Welcome to the LAAO Registry bi-monthly case scenario. This case scenario is for February 2024, where we will continue to resume our CHADS VAST series by addressing sequence number 4030, Stroke. In this scenario, the patient is admitted for an LAAO procedure with at least a two-year history of non-valvular AFib categorized as persistent. The patient takes a daily antiarrhythmic. The patient also has a history of hypertension and has had a hemorrhagic stroke. The patient is taking oral anticoagulant apixaban and aspirin 81 mg. In his documentation of the CHADS VAST score, the physician did not include the previous history or the hemorrhagic stroke. When capturing the patient's CHADS VAST risk score based on the documentation provided, how will sequence number 4030, CHADS VAST Stroke, be coded? 1. No. 2. Yes. Please take a moment to review the documentation in question before making a final answer. The answer to sequence number 4030 would be no, and the rationale is as follows. Based on the coding instructions, CHADS VAST Stroke is coded to indicate if the patient has a history of a stroke of ischemic origin or a stroke of undetermined origin. The target value for this sequence is any occurrence between birth and the procedure. Any documentation found can be used to code this element. In this case, there is documentation of a history of stroke. However, the stroke origin is documented as hemorrhagic. This element does not include strokes of hemorrhagic origin. Based upon the documentation of the patient having a history of a hemorrhagic stroke in their medical record, we would code no to this element, as CHADS VAST Stroke does not include hemorrhagic strokes. It only includes ischemic and undetermined origin strokes. Additional information that may aid in coding this data element, this CHADS VAST element may be coded with these other two options. Either documented CHADS VAST assessment performed and the stroke was included, or documented history of ischemic or undetermined stroke. We thank you for taking the time to review our latest case scenario. We will continue with the series on CHADS VAST elements in April of 2024.

coding sequence number 4025

diabetes mellitus

LAAO procedure

Mr. Hernandez

non-valvular atrial fibrillation

patient

left atrial appendage occlusion

non-valvular AFib

hypertension