The April 2024 case scenario reviews sequence number 10-205, Discharge Medication Prescribed, and metric 12, ACE1, ARB, or ARNI for LVSD at discharge. A 62-year-old African-American male prevents for chest pain and diaphoresis via EMS. He has a long-standing history of hypertension, hyperlipidemia, myocardial infarction, resulting in ischemic cardiomyopathy with an EF of 30%. The EMS ECG reveals ST elevation of one millimeter in one lead. A repeat ECG after arrival demonstrates ST elevation in three contiguous leads, and the cath lab is activated. The patient proceeds for primary PCI. At discharge, the clinician documents, patient is unable to tolerate ARNI. The patient is to continue the home medications at their current dose consisting of carvitalol, aspirin, furazamide, simvastatin, and clopidogrel. The question we have is, how is angiotensin receptor neprillicin inhibitor, ARNI, coded in sequence number 10205, discharge medications prescribed? One, yes, prescribed. Two, no, no reason. Three, no, medical reason. Or four, no, patient reason. Please take a few moments to make the best selection. Pause here until you make your selection. The answer is number three, not prescribed, medical reason. Prescribing medications is at the provider's discretion regardless of guideline recommendations. To code no medical reason or no patient reason, there must be documentation of a medical or patient reason or concern as to why the medication was not prescribed at discharge. The documentation must include a link or reason to the medication or medication class. No medical reason is coded when there is clear documentation of a reason related to the patient's medical issue or concern linking why the medication or medication class was not prescribed. For no patient reason, there is clear documentation of a reason related to the patient's and or the patient's family's preference linking why the medication or the medication class was not prescribed. This documentation supports the coding of no medical reason for the medication category of angiotensin receptor nephrocyllin inhibitor, ARNI. Now knowing that ARNI is coded as no for medical reason, how is angiotensin receptor blocker, an ARB, any coded in sequence number 10205 for discharge medications prescribed? One, yes, prescribed. Two, no, no reason. Three, no, medical reason. Four, no, patient reason. Please take a few moments and pause here to make the best selection for question number two. The answer is number two, no, no reason. Take a few minutes to review the FAQ on this slide. In this scenario, there is no documented reason why an ARB was not prescribed. Therefore, no, no reason is coded. Now that we've reviewed the FAQ, we know that no, no reason is coded angiotensin to receptor blocker. In this scenario, there is no documentation linking a reason why angiotensin converting enzyme inhibitor, ACE1, is not prescribed at discharge. Therefore, no, no reason is coded. Let's review a bit further on metric 12. ACE1, ARB, or ARNI for LVSD at discharge. Metric 12 evaluates the percentage of patients hospitalized with AMI and LVSD who are prescribed an ACE1, ARB, or ARNI at discharge. Denominator exclusions are left against medical advice, 10110. Deceased during hospitalization, 10105. Comfort measures only, 10075. Hospice care, 10115. Transferred to another acute care hospital, 10110. Denominator exceptions are documented medical reason and or patient reason for not prescribing an ACE1, ARB, and ARNI, 10205, at discharge. ACE and ARB and ARNI are not prescribed, and the patient is in a renin-angiotensin-aldosterone system, RAAS, related clinical trial, 12456. Question number three. Is this patient excluded from the denominator of metric 12, ACE1, or ARB, ARNI for LVSD at discharge? Number one, no. Or number two, yes. Please take a few moments to read the information before you make a decision. Pause here for a few minutes. The answer is number one, no. The case is coded with no medical reason for a category ARNI. No, no reason for ARB and ACE. Therefore, the denominator exception is not applicable to the case. The patient will remain in the denominator with the numerator not met. Although this FAQ does not affect the coding in this scenario, it is important to know, as it provides coding advice, for when there is a documented medical or patient reason why an ARB is not prescribed. Please take a few moments and pause here to read this FAQ. Thank you for viewing the Chest Pain in My Registry April 2024 case scenario.

heart issues

myocardial infarction

ARNI medication

coding process

documentation