R928 – R-V outflow tract with valve and tubular graft
OHIP Radiology Code — CARDIOVASCULAR SURGICAL PROCEDURES · Schedule of Benefits
R-V outflow tract with valve and tubular graft is a surgical procedure listed under the 'Cardiovascular Surgical Procedures' section of the Schedule. It involves the repair of the heart's right ventricular outflow tract. The fee for this service can be claimed by the operating surgeon (suffix A). Additional fees are calculated for surgical assistance (suffix B) and anaesthesia (suffix C) based on a system of basic units plus time units. The basic units for an assistant are 18 and for anaesthesia are 28.
When to Use
- Use R928 specifically for the surgical reconstruction of the right ventricular outflow tract (RVOT) involving both a prosthetic valve and a tubular graft.
- Select R928 when the procedure is the primary major surgical intervention, as it dictates the basic units for both the surgical assistant and the anaesthesiologist.
Common Pitfalls
- Attempting to bill for a second surgical assistant without prior authorization from a medical consultant, as R928 is not on the pre-approved list for secondary assistance.
- Failing to document the Injury Severity Score (ISS) in the medical record when attempting to claim the E420 trauma premium, which leads to automatic rejection.
Billing Tips
- Ensure that when multiple procedures are performed during the same anaesthetic, you only claim the basic units associated with the major procedure (R928) to avoid billing conflicts.
- Always verify if the procedure qualifies for age-based premiums (e.g., under 30 days or under 1 year) and apply them to both the surgical (A) and assistant (B) fees to maximize the claim.
Effective: April 1, 2025
Q. Cardiovascular Surgical Procedures
CARDIOVASCULAR SURGICAL PROCEDURES
Surgical
Cardiovascular Surgical Procedures
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