0423 - Sequence # 8090 | Bleeding Events-0423 - Sequence # 8090

Video Transcription

This is the IMPACT registry case scenario for April of 2023, where we will focus on intra and post-procedure events. A 22-year-old female presents to the emergency department.  She states she has been doing well until a week ago and has a history of mild tetralogy of fallot and has undergone several surgical procedures to correct, but is now experiencing  dyspnea on exertion, palpitations, and near-syncopal events. Further workup demonstrates severe pulmonary regurgitation, and she is scheduled for TPVR.  Her right groin is accessed for the TPVR procedure. The patient remains hemodynamically stable throughout the procedure.  The valve is deployed in good position without evidence of perivalvular leaks or pericardial effusion.  Postoperatively, the nurse notes groin bleeding at the right access site despite applying manual pressure.  The patient's hemoglobin is unchanged, but the patient is taken to the cath lab for arterial repair under fluoroscopic guidance with balloon angioplasty.  There is no further bleeding status post-repair, and the patient is discharged home the next day. Our question is, how is sequence number 8090, bleeding event, coded?  Number one, no, or number two, yes. Please take a few moments to review the documentation and the question before making your final  determination. And the answer is yes. The patient required a procedural intervention at the bleeding site to reverse or stop or correct the bleeding.  Two days status post the TPVR procedure, right arterial access site repair. The patient returns to the emergency department with a large hematoma at the access site and  a significant change in her hemoglobin. She's admitted to the hospital for further observation and receives two units of packed red blood cells.  How is sequence number 8130, red blood cell transfusion, coded? Number one, no, or number two, yes.  Please take a few moments to review the documentation and the question before making your selection.  And the answer is no. Once the patient is discharged from the facility, this ends their episode of care, and the target  value of any occurrence between start of procedure and 72 hours post procedure or next procedure surgery or discharge is not met.  Thank you for viewing the impact registry case scenario for April of 2023.

Video Summary

In this video, an IMPACT registry case scenario for April 2023 is presented. The scenario focuses on intra and post-procedure events. A 22-year-old female with a history of tetralogy of Fallot presents to the emergency department with symptoms of dyspnea, palpitations, and near-syncopal events. Further investigations reveal severe pulmonary regurgitation, and the patient is scheduled for transcatheter pulmonary valve replacement (TPVR) procedure. During the procedure, the patient remains stable, but postoperatively, she experiences bleeding at the right access site. The patient undergoes arterial repair with balloon angioplasty, and there is no further bleeding. However, two days later, the patient returns to the emergency department with a significant hematoma and a change in hemoglobin. She receives packed red blood cell transfusion and is admitted for observation. The coding question regarding the bleeding event is answered as "yes," while the red blood cell transfusion is coded as "no." The video concludes by stating the patient's episode of care ends upon discharge from the facility. No credits are mentioned in the video.

Keywords

IMPACT registry

case scenario

April 2023

intra and post-procedure events

tetralogy of Fallot