Thank you for reviewing the AFib ablation registry monthly case scenario for February 2022. The case scenario will be focused on the capture of genitourinary bleeding as an intra or post procedure event in sequence 9095. Our patient Mr. Murphy was admitted to the hospital for an AFib ablation procedure and goes on to have a successful ablation in which PVI was used as the strategy. Mr. Murphy developed bleeding from his Foley catheter during the procedure. Overnight continuous bladder irrigation was ordered by urology and started post procedure. The bladder irrigation was discontinued in the morning. Mr. Murphy's hemoglobin level had only dropped from 12.0 pre-procedure to 10.0 grams per deciliter in the morning after the procedure, giving us only a drop of 2 grams per deciliter. Mr. Murphy was discharged home after being cleared by urology and cardiology the day after the procedure. Based on the documentation of Mr. Murphy's intra and post procedure bleeding, would we code GU bleeding as an intra or post procedure event in sequence 9095? Number one, no. Or number two, yes. Please take a few moments to review the documentation and question to determine the best response. And the answer is number one, no. For the bleeding to be coded as a GUI bleeding event, the episode would have to meet at least of the three criteria listed in the data dictionary, which are a hemoglobin drop of equal or more than 3 grams per deciliter, transfusion of whole blood or packed red blood cells, or a procedural intervention surgery at the bleeding site to reverse stop or correct the bleeding. In this case, the patient's hemoglobin did not decrease by 3 grams per deciliter or more. The patient did not have a transfusion and the registry does not consider bladder irrigation as a procedural intervention or surgery at the bleeding site to reverse stop or correct the bleeding. None of the criteria necessary to code a bleeding event have been met. And our bonus question, if Mr. Murphy would have acquired and received a transfusion of packed red blood cells, meeting the criteria for GU bleeding to be coded as an event, would he be included in metric number four as having a major adverse event? Number one, yes, or number two, no. And the answer is number two, no. Genitourinary bleeding is not an event that is categorized as a major adverse event by the metrics numerator. Therefore, Mr. Murphy will not be included in the numerator of metric four as a major adverse event. Please refer to the executive summary measures and metrics companion guide, which has been recently updated. The document is located in the resources tab under documents. Thank you for reviewing the AFib Ablation Registry Monthly Case Scenario for February 2022.

AFib ablation procedure

bleeding

Foley catheter

continuous bladder irrigation

hemoglobin level