Thank you for joining us. The February 2025 case scenario for the Chest Pain MI Registry will review inclusion and exclusion criteria. A 32-year-old female patient arrives via EMS with severe chest pressure radiating to her shoulders, shortness of breath, and nausea and vomiting. She has a past medical history of fibromuscular dysplasia. The EMS and ED ECGs are negative for STEMI. Rainbow labs are drawn with a positive troponin value, and a second troponin value demonstrating a rise. Observation orders are written, which includes an order for a coronary angiogram to be performed the same day, based on cath lab availability. The coronary angiogram is performed and reveals a coronary artery dissection in the mid-distal circumflex. No intervention is performed. Cardiologist documents will treat medically in the cath lab report. Is this patient included in the registry based on the information provided, number one, no, or number two, yes? Please review the documentation, question, and selections prior to choosing your answer. The answer is no. This patient is not included in the registry based on the information provided. The patient met the exclusion criteria as outlined in the inclusion criteria document. Patients who are assigned a clinical diagnosis of NSTEMI that are deemed by the cardiologist to be due to a non-thrombotic mechanism are not included in the registry. With the information provided, a clinical diagnosis of NSTEMI with cardiologist documentation of SCAD meets the exclusion criteria. However, the episode of care continues. To recap, a 32-year-old female patient arrives via EMS with severe chest pressure radiating to their shoulders, along with shortness of breath, nausea, and vomiting. She has only a past medical history of fibromuscular dysplasia. The EMS and ED ECGs are negative for STEMI. Rainbow labs are drawn. A positive troponin value results, and a second troponin value demonstrates a rise. Observation orders are written, which includes an order for a coronary angiogram. The coronary angiogram is performed and reveals a coronary artery dissection in the mid-distal circumflex. No intervention is performed, and the cardiologist documents will treat medically in the cath lab report. The scenario continues, and the patient is transported to the recovery unit. Approximately two hours later, the patient has an acute and significant event that includes chest pain, shortness of breath, accompanied by a near-sinkable episode. An ECG is immediately obtained and reveals ST elevations and leads V3 through V6. The patient immediately returns to the cath lab for reperfusion of the clinical diagnosis of STEMI, and a stent is placed in the LAD for a thrombotic occlusion of greater than 90%. Inpatient orders are written at 1622. Based on the additional information provided, is this patient included in the registry? Number one, no. Or number two, yes. Please take a moment to review the documentation, question, and selections prior to choosing your answer. And the answer is yes. This patient is included in the registry. This patient is included in the registry based on the subsequent event and the STEMI clinical diagnosis that followed. Per the inclusion criteria document, the patient meets the inclusion criteria for the STEMI patient type. The patient was assigned a clinical diagnosis of STEMI, received revascularization for the STEMI diagnosis, has symptoms of an acute myocardial ischemia, new ST elevation, and identification of intracoronary thrombus by angiography. Now that we know that the patient meets inclusion criteria as a STEMI, what is coded in sequence 12447, STEMI type? Number one, pre-admit. Number two, in-hospital. Please review the documentation, question, and selections prior to choosing your answer. The correct answer is number one, pre-admit. Once STEMI has been identified, then the line in the sand is the admitting order when determining the STEMI type. The admitting orders will determine if a STEMI is captured as a pre-admit or in-hospital in sequence 12447. Pre-admit STEMI is a pre-admit, in-hospital, or in-hospital STEMI type. Pre-admit STEMI is a pre-admit, in-hospital, or in-hospital STEMI type. Pre-admit STEMI is selected when a STEMI occurs pre-hospital or anytime prior to the order for admission being written. Orders for observation status or a like designation do not qualify as admitting orders. In-hospital STEMI is selected when the STEMI occurs after order for admission is written. The diagnostic ECG occurs after the cardiac or non-cardiac admission order. The STEMI occurred prior to orders being written for admission for inpatient status in this scenario. Thus, pre-admit is selected. The patient presented for the care of an end STEMI with a non-thrombotic mechanism, sudden coronary artery dissection was identified, and the plan was to treat the patient medically. Two hours later, a new and different MI occurred, and a STEMI clinical diagnosis was assigned with a PCI performed on the culprit lesion. We know that this patient is abstracted by coding STEMI pre-admit. The non-thrombotic mechanism present was associated with the end STEMI clinical diagnosis and not the STEMI diagnosis. Therefore, sequence 15-599 non-thrombotic mechanisms present will be left blank. The patient arrived at the hospital at 4-09. The first ECG was performed at 4-16 and was negative for STEMI. The second ECG at 15-47, nearly 12 hours after the patient arrived, revealed ST elevations and leads V2 through V6 with a clinical diagnosis of STEMI assigned. Let us review how this patient will be evaluated in metric key 7652, first medical contact to device. The patient is included in the denominator as the denominator criteria is met. The patient's STEMI clinical diagnosis is a pre-admit STEMI who received immediate PCI for acute STEMI. There are no denominator exclusions or exceptions to apply in this scenario. The numerator is met. The first positive ECG occurred at 15-47, and the first device was deployed at 16-43. The first medical contact to device time is 56 minutes. Thank you for viewing the Chest Pain MI Registry February 2025 case scenario.

cardiac rehabilitation

coronary atherectomy

medical coding

documentation

dementia

NSTEMI

STEMI

fibromuscular dysplasia

coronary artery dissection

PCI