Welcome to the STS-ACC TVT Registry March 2022 case scenario. This month, we will review what happens when sequence 13704, mitral valve disease, is coded as yes for mitral valve procedures. Do sequence numbers 13316 and 13317 need to be coded? In this scenario, a 68-year-old female presents for a scheduled mitral valve repair for a history of severe mitral regurgitation. The pre-procedure echocardiogram shows moderate severe mitral regurgitation with no documented mitral stenosis. For mitral procedure patients where sequence number 13704 is coded as yes, but there is no mitral stenosis, do we have to answer sequence number 13316, mitral valve area, and sequence number 13317, mitral valve mean gradient, number one, no, or number two, yes? Please take a few moments to review the documentation and the question prior to making your final selection. For mitral procedure patients where sequence number 13704 is coded as yes for mitral regurgitation, but there is no mitral stenosis coded in sequence number 13308, do we have to answer sequence number 13316, mitral valve area, and sequence number 13317, mitral valve mean gradient? The answer is no. When documentation allows for sequence number 13704, mitral valve disease, to be coded as yes, it will open up all of the other data elements under mitral valve disease. Sequence numbers 13316 and 13317 are child fields of sequence number 13704 and are dependent upon the coding of sequence number 13308. Therefore, when mitral stenosis is coded as no, you will not need to answer mitral valve area and mitral valve mean gradient. This is further supported in the DQR composite threshold guide, which shows that sequence numbers 13316 and 13317 are conditional thresholds for sequence number 13704 being coded as yes and sequence number 13308 being coded as yes. This threshold only applies to mitral procedures. Now for a bonus question. When the patient has a TAVR procedure and sequence number 13704 is coded as yes and sequence 13308 is coded as yes, do both sequence 13316 and 13317 need to be coded? The answer is no. The thresholds for mitral valve area and mitral valve mean gradient do not apply to TAVR procedures. And now for a second bonus question. When the patient has a mitral procedure, clip, or replacement where sequence 13704, mitral valve disease, and sequence 13308, mitral stenosis are coded as yes, are sequences 13316 and 13317 required to be coded? Yes. When a mitral procedure is coded as having mitral valve disease and mitral stenosis, mitral valve area and mitral valve mean gradient will both need to be coded and will carry a threshold of 10% minimum and 80% supporting. See the in-hospital threshold guide for supporting documentation. Thank you for viewing the March 2022 STS ACC TVT Registry Case Scenario. We'll see you next month.

coding scenarios

mitral valve procedures

STS-ACC TVT Registry

sequence numbers

mitral stenosis