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R870
R870 – Orthotopic cardiac transplantation
OHIP Radiology Code — CARDIOVASCULAR SURGICAL PROCEDURES · Schedule of Benefits
Orthotopic cardiac transplantation is a major surgical procedure involving the replacement of a patient's diseased or failing heart with a healthy heart from a deceased donor. The fee is payable to the surgeon (R870A), surgical assistant (R870B), and anaesthesiologist (R870C). The fees for the assistant and anaesthesiologist are calculated based on basic units plus time units.
When to Use
- Use R870A for the primary surgeon performing the orthotopic cardiac transplantation procedure.
- Use R870B for the surgical assistant, noting that a second assistant is automatically eligible for payment without prior medical consultant authorization.
- Use R870C for the anaesthesiologist, ensuring that additional units for patient complexity (e.g., ASA status, BMI > 40) are claimed using the appropriate anaesthesia extra unit codes.
Common Pitfalls
- Failing to document the Injury Severity Score (ISS) in the medical record, which is a mandatory requirement to successfully claim the E420 trauma premium.
- Attempting to claim after-hours premiums (E409, E410) concurrently with the trauma premium (E420), as these are mutually exclusive per OHIP billing rules.
- Incorrectly applying age premiums; ensure the percentage increase is calculated precisely based on the patient's age bracket (e.g., 30% for <30 days vs 10% for 5-16 years).
Billing Tips
- Always verify the start time of the procedure to determine if E400-series after-hours premiums apply, as these are calculated based on the case commencement time.
- For anaesthesia, maximize the claim by reviewing the full list of extra unit codes (e.g., E025C for massive transfusion) to account for the high-acuity nature of cardiac transplantation.
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