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R921
R921 – Complete A-V canal
OHIP Radiology Code — CARDIOVASCULAR SURGICAL PROCEDURES · Schedule of Benefits
Complete A-V canal refers to the surgical procedure for the total repair of a complete atrioventricular canal heart defect.
When to Use
- Use R921 specifically for the complete surgical repair of an atrioventricular septal defect (AVSD) involving both atrial and ventricular septal components and common AV valve.
- Do not use R921 for partial AV canal repairs; these must be billed under the appropriate alternative cardiovascular surgical codes for atrial septal defect or valve repair.
- Use R921 as the primary procedure code when the surgical intent and execution involve the total correction of the complete AV canal morphology.
Common Pitfalls
- Failure to apply the mandatory age-based premiums (e.g., AGE_PREMIUM_UNDER_1_YEAR) results in significant underpayment, as these are not automatically calculated by the system.
- Billing R921 in conjunction with other cardiac repair codes without explicit documentation of separate, distinct procedures often triggers automatic claim rejection or audit review.
- Miscalculating after-hours premiums (E409/E410) by using the time the patient entered the OR rather than the actual commencement time of the surgical procedure.
Billing Tips
- Always verify the patient's exact age in days at the time of surgery to select the correct age-based premium percentage, as these thresholds are strictly enforced.
- Ensure the surgical report clearly delineates the components of the complete repair to justify the use of R921 over less comprehensive cardiac defect codes.
Provider Fee$1,480.40
Surgical Assistant Fee$225.18
Anaesthetist Fee$433.72
Non-Anaesthetist Fee$433.72
Effective: April 1, 2025
Category
Q. Cardiovascular Surgical Procedures
Subcategory
CARDIOVASCULAR SURGICAL PROCEDURES
Service Type
Surgical
Code Classes
Cardiovascular Surgical Procedures
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