This is the Cath PCI Registry case scenario for May 2021. We will review aspirin at discharge. A 38-year-old male with a history of atrial fibrillation, hypertension, hyperlipidemia, new onset angina, and a positive stress test presents for a Cath Lab visit. His current medications include apixaban 5 mg twice daily, atorvastatin 40 mg once daily, and carvedilol 25 mg twice daily. Diagnostic coronary angiography reveals a 90% mid-RCA lesion, which the physician treats with a drug-eluting stent in the same Cath Lab visit. On discharge, the physician documents patient-to-continue home medications given prescription for clopidogrel 75 mg daily. How is aspirin coded in Sequence 10205 Discharge Medications Prescribed? Is it 1. Yes, 2. No, no reason, 3. No, medical reason, or 4. No, patient reason? Here is your documentation and question for review. The answer is number 2, no, no reason. This medication was not prescribed at discharge, and there was no mention of a reason why it was not ordered within the medical documentation. Is this patient eligible for metric 8, aspirin at discharge, no, or yes? Here is your documentation and question for review. The answer is no. Metric 8 measures the percentage of patients with PCI who were prescribed aspirin at discharge. While this patient did undergo PCI, he was not prescribed aspirin at discharge, which would lead you to believe the patient is eligible for the metric but will not meet the numerator. However, a denominator exception for metric 8 identifies that when an anticoagulant, such as apixaban, and a P2Y12 inhibitor, such as clopidogrel, are prescribed at discharge, the aspirin requirement is removed. A denominator exception recognizes when a patient or procedures is not eligible for the numerator criteria and therefore removes the patient from the denominator population. In this way, the metric is only considering eligible patients or procedures. Now let's look at metric 38, composite medications prescribed at discharge, which measures the percentage of PCI patients who were prescribed all medications for which they were eligible. Is this patient eligible for metric 38, composite guideline medications prescribed at discharge, no or yes? Here is your documentation and question for review. The answer is yes. Metric 38 measures the percent of PCI patients who were prescribed all medications, aspirin, and P2Y12 inhibitors, for which they were eligible. And because this patient had PCI with stent placement, they are eligible for all three medication categories. As we know, the patient was not prescribed aspirin. However, he was prescribed both an anticoagulant and a P2Y12 inhibitor, thus meeting the exception criteria and effectively removing the requirement for aspirin. Therefore, this patient is not only included in the denominator, but also meets the numerator criteria of metric 38. Thank you for viewing the CAHPS PCI Registry Monthly Case Scenario for May 2021.

Cath Lab visit

38-year-old male

health conditions

drug-eluting stent

clopidogrel