Welcome to the STS-ACC TBT Registry February Case Scenario. We will be discussing Discharge Medications for Version 3.0. A 75-year-old male underwent a successful TAVR procedure at a local hospital. The patient was transferred to a step-down unit post-procedure and started on lisinopril for blood pressure control. After ingesting the drug, the nurse noticed severe facial swelling and alerted the care team. The patient was treated and recovered. Consequently, the discharging physician documented hold lisinopril due to allergic reaction in the patient's discharge note. How would Sequence 10200 and 10205 Discharge Medications be coded for ACE inhibitor? 1. Yes, prescribed. 2. Not prescribed, no reason. 3. Not prescribed, medical reason. Or 4. Not prescribed, patient reason. Please take a moment to review the documentation and the question prior to making a final selection. For this scenario, not prescribed, medical reason is coded for ACE inhibitor in Sequence 10200 and 10205 Discharge Medications. With the updated registry alignment regarding Sequence 10200 and 10205 in Version 3.0, documentation of a medication contraindicated anywhere in the medical record – progress notes, procedure notes, etc. – supports coding not prescribed, medical reason, with the understanding that the contradiction or medical reason continues to be a clinically valid reason for not prescribing all medications within that class. In this scenario, the physician clearly states that angiotensin-converting enzyme inhibitors would be contraindicated for this patient. Documentation acceptable to support coding not prescribed, medical reason must include a specific reason. Examples of acceptable documentation include physician documentation that medication was not prescribed due to existing medical conditions such as renal disease, hypotension, angioedema, insulin tolerance or allergy to medication, active bleeding, oral anticoagulation therapy as pre-arrival medication, as medical exception to aspirin. Further examples of acceptable documentation to support coding not prescribed, medical reason are specific reasons for not prescribing one medication applies to the entire class. This gives this physician credit for addressing the medication and assumes the reason provided applies to the entire class. An example would be documentation of no plavix due to bleeding risk. This would support coding not prescribed, medical reason for all P2Y12 inhibitors. Documentation acceptable to support coding not prescribed, patient reason must identify the patient-centered reason. Examples of acceptable documentation include physician documentation that medication was not prescribed due to documentation providing patient cannot afford the medication and therefore it was not prescribed, documentation providing patient refusal of prescription and therefore it was not a discharge medication. Thank you for viewing the February 2021 STS-ACC TVT Registry Case Scenario. We'll see you next month.

TAVR procedure

allergic reaction

lisinopril

ACE inhibitor

facial swelling