Hello, everyone, and welcome back to our bi-monthly case scenario. For this case scenario, we will take a break from our CHADS VAST series by addressing how to code a scenario in which the original LAAO device implanted becomes dislodged, requiring a second procedure in the same episode of care. In this scenario, the patient is admitted and has a successful LAAO implantation. The next day prior to discharge, the patient's TEE shows the LAAO device has moved from its original position and is now lodged in the mitral valve. The patient returns to the procedure room on post-op day one and has successful percutaneous retrieval of the first device, followed by a successful implantation of a new LAAO device. The patient is discharged without further events on the day after the second device implant. The question we have for you is, for the first procedure, what events will be coded in sequence number 12153 for intra- or post-procedure events when the LAAO device is seen to be dislodged and moves to the mitral valve as evidenced by the TTE on post-op day number one and is retrieved during the second procedure? Number one, none. Number two, device migration. Number three, device systemic embolization. Number four, device explant. Number five, both two and four. Or number six, both three and four. Please take a moment to review the documentation and question before making a final answer. The answer is number six for selections three and four. Device systemic embolization for catheter retrieval is coded when the implanted device has dislodged from its original implanted position in the LAA orifice and is introduced into the circulatory system, as in this case, where the LAAO device became free and lodged in the mitral valve. Device explant is coded for the catheter retrieval and removal of the first device. In this scenario, device migration would not be coded because the device has moved outside of the left atrial appendage orifice opening and has lodged in the mitral valve. Device migration is coded when the device moves from its original position, but it is still within the left atrial appendage. For further information on the definitions of device embolization and device migration, please review the adverse events definition document on the documents homepage under user guide documents. The difference between the coding of device migration and device systemic embolization is better appreciated through this animation. In device migration, the device moves from its original position, but it is still within the left atrial appendage. In device systemic embolization, the device dislodges completely from the left atrial appendage and is introduced into the circulatory system. When the patient has the second procedure in the same episode of care for the successful implantation of the new LAAO device, what inter- or post-procedure events would be captured for sequence number 12153? The answer is none per the documentation that the patient had successful implantation of the second device and was discharged the next day without further events. For bonus question number two, how would second procedure be entered into the LAAO registry since the patient was not discharged? Number one, create a second episode of care for the same admission and discharge date as the first procedure. Or number two, create a second procedure under the same episode of care. The answer to bonus question number two is to create a second procedure under the same episode of care by utilizing the add procedure function. From the left navigation bar, choose the procedure tab. On the procedure page, go to the upper right hand corner and choose add procedure. When the add procedure tab is selected, a new LAAO procedure data collection tool page will open up and may be coded with the new information from the second procedure. A second episode of care would not be created as anytime there are two procedures within the same admission and discharge date, an error would be created that will produce a red submission error and the error would need to be resolved before there can be a successful DQR submission. We thank you for taking the time to review our latest case scenario. See you for the next case scenario in June.

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