This is the cath PCI case scenario for February 2024. This is going to cover sequence number 4560, which is currently on dialysis and the intra and post procedure event new requirement for dialysis. A 72-year-old female with history of coronary artery disease with a prior PCI to the RCA and LAD has hypertension and chronic renal failure, presents to the ED via private vehicle. She's been experiencing chest discomfort, which has increased in frequency and severity over the past several weeks, with associated dyspnea on minimal exertion and two-pillow orthopnea. She also reports increased swelling in her lower extremities and decreased urine output in the last 48 hours. The ECG on arrival reveals atrial fibrillation with rapid ventricular response and negative for STEMI. Lab work is significant for elevated troponin levels, acute kidney injury, and hyperkalemia. She's admitted to the telemetry floor. Echocardiogram reveals an LVEF of 30%. Nephrology consulted and recommends hemodialysis with the first session later that same day. The following day, the patient complains of increasing chest pain at rest and was brought urgently for diagnostic coronary angiogram, which demonstrated an 80% lesion in the proximal LAD and a 90% lesion in the mid-circumflex. Both lesions were treated successfully with PCI in the same lab visit. The question we have is, how is sequence number 4560 currently on dialysis coded for the PCI procedure? Is it 1, no, or 2, yes? Please pause here to review. In this scenario, how is sequence number 4560 currently on dialysis coded for this PCI procedure? The answer is yes. To further clarify, the coding instructions for sequence number 4560 currently on dialysis states, indicate if the patient is currently undergoing hemodialysis or peritoneal dialysis on an ongoing basis as a result of renal failure between birth and the first procedure in this admission. While the definition refers to receiving dialysis on an ongoing basis, for the purpose of the registry when the patient requires and receives dialysis for renal failure, even one session after arrival and before the start of the first procedure, then the intent of the element is met and sequence number 4560 will code to yes. Another question, when the patient continues with hemodialysis after PCI and prior to discharge, how will new requirement for dialysis as an intra and post-procedure event, sequence number 9001, be coded for the PCI procedure? 1, no, or 2, yes? Again, take your time and pause here to read the information. And the answer is no. The coding instructions for new requirement for dialysis are, indicate if the patient experienced acute or worsening renal failure necessitating renal dialysis between the start of the procedure and until the next procedure or discharge are met. Dialysis was started prior to the PCI procedure. So another question is, is the patient eligible to be included in metric 57, which is PCI in-hospital risk standardized acute kidney injury, for all patients? Your options are 1, yes, the patient had a PCI procedure. 2, no, the patient was discharged the same day as her PCI. Or 3, no, the patient is currently on dialysis. Pause here to review the information. And the answer is number 3, no. The patient is currently on dialysis and so she is excluded from the metric. Even though she did have a PCI during the episode of care because she was currently on dialysis, she will not be eligible for the metric. Based on the information provided, we do not know if the other exclusion criteria were met. Another question, if the patient post-procedure creatinine increased 0.4 milligrams per the pre-procedure value, will she be considered an observed acute kidney injury by metric number 57? 1, yes, the increase in creatinine will be considered an observed AKI event. 2, no, the increase in creatinine will not be considered an observed AKI event. And the answer is number 2, no, it will not be considered an observed AKI event, even though there was an increase in the post-procedure creatinine of greater than 0.3. From the pre-procedure value, this will not be considered an AKI event, as the patient is currently on dialysis and excluded from the metric. The risk model will assess patient variables that are predictive of AKI. And when reviewing the patient level drill down, this can be appreciated by reviewing the patient's predicted probability of AKI. This view also provides information on whether the patient is eligible and if they are an observed AKI and all the variables utilized in the model. When reviewing your facility data, remember to utilize the risk-adjusted values found in the detail lines of the dashboard. They're located under the section PCI with or without diagnostic coronary angiogram. The observed AKI, expected AKI, and the observed expected AKI ratio can be used to identify opportunities for improvement in care delivery or the need for improved documentation to be captured for patient risk. Thank you for viewing the CAF PCI Registry Monthly Case Scenario for February 2024, sequence number 4560, currently on dialysis and intra and post-procedure event, new requirements for dialysis.

sequence number 10116

cardiac rehabilitation referral

PCI

inpatient cardiac rehab nurse

referral order

72-year-old female

coronary artery disease

chronic renal failure

chest discomfort

dyspnea