Thank you for viewing this CAF PCI registry case scenario. In this scenario, we will cover sequence number 7400, indications for cath lab visit. A patient was admitted with STEMI to an outside hospital where a visit to the cath lab revealed an occluded proximal RCA. However, despite multiple attempts, crossing the lesion was unsuccessful and the decision to transfer PCI was established. At the receiving hospital, the interventionalist documents continued ST elevation on ECG and pain. The patient went on to undergo PCI of the proximal RCA with 0% residual stenosis. Question, can ACS less than or equal to 24 hours be captured for the second cath lab visit at the receiving facility in sequence number 7400, indications for cath lab visit? Number one, no. Or number two, yes. Please take a few moments to review the documentation prior to making your final selection. And the answer is number two, yes. As the physician documents continued ST elevation on EKG, we understand that this one, and potentially only patient symptom or condition prompting the cath lab visit, is ACS less than or equal to 24 hours, and therefore would be coded in sequence number 7400, indications for cath lab visit. So what if we have the same scenario, but the physician does not provide this type of documentation? Well, let's look at that scenario. So in this scenario, we still have a patient who is admitted with STEMI to an outside hospital where a visit to the cath lab revealed an occluded proximal RCA. However, despite multiple attempts, crossing the lesion was unsuccessful, and the decision to transfer PCI was established. At the receiving hospital, the patient went on to undergo PCI of the proximal RCA with 0% residual stenosis. Can ACS less than or equal to 24 hours be captured for the second cath lab visit at the receiving facility in sequence number 7400, indications for cath lab visit in this scenario? Number one, no, or number two, yes. Please take a few moments to review the documentation prior to making your final selection. And the answer is number one, no. Now we imagine seeing a lot of hands going up, and you're probably wondering, how can the same scenario of failed PCI for STEMI be coded differently for the second cath lab visit when it's clinically the same? And we hear you. Let's go ahead and review the rationale and go over some education points first. Number one, PCI is defined as the placement of an angioplasty guide wire, balloon, or other device. For example, a stent, atherectomy, brachytherapy, or thrombectomy catheter into a native coronary artery or coronary artery bypass graft for the purpose of mechanical coronary revascularization occurred. In both scenarios, the patient received PCI at the transferring hospital, albeit unsuccessful. And number two, if and when a patient receives PCI for any indication for cath lab visit in sequence number 7400, that event is considered over by the registry. Thus only current conditions, indications, in sequence number 7400 for the second cath lab visit would be coded. Therefore, regarding the initial scenario, as the physician documents continued ST elevation on EKG, we understand that one or maybe the only patient symptoms or condition prompting the cath lab visit is ACS less than or equal to 24 hours and would subsequently be coded in sequence number 7400. It is not assumed. So we are sure many of you are asking, well, if we can't code ACS less than or equal to 24 hours for the second cath lab visit at the receiving facility in sequence 7400, then what can we code? Well, let's pause here and review the documentation provided. And in this scenario, we all know is that the patient presented with STEMI to the first facility and went to the cath lab where they noted an occluded proximal RCA. However, were unable to cross the lesion. So they transferred the patient and there they were able to perform PCI of the proximal RCA resulting in 0% residual stenosis. And that's it. So you can see we have no new documented patient symptoms or conditions by the second facility that indicate the reason for the cath lab visit which warrants provider clarification with an amendment to the medical record. Thank you for viewing this cath PCI registry case scenario.

CAF PCI registry

STEMI

occluded proximal RCA

transfer PCI

ACS less than or equal to 24 hours