Thank you for reviewing the AFib Ablation Registry Monthly Case Scenario for April 2021. This month's case scenario is focused on Sequence 4005, Chad's Vasque Congestive Heart Failure. Our patient, Mrs. Schmidt, a 76-year-old female, is admitted for an AFib ablation procedure. Her past documented medical history includes symptomatic paroxysmal AFib, prior MI, ischemic stroke, several unsuccessful attempts to cardiovert using both direct current and pharmacological approaches, and a documented NYHA Class of 3. Her pre-procedure assessment documents the patient being asymptomatic with no complaints and in no apparent distress. When capturing the patient's Chad's Vasque risk score based on the patient's past medical history, how will congestive heart failure be coded? Will it be coded yes or no? Let's review the documentation and question to determine the best answer. The answer is number one, yes. In order to code yes to Sequence 4005, Chad's Vasque Congestive Heart Failure, the following options to the abstractor are available. In the best case scenario, the provider has documented their own Chad's Vasque assessment of the patient, in which case the abstractor can just code the conditions used by the provider in his or her assessment. But in a case where a provider has not documented a Chad's Vasque assessment of the patient, the following documentation can be used to code yes to CHF Sequence 4005. The patient has been diagnosed with or had an episode of heart failure between 30 days prior to the procedure, a chronic or new diagnosis documented within 30 days prior to the procedure. The abstractor may also utilize patient's CHF symptoms exhibited pre-procedure or documented between 30 days of the procedure. The abstractor may use a documented NYHA class of 2, 3, or 4 to code Chad's Vasque CHF as yes, as this is a functional evaluation regarding the patient's limitation in ADL as a result of their heart failure. And if the patient is being medically treated for CHF with medication, for example, furosemide, they may code yes as the patient's CHF is a chronic and current condition as they are still being medically treated. When abstracting this procedure based on the documentation available, the option that is available to us is the documentation of an NYHA class of 3, which we can use to code yes to Sequence 4005, Chad's Vasque CHF. If the provider documented their own Chad's Vasque assessment of the patient, it is sufficient to code yes to all the conditions documented as part of the score. Sequence 4010 NYHA classification is a child field of Sequence 4005. If 4005 is coded as no, Sequence 4010 will gray out and will not become available to code. Unlike Sequence 4005, Sequence 4010 NYHA classification cannot be coded based on patient's symptoms. It would have to be documented by a provider. Based on Mrs. Schmidt's documented history, her Chad's Vasque risk score will be coded as yes to CHF and NYHA will be coded as class 3, yes to stroke, yes to thromboembolic event, and yes to vascular disease and myocardial infarction based on the history of a previous MI. Thank you for reviewing the AFib Ablation Registry Monthly Case Scenario for April 2021.

AFib Ablation Registry

Chad's Vasque Congestive Heart Failure

paroxysmal AFib

MI

ischemic stroke