This is the cath PCI registry case scenario for February 2021. We will review sequence 7410 and sequence 7415, cardiovascular instability and instability type. A 57-year-old male presents to your facility via EMS with hypertensive emergency and NSTEMI diagnosed by ECG by the receiving ED physician. Upon arrival, the patient's blood pressure is 210 over 105. ECG shows sinus tachycardia with a rate of 150 beats per minute. Before moving to the cath lab, the goal was to decrease blood pressure by 25%, therefore a nitroprusside infusion was started in the ED at 0.5 micrograms per kilogram per minute along with one IV bolus of labetalol 20 milligrams. One hour later, with his blood pressure reduced to goal, the patient moved to the cath lab for a diagnostic coronary angiography and possible PCI. The nitroprusside drip was still infusing upon arrival to the cath lab. During the diagnostic cath, the patient had an episode of SVT requiring 6 milligrams of adenosine bolus. The physician noted an 80% stenosis in the proximal LAD and moved towards an urgent PCI. Just after balloon inflation, the patient had another episode of SVT, which quickly deteriorated into pulseless ventricular tachycardia and cardiac arrest. The patient was defibrillated once with return of spontaneous circulation. The patient was given 300 milligrams amiodarone bolus followed by an infusion of 1 milligram per minute. The physician successfully stented the proximal LAD and the patient was moved to the ICU. How is sequence 7410 cardiovascular instability coded? No or yes? Please take a moment to review the documentation and the question. The answer is yes. The patient had ongoing hemodynamic instability, which was present and being actively treated at the start of the cath lab visit. How is sequence 7415 cardiovascular instability type coded? Here is your documentation and question for review. The answer is hemodynamic instability, not cardiogenic shock, and ventricular arrhythmias. Since cardiovascular instability was present at the start of the cath lab visit and yes was coded in sequence 7410, then all instability types which were present at the start of the cath lab visit and or developed during the visit are coded in sequence 7415. You will notice the data definition of hemodynamic instability, not cardiogenic shock, includes reduced unstable or abnormal blood pressure. This supports coding both severe hypotension and hypertension. Then the patient experienced SVT, which turned into VT during the cath lab visit. This supports coding ventricular arrhythmias in sequence 7415. Our final question is, how is cardiac arrest captured in this scenario? Is it captured by coding ventricular arrhythmias in sequence 7415? By coding yes in sequence 9002 intraposte procedure cardiac arrest? Or is it not captured in this scenario? Here is your documentation and question for review. The answer is to code yes in sequence 9002 intraposte procedure cardiac arrest. You will notice cardiac arrest is not a coding selection in sequence 7415 cardiovascular instability type, as it has its own data elements in sequence 4630, 4635, 7340, and 9002, depending on the timing of the arrest. When cardiac arrest occurs during or after a cath lab visit, it is always coded in sequence 9002. It is considered an event rather than an instability type. Thank you for viewing the Cath PCI Registry Monthly Case Scenario for February 2021.

hypertensive emergency

NSTEMI

proximal LAD stenosis

cardiac arrest

ventricular arrhythmias