R772 – Pulmonary valve replacement
OHIP Radiology Code — CARDIOVASCULAR SURGICAL PROCEDURES · Schedule of Benefits
Pulmonary valve replacement is a major cardiovascular surgical procedure to replace a diseased or damaged pulmonary valve with a prosthetic valve. This service includes the fee for the surgeon (suffix A). This procedure is eligible for separate fees for an assistant (suffix B) and an anaesthesiologist (suffix C), which are calculated based on basic units plus time units. This procedure has 18 base units for an assistant and 28 base units for an anaesthesiologist. As per , a second assistant's service is payable for this procedure without special authorization. According to the note on , when performing a multivalvular replacement, the fee is the total of the fee for the major valve replaced plus 85% of the fee for the additional valve or valves.
When to Use
- Use R772 as the primary code when performing an isolated pulmonary valve replacement.
- Use R772 in conjunction with other valve codes (e.g., R773, R774) for multivalvular procedures, applying the 85% reduction rule to the additional valve(s) per Q10.
- Use R772 for pulmonary valve replacement in pediatric patients, ensuring the appropriate age-based premium (e.g., AGE_PREMIUM_LT_1Y) is applied to the base fee.
Common Pitfalls
- Failing to apply the 85% fee reduction for additional valves when performing multivalvular replacements, which leads to automatic claim adjustments or audit recovery.
- Incorrectly billing for a second assistant; while R772 allows for a second assistant per GP90, ensure the claim explicitly reflects the assistant's role to avoid rejection.
- Overlooking the requirement that trauma premiums (E420) must be documented with an ISS score and cannot be combined with after-hours premiums.
Billing Tips
- Always calculate assistant and anaesthesiologist fees based on the specific base units (18 and 28 respectively) plus time units, rather than assuming a flat fee.
- When performing after-hours surgery, ensure the start time is clearly documented to support the application of E400/E401 series premiums for both the surgeon and the anaesthesiologist.
Effective: April 1, 2025
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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