Welcome to the STS-ACC TBT Registry April 2022 case scenario. This month, we will review sequence number 13381, Number of Diseased Vessels. An 87-year-old patient had a diagnostic coronary angiogram performed six months prior to her TAVR procedure, which revealed a left main artery that's 50% stenosed. Additionally, a proximal LED 90% stenosis, a mid-LED 100% stenosis, and a patent LEMA to the patient's distal LED, as well as a mid-left circumflex 100% stenosis, and which is a new finding. And finally, a proximal RCA 100% stenosis with a patent saphenous vein graft to her distal RCA. How is sequence number 13381, Number of Diseased Vessels coded? Is it none, one, two, or three? Please take a few moments to review the documentation and the question prior to making a final selection. And the answer is three. Sequence number 13381, Number of Diseased Vessels, would be coded as three. FAQ ID number 25359 educates sites that, per the data dictionary, sequence number 13381, Number of Diseased Vessels, is indicating the number of diseased major native coronary vessel systems from a diagnostic cath. The LED system, the circumflex system, and or the right system, with 50% or greater narrowing of any vessel preoperatively from between birth and the start of the procedure. Meaning that sequence number 13381 is capturing any history of native vessel stenosis greater than 50%, even if it has been treated with a stent and is now at 0%, or treated with cabbage and grafts are patent. So why is it captured like this when the patient has been revascularized? Well, the intent of this data element is to capture the extent of a patient's atherosclerotic heart disease or CAD. And as there is no cure for CAD, only treatment, once diseased, always diseased. Now let's try some bonus questions. Same scenario, but now, how is sequence number 13260 left main stenosis greater than or equal to 50% coded? Number one, no. Or number two, yes. Please take a few moments to review the documentation and the question prior to making a final selection. And the answer is number two, yes. Sequence number 13260 would be coded as yes. Sequence number 13260 is capturing the current state of disease in the left main coronary artery. In this scenario, the current state of disease is in the left main coronary artery. is capturing the current state of disease in the left main coronary artery. In this scenario, the current state of the left main is 50% stenosed with the native LED and left circumflex occluded with a graft only supplying perfusion distal to the LED blockages. For bonus question number two, we'll take the same scenario, but now, we'll ask how is sequence number 13301 proximal left anterior descending artery disease greater or equal to 70% coded? Number one, no. Or number two, yes. And please take a few moments to review the documentation and the question prior to making a final selection. And the answer is number two, yes. Sequence number 13301 proximal left anterior descending artery disease greater or equal to 70% would be coded as yes. Sequence 13301 is capturing the current state of disease in the proximal left LED coronary artery. In this scenario, the current state of the proximal LED is 90% stenosed with the native mid LED occluded with a graft only supplying perfusion distal to the mid LED blockage. So why are these data elements captured like this? Well, the intent of these data elements are to capture the current state of disease burden. Additionally, the current state of disease burden will drive patients into their appropriate AUC ratings once developed. Thank you for viewing the April 2022 STS-ACC-TVT registry case scenario. We'll see you next month.

diseased vessels

coronary angiogram

left main artery

atherosclerotic heart disease

treatment