the surgeon is a flat rate, while fees for the surgical assistant and anaesthesiologist are calculated based on basic and time units. - Surgeon (Suffix A): The listed fee for the surgical procedure. - Surgical Assistant (Suffix B): Fee is calculated based on 9 basic units plus time units. (:, :) - Anaesthesiologist (Suffix C): Fee is calculated based on 9 basic units plus time units. (:, :)
When to Use
- Use R763 for the specific creation of an atrial septal defect via balloon septostomy in neonates with transposition of the great arteries or other cyanotic congenital heart defects.
- Use this code when the procedure is performed as a primary intervention to improve systemic oxygenation by facilitating interatrial mixing.
Common Pitfalls
- Do not bill R763 in conjunction with R762, as these procedures are mutually exclusive for the same anatomical intervention.
- Failure to document the specific clinical necessity for the septostomy, particularly when performed as an emergency, can lead to claim rejection or audit recovery.
- Incorrectly applying after-hours premiums (E400 series) to the surgeon's fee; ensure these are only applied to the assistant (Suffix B) or anaesthesiologist (Suffix C) claims as per their respective fee schedules.
Billing Tips
- Ensure the surgical assistant and anaesthesiologist correctly calculate their total fee using the 9 basic units plus the appropriate time units, as the flat fee only applies to the surgeon (Suffix A).
- Always verify the patient's age at the time of the procedure to ensure the correct age-based surgical premium (e.g., AGE_PREMIUM_UNDER_30_DAYS) is applied to the surgeon's fee.
Effective: April 1, 2025
Q. Cardiovascular Surgical Procedures
CARDIOVASCULAR SURGICAL PROCEDURES
Surgical
Cardiovascular Surgical Procedures
A copy of the written request for the consultation, signed by the referring physician, nurse practitioner or dental surgeon must be kept in the consulting physician’s medical record, except in the case of a consultation which occurs in a hospital, long-term care institution or multi-specialty clinic where common medical records are maintained. In such cases, the written request may be contained on the common medical record.
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