0421 - Sequence # 4600 | Left Atrial Appendage Intervention-0421 - Sequence # 4600

Video Transcription

The LAAO case scenario for April 2021 is sequence number 4600, left atrial appendage intervention.  This element number was updated to sequence number 14804 to reflect the version 1.4 upgrade. A patient was admitted for an LAAO procedure.  After successful access and the subsequent transeptal puncture, a moderate pericardial effusion was seen on the TEE.  An immediate successful pericardiocentesis was performed, which resolved the effusion. The procedure was aborted.  The patient was discharged home two days later with instructions to return in one month to attempt the LAAO procedure again.  The patient was readmitted in one month with successful placement of the Watchman device. Our question, when the patient returns for the second and successful LAAO procedure,  how will sequence number 4600 be coded? Number one, no, or number two, yes. Please take a few moments to review the documentation in question before determining the best answer.  Sequence number 4600 would be coded as yes. During the first procedure, access had already been obtained and the transeptal puncture  had been completed, making the procedure an aborted procedure. In this scenario, the first attempted procedure would be coded as an aborted procedure and  therefore when the patient returns for their second attempt, sequence 4600 would be coded as yes, as a left atrial appendage occlusion intervention was attempted.  For the purpose of the LAAO registry, if the prior procedure was canceled, meaning that it was stopped before having obtained central venous or epicardial access, no will  be coded for sequence number 4600, left atrial appendage intervention, when the patient returns for a second procedure as the left atrial occlusion intervention was not attempted.  If the procedure was aborted, meaning that it was stopped after having venous or epicardial  access, yes will be coded for sequence number 4600, as the attempt for an intervention had already began.  When sequence number 4600 is coded as yes, sequence 4605, intervention type, will become open to code.  This element will be coded based on what device was attempted or planned to be attempted in the prior procedure.  If in the past procedure, a Watchman device was planned or attempted to be implanted, percutaneous occlusion will be coded.  If the plan or attempt was for a Lariat device, epicardial ligation will be coded. The rest of the choices will be coded depending on what type of surgical occlusion was planned  or attempted. Thank you for viewing the April case scenario regarding the coding of left atrial appendage intervention. We'll see you next month.

Video Summary

In this video, the LAAO case scenario for April 2021 is discussed. The sequence number for the case is 4600, which was later updated to 14804 to reflect an upgrade. A patient underwent an LAAO procedure but developed a moderate pericardial effusion, which was successfully resolved through pericardiocentesis. The procedure was then halted, and the patient was discharged. After one month, the patient was readmitted and the Watchman device was successfully placed. The question posed is how sequence number 4600 should be coded for the second procedure. It is determined that it should be coded as "yes" since the first attempt constituted an aborted procedure. The coding of sequence number 4600 also affects the coding of the intervention type, such as percutaneous occlusion or epicardial ligation based on the attempted or planned device. No credits were mentioned in the video.

Keywords

LAAO case scenario

pericardial effusion

Watchman device

aborted procedure

intervention type