R863 – Replacement of aortic valve, replacement of ascending aorta, and reimplantation of coronary arteries (Modified Bentall)
OHIP Radiology Code — CARDIOVASCULAR SURGICAL PROCEDURES · Schedule of Benefits
Replacement of aortic valve, replacement of ascending aorta, and reimplantation of coronary arteries (Modified Bentall). The amount payable for the surgical assistant service is calculated by adding together the number of basic (18) and time units and multiplying that total by the unit fee. The amount payable for the anaesthesia service is calculated by adding the number of basic (28) and time units and multiplying the total by the anaesthesiologist unit fee. See the Surgical Assistants' Services (-) and Anaesthesiologists' Services (-) sections of the General Preamble for full details on unit calculation.
When to Use
- Use R863 specifically for the full Modified Bentall procedure involving the composite replacement of the aortic valve and ascending aorta with coronary artery reimplantation.
- Do not use R863 for isolated aortic valve replacement (e.g., R724) or isolated ascending aorta replacement (e.g., R731); R863 is reserved for the combined complex procedure.
Common Pitfalls
- Failing to correctly calculate anaesthesia units using the mandatory base of 28 units plus time units, which differs from standard cardiovascular procedure base units.
- Attempting to bill R863 alongside other valve replacement codes without applying the multivalvular replacement rule (major valve fee plus 85% of additional valve fees).
- Incorrectly assuming a second surgical assistant requires prior authorization; R863 is explicitly exempt from this requirement.
Billing Tips
- Ensure the surgical assistant fee is calculated using the base of 18 units plus time units, and verify that after-hours premiums (E400B/E401B) are applied to the total assistant fee if the case start time qualifies.
- When billing for a second assistant, use code E005B in conjunction with R863, ensuring the claim reflects the total time spent by the second assistant to correctly calculate the time-based unit component.
Effective: April 1, 2026
Q. Cardiovascular Surgical Procedures
CARDIOVASCULAR SURGICAL PROCEDURES
Surgical
Cardiovascular Surgical Procedures
Note: Multivalvular replacement - the fee will be that for the major valve replaced plus 85% of the fee for the additional valve or valves.
R863 is one of the services where a second assistant's services are payable and authorization is not required.
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