Welcome to the CATH PCI Registry January 2020 case scenario. This case scenario will discuss and review metric 40, PCI in-hospital risk-standardized bleeding, all patients. Our documentation for this case scenario is a 56-year-old male who arrived at your facility by EMS with a diagnosis of STEMI and cardiogenic shock. He was taken immediately to the CATH lab after a brief triage in the ED where a dopamine drip was started at 10 micrograms per kilogram per minute. The diagnostic coronary angiography revealed an 80% stenosis in the proximal LAD. The cardiologist placed an impella and proceeded with emergent PCI. The patient's pre-procedure hemoglobin was 12.4 grams per deciliter, which was coded in sequence 6030 pre-procedure hemoglobin. After successful PCI to the LAD, the patient was transferred to the ICU. There were no signs or symptoms of bleeding. However, the next day, the hemoglobin dropped to 8.2 grams per deciliter, which was coded in sequence 8505 post-procedure hemoglobin. While there were still no signs or symptoms of bleeding, the patient received two units of packed red blood cells. Question number one, how is sequence 9002 intra and post-procedure events bleeding coded? Is it 1, no, or 2, yes? The answer is 1, no. There was no observed and documented bleed. Therefore, the data definition of bleeding event is not met. Question 2, how is sequence 9275 packed red blood cell transfusion and the children fields number of units transfused and transfusion PCI coded? Is it 1, no, 2, yes, 2 units, and no, or 3, yes, 2 units, and yes? The answer is number 3, yes, 2 units, and yes. The patient was transfused the day after PCI, thereby meeting the target value of any occurrence between start of procedure and until next procedure or discharge. And yes is coded for sequence 9275 RBC transfusion. Two units of packed red blood cells were administered, and this is also coded. Lastly, because the patient was transfused within 72 hours of the PCI procedure, yes is coded for sequence 9277 transfusion PCI. Question 3, how are sequence 7420 and 7422 mechanical ventricular support coded? Is it 1, no, or 2, yes, and yes? The answer is 2, yes, and yes. The documentation provides an impella was inserted during the cath lab procedure. Therefore, the coding instructions and target value are met for both data elements and yes is coded. Now that we have determined correct coding for these data elements, let's look at how those answers play into metric 40. Question 4, does this patient have any exclusions for risk eligibility? 1, yes, 2, no. The answer is 2, no. The patient had only one PCI procedure during his episode of care, therefore it was the index PCI. There are no missing values for bleeding event within 72 hours and transfusion. The patient did not die on the same day of procedure and did not undergo CABG during his episode of care. All eligibility is met at the patient level. Our final question is question 5, does this patient meet the definition of an observed bleed? 1, yes, 2, no. The answer is 1, yes. As you can see, only one of the five outcomes need to be met for the patient to be included in the numerator. The patient did not have a bleeding event within 72 hours, a hemorrhagic stroke or tamponade. Although the patient did have a greater than or equal to 4 grams per deciliter drop in hemoglobin from pre-PCI to post-PCI, a mechanical ventricular support device was used as coded in sequence 7422, therefore outcome 5 is not met. However, the patient did receive a transfusion and with a pre-procedure hemoglobin of greater than 8 grams per deciliter, this outcome is met. Remembering that only one of the five outcomes need be met, this patient is an observed bleed in metric 40. This concludes the January case scenario reviewing metric 40, PCI in-hospital risk standardized bleeding, all patients. We thank you for your participation.

CATH PCI Registry

metric 40

STEMI

cardiogenic shock

red blood cell transfusion