Welcome to the STS-ACC-TVT Registry Case Scenario, where we will discuss the nuances of capturing dialysis as a history and risk factor, or as an intra- or post-procedure event. A 68-year-old male with a significant medical history of chronic kidney disease, hypertension, and heart failure, to name a few, presents for his transcatheter mitral valve repair. His outpatient blood work reported a creatinine of 2.9 mg per deciliter, which is as usual as he normally fluctuates between 2.5 and 3. A multidisciplinary telehealth visit with his cardiologist and nephrologist outlined his plan of care to include a left and right heart catheterization before the device implant to assess hemodynamics and his known CAD. Additionally, the possibility for dialysis as a potential outcome was discussed in detail and the patient agreed to proceed. Because of difficulties crossing the septum, the procedure was aborted and the patient received gentle hydration protocol. However, post-lab visit, his creatinine climbed to 3.6 mg despite kidney-supportive efforts. As well, his GFR worsened and his urine output decreased significantly. Dialysis was initiated and the patient underwent his TMV repair procedure two days later. How is sequence number 13880 currently on dialysis coded in this scenario? Number one, no. Or number two, yes. Please take a few moments to review the documentation before making a final selection. And the answer is number one, no. This data element is only assessed once at the episode of care level and must occur prior to the first TBT procedure regardless of procedure success and or completion. As dialysis was started after the first TBT procedure, albeit it was aborted, the target value is not met and no is coded. Let's now expand on this scenario and ask another question. Will new requirement for dialysis be coded as an intra and post-procedure event? Number one, no. Number two, yes for the first lab visit. Number three, yes for the second lab visit. Or number four, yes for both lab visits. Please take a few moments to review the documentation before making your final selection. And the answer is number two. New requirement for dialysis will be coded as yes in sequence 9,002, intra-post-procedure events occurred for the first cath lab visit. The target value for sequence 9,002 can best be understood if written, and please feel free to make a note in your data dictionary for future reference, to capture an event that occurred either between the start of the TBT procedure, sequence 7,000 procedure start date and time, and next TBT procedure, sequence 7,000 procedure start date and time in the same episode of care, or between the start of the TBT procedure, sequence 7,000 procedure start date and time, and discharge. As the patient experienced acute or worsening renal failure necessitating a new requirement for renal dialysis between the start of the TBT procedure and next TBT procedure in the same episode of care, it would be captured for the first cath lab visit. Thank you for viewing the TBT registry case scenario.

tricuspid valve procedures

STS-ACC TVT Registry

risk scores

coding practices

heart team

chronic kidney disease

transcatheter mitral valve repair

dialysis initiation

creatinine levels

intra-post-procedure event