Welcome to the CATH PCI registry case scenario for May 2020. This case scenario will review sequence 7820, PCI for multivesel disease. The scenario involves a 72-year-old male who presents electively to the CATH lab with a diagnosis of worsening angina. The patient has a history of angina and CAD, which was treated with CABG in 2012. The diagnostic coronary angiogram reveals 99% stenosis in the native proximal LAD, however, the lemma to mid-LAD is patent. The patient also has a 90% stenosis to the native RCA. The SVG to mid-RCA graft has a 50% stenosis. The patient's native circumflex artery has a 90% stenosis in the mid-segment. The SVG to proximal left circumflex graft has 90% stenosis. The physician performs PCI on the SVG to proximal left circumflex lesion using a drug-eluting stent which brings the stenosis to zero with TIMI 3 flow. No other treatment is done in this CATH lab visit and the patient is discharged the next day. How is sequence 7820, PCI for multivesel disease, coded in this scenario? No or yes. Here is the information and question for your review. The answer is no. The patient does not have obstructive disease greater than or equal to 70% stenosis in greater than or equal to two coronary vessels on current procedure. Per the definition provided in the data dictionary for this sequence, a coronary vessel is defined as LAD and any of its branches, left circumflex and any of its branches, RCA and any of its branches, a true ramus greater than two millimeters in diameter. When a patient has bypass grafts, this complicates the definition of multivesel disease as you must determine whether the stenosis in the native artery is protected by a bypass graft with less than 70% stenosis. Both the native vessel and the graft supplying that vessel must have greater than or equal to 70% stenosis to count as one vessel in the data definition. The patient must then have another vessel with greater than or equal to 70% stenosis. This may be a native vessel that does not have a bypass graft supplying blood flow or a native vessel along with a bypass graft with greater than or equal to 70% stenosis. In this scenario, the patient has single vessel disease. The native LAD 99% plus patent LEMA to mid-LAD equals zero vessel disease. The native RCA 90% plus SVG to mid-RCA 50% equals zero vessel disease. The native circumflex 90% plus SVG to proximal circumflex 90% equals one vessel disease. Thank you for viewing the CATH PCI Registry Monthly Case Scenario for May 2020. We appreciate your participation.

PCI for multivessel disease

CATH PCI registry

coronary vessels

drug-eluting stent

multivessel disease