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R923
R923 – Double outlet - right/left ventricle
OHIP Radiology Code — CARDIOVASCULAR SURGICAL PROCEDURES · Schedule of Benefits
R923 is a cardiovascular surgical procedure for the repair of a double outlet right or left ventricle. This is a complex procedure to correct a congenital heart defect where both the aorta and the pulmonary artery arise from the same ventricle.
When to Use
- Use R923 for the definitive surgical repair of double outlet right ventricle (DORV) or double outlet left ventricle (DOLV) where both great arteries originate from the same ventricle.
- Select R923 when the procedure involves complex intra-cardiac baffling or arterial switching to redirect ventricular outflow, distinguishing it from simpler septal defect repairs like R720 or R721.
Common Pitfalls
- Billing R923 in conjunction with other cardiac septal defect codes (e.g., R720, R722) is generally considered unbundling, as the repair is typically inclusive of the septal closure.
- Failure to apply the mandatory age-based premiums for pediatric patients under 16 years of age will result in significant underpayment, as these are not automatically calculated by the system.
Billing Tips
- Always verify the patient's age at the time of the procedure to ensure the correct percentage increase (ranging from 10% to 30%) is appended to the claim.
- If the procedure is performed on an emergency basis after hours, ensure you select either E409 or E410, but note that these cannot be combined with the E420 trauma premium.
Provider Fee$1,516.70
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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