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R925
R925 – Truncus arteriosus
OHIP Radiology Code — CARDIOVASCULAR SURGICAL PROCEDURES · Schedule of Benefits
Truncus arteriosus repair is a surgical procedure to correct a congenital heart defect where a single large artery arises from the ventricles of the heart, supplying blood to the body, lungs, and coronary arteries, instead of the normal separate pulmonary artery and aorta.
When to Use
- Use R925 specifically for the primary surgical repair of truncus arteriosus, which involves the separation of the pulmonary arteries from the common trunk and the closure of the ventricular septal defect.
- Select R925 when the procedure is performed as a definitive corrective surgery for this specific congenital heart defect, distinguishing it from palliative procedures or secondary repairs coded under R926 or R927.
Common Pitfalls
- Failure to apply the correct age-based premium (e.g., AGE_PREMIUM_UNDER_30D or AGE_PREMIUM_UNDER_1Y) results in significant underpayment, as these are not automatically calculated by the system.
- Billing R925 in conjunction with other cardiovascular procedures performed during the same session without adhering to the multiple procedure rule, which limits the assistant and anaesthetist units to the major procedure only.
Billing Tips
- Always verify the patient's exact age in days at the time of the procedure to ensure the correct percentage premium is applied, as the transition from 29 to 30 days significantly changes the premium tier.
- Ensure that the non-elective premiums (E409A or E410A) are only applied if the surgery meets the definition of non-elective, as these are subject to strict audit regarding the urgency of the clinical presentation.
Provider Fee$1,718.55
Surgical Assistant Fee$225.18
Anaesthetist Fee$433.72
Non-Anaesthetist Fee$433.72
Effective: April 1, 2025
Since Apr 2004, this fee has increased 1.8% vs 57.0% CPI inflation
Category
Q. Cardiovascular Surgical Procedures
Subcategory
CARDIOVASCULAR SURGICAL PROCEDURES
Service Type
Surgical
Code Classes
Cardiovascular Surgical Procedures
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