Welcome to the CAF PCI Registry February 2020 case scenario focused on sequence 10200 and sequence 10205, Discharge Medications. A 60-year-old male presents to the emergency department complaining of severe chest pain and shortness of breath. An ECG is positive for STEMI and the patient is taken emergently to the CAF lab for immediate PCI. The patient is found to have an occluded mid-LED, which is treated with balloon angioplasty and a bare metal stent. PCI is successful and there are no complications post-procedure and the patient is discharged. A progress note in the medical record states the patient was being prescribed aspirin, apixaban, and statin, but not clopidogrel due to a prior reaction caused by hypersensitivity to the drug leading to angioedema. How are clopidogrel, prazogrel, ticagrelor, and ticlopidine coded in sequence 10200 and sequence 10205? Is it number one, yes? Number two, no, no reason? Number three, no, medical reason? Or number four, no, patient reason? This slide offers an opportunity to review the documentation and question to test your knowledge. And the answer is no, medical reason. No medical reason in this scenario is coded for all four P2Y12 inhibitors in sequence 10205. With the updated registry alignment regarding sequence 10205, documentation of a medication contraindication anywhere in the medical record, whether it be progress notes, procedure notes, supports coding no medical reason for that medication if the contraindication or medical reason continues to be a clinically valid reason at discharge. Additionally, the contraindication for one medication can be applied to all medications within that class. In this scenario, the clopidogrel contraindication extends to the entire class of P2Y12 inhibitors for the purposes of the CAP PCI registry. Now let's evaluate how metric 9 P2Y12 inhibitor prescribed at discharge will handle this patient. This patient meets the denominator because they had a stent implanted, but they were not prescribed a P2Y12 on discharge, meaning they will fall out of the numerator. However, because all P2Y12s were quoted as not prescribed for a medical reason, the patient will be removed from the denominator and not appear in this metric at all. When reviewing guideline medications prescribed at discharge, we can see that because the patient had a stent placed, they are eligible for statin, aspirin, and a P2Y12 at discharge. Because they received statin and aspirin at discharge, and there was a medical reason for not prescribing a P2Y12, the patient will remain in the metric and included in the numerator for metric 38, composite, and P2Y12. The patient will remain in the metric and included in the numerator for metric 38, composite, guideline medications prescribed at discharge. This concludes our February 2020 CAP PCI registry case scenario. Thank you for joining us.

chest pain

shortness of breath

occluded artery

percutaneous coronary intervention

aspirin