Thank you for reviewing the AFib Ablation Registry Monthly Case Scenario for April 2020. We will be discussing Sequence 4045, Chad's Vascular Disease. When abstracting a procedure for the AFib Ablation Registry, we have a documented pre-procedure H&P in which persistent AFib, CAD with PCI, and hyperlipidemia are included in the patient's history. In this pre-procedure documentation, we also find a Chad's Vasc assessment performed by the clinician with a total score of 4. The documentation included hypertension, ischemic origin stroke, and CHF to calculate the patient's Chad's Vasc score. Our question is, when coding the patient's Chad's Vasc score, should Chad's Vasc vascular disease be coded? 1. Yes. 2. No. Please review the documentation and question to determine the best answer. We will give you a few seconds to review. The answer is 2, no. After discussion with the steering committee, a decision was made for Sequence 4045, Chad's Vasc vascular disease, to include a patient's history of CAD, PCI, CABG, carotid disease, carotid stent, and carotid endarterectomy, as well as prior MI, PAD, and known aortic plaque. However, the conditions of CAD, PCI, CABG, carotid disease, carotid stent, or endarterectomy can only be used for coding Sequence 4045 if the clinician documented using one of these when factoring Chad's Vasc score. In this case, the clinician documented the patient's Chad's Vasc score, but did not include history of CAD or PCI in score calculation. The finding of any CAD, PCI, CABG, carotid disease, carotid stent, or carotid endarterectomy in the patient's history does not automatically allow the coding of Yes to Sequence 4045, Chad's Vasc vascular disease, based only on an abstractor finding the presence of these conditions in the medical record. Please only code if the physician utilized any of these conditions as part of the score when documenting or determining the patient's Chad's Vasc risk score. The next slides will give a little history of why this change was made. During the Registry's initial development, the workgroup elected to utilize the strict Chad's Vasc risk score definitions from the Chad's Vasc Validation Study. This strict definition included only coding Sequence 4045 and 4050, only with a history of PAD, prior MI, and known aortic plaque. The change to include the new conditions in the coding was propelled by real-world practice of clinicians utilizing a variety of other vascular disease conditions when calculating a patient's Chad's Vasc risk score. After a discussion with Steering Committee, the decision was made to include a patient's history of CAD, CABG, PCI, and carotid disease if the clinician documented these conditions as contributing factors to their Chad's Vasc risk score assessment. This change will give facilities the ability to code as per real-world practice. Sequence 4050, Vascular Disease Type, will be left blank if the patient does not have a history of prior MI, PAD, or known aortic plaque, and Sequence 4045 was coded based on CAD, PCI, CABG, carotid disease, carotid stent, or endarterectomy. The threshold for this sequence has been lowered, and leaving it blank will not impact the DQR submission. Thank you for reviewing the AFib Ablation Registry Monthly Case Scenario for April 2020.

coding process

Chad's Vasc vascular disease

AFib Ablation Registry

Chad's Vasc assessment

total score