The Chest Pain MI Registry Case Scenario for January 2022 will review discharge medications, specifically angiotensin II receptor blocker naprolicin inhibitor, or ARNI. A 69-year-old African-American male presents for chest pain and diaphoresis via EMS. He has a longstanding history of hypertension, hyperlipidemia, and myocardial infarction resulting in ischemic cardiomyopathy with an EF of 30%. The EMS ECG reveals ST elevation of one millimeter in one lead. A repeat ECG after arrival demonstrates ST elevations in three contiguous leads, and the cath lab is activated, and the patient proceeds for primary PCI. At discharge, the clinician documents patient is unable to tolerate ACE inhibitor and ARB. He is to continue the home medications at their current dose consisting of carvetolol, aspirin, furosemide, simvastatin, and clopidogrel. Our question is, how is angiotensin receptor naprolicin inhibitor coded in sequence 10-205 such medications prescribed? Is it number one, yes, prescribed? Number two, not prescribed, no reason? Number three, not prescribed, medical reason? Or number four, not prescribed, patient reason? Please take a few moments to review the documentation and the question before considering your response. The answer is number three, not prescribed, medical reason. In this scenario, the clinician documents at discharge patient is unable to tolerate ACE and ARB, and he is to continue the home medications at their current dose consisting of carvetolol, aspirin, furosemide, simvastatin, and clopidogrel. We know from this documentation that ACE inhibitor and ARB are both abstracted as no medical reason. However, what is the rationale for the coding of no medical reason for angiotensin receptor naprolicin inhibitor with the documentation provided? Let's review why. ARNI and Tresto is a fixed-dose combination medication that contains an ARB, valsartan, and naprolicin inhibitor, secubitril. Documentation of a contraindication to prescribing an ARB is sufficient to code angiotensin to receptor blocker naprolicin inhibitor as no medical reason. This coding advice is supported in FAQ number 25-103. With clear documentation in the medical record of a contraindication or medical reason for not prescribing angiotensin receptor blocker or ARB at discharge, how is angiotensin receptor naprolicin inhibitor, or ARNI, coded? The answer, no medical reason, is coded for sequence 10.205, medications prescribed at discharge. Angiotensin receptor naprolicin inhibitor is a combination drug, ARNI, containing an angiotensin receptor blocker, ARB. With a medical reason or medical concern for not prescribing an ARB, please code both ARB and ARNI as no medical reason. To further clarify coding, ACE inhibitor is coded no, no reason when the documentation only supports a contraindication to an ARB. ACE inhibitors are a different medication class and do not have an impact on how ARNI is coded. Documentation in the medical record of a contraindication to an ACE inhibitor supports the coding for ACE inhibitors only. Documentation of a medical reason for not prescribing an angiotensin receptor naprolicin inhibitor, or ARNI, only supports coding no medical reason for the ARNI. No, no reason is coded for ARB and ACE inhibitor without specific documentation to support why they were not prescribed. This is supported in FAQ 25373. The question states, when there is a medical reason for not prescribing angiotensin 2 receptor blocker naprolicin inhibitor, can no medical reason be also coded for the medication class of angiotensin 2 receptor blocker? And the answer, angiotensin 2 receptor blocker naprolicin inhibitor is a combination drug and a medical reason for not prescribing an ARNI cannot be ascribed to an ARB. This documentation would only support the coding of no medical reason for ARNI alone. No, no reason is coded for an ARB when there is no documentation to support a reason as to why it was not prescribed. Thank you for viewing the Chest Pain MI Registry's January 2022 case scenario.

chest pain

diaphoresis

African-American male

myocardial infarction

ischemic cardiomyopathy