Welcome to the Chest Pain MI Registry Case Scenario for February 2024. This scenario will review sequence number 15521, left ventricular ejection fraction assessed, and sequence number 12307, left ventricular ejection fraction measurement. A male of 85 years of age presents via EMS due to chest pain. The EMS ECG was negative for STEMI. Upon arrival at the ED, the physician read the EMS ECG as non-emergent. During the examination, the patient's family stated the patient was admitted to another facility one month ago for chest pain and diagnosed with heart attack. A cardiology consult was requested. The patient was admitted to telemetry after a positive troponin result. A coronary angiogram was performed the next day and minimal contrast was used due to a creatinine value of 1.6. A PCI was not indicated. The physician documented the echo results that were performed one month ago and stated the LVEF was 35%. The patient was discharged with an end STEMI diagnosis on day three without documentation of a planned LVEF. Here's our question. Is physician documentation of an LVEF value of 35% coded in sequence number 12307 for left ventricular ejection fraction measurement? One is no, two is yes. Please take a few moments to make the best selection. The selection is no. Assessing LVEF is important from a therapeutic and prognostic standpoint for patients with acute AMI. Sequence number 12307, left ventricular ejection fraction measurement is with the target value of the last value between arrival at the first facility and discharge. Therefore, the LVEF of 35% from the prior index of care did not meet the coding instruction. Here's our other question. How is sequence number 15521, left ventricular ejection fraction assessed, coded? One, no, no reason. Two, no, there's a medical reason. Three, no, there's a patient reason. Please take a few moments to make the best selection. Re-evaluating LVEF of each episode of care is at the provider's discretion regardless of guideline recommendations. No medical reason or no patient reason is specific to when there is clear documentation of a reason related to the patient's medical issue or concern explaining why it was not done. The stated reason must be documented and linked to why the LVEF was not obtained. The key is to link the stated reason as to why the LVEF was not assessed in one thought. Per the 2017 AHA, ACC STEMI and INSTEMI measure, patients with reduced LVEF may benefit from a specifical medical therapy such as inhibitors of the renin-angiotensin-aldosterone system. The presence of LVSD may help inform and guide the invasive strategy and revascularization modality. For example, further risk stratification in patients with INSTEMI, use of percutaneous circulatory assist devices during percutaneous coronary interventions and choice of surgical revascularization. LVEF is one of the strongest predictors of long-term survival following acute MI. LVEF measurement during hospitalization provides a baseline and dictates outpatient reassessment a few weeks later in patients with initially depressed post-MI LVEF. This will help guide the need for device therapy. Thank you for your time in viewing the Chest Pain MI Registry February 2024 case scenario.

coding

cerebral performance category

CPC score

cardiac arrest

medical record

chest pain

emergency department

ECG

troponin

coronary angiogram