Thank you for reviewing the AFib Ablation Registry Monthly Case Scenario for May 2021. This month's case scenario is focused on Sequence 9080, Hemorrhage Non-Access Site, part of intra- and post-procedure systemic events. Our patient, Mr. Oliver, is admitted for an AFib-A-Flutter ablation procedure, which goes on to be a successful procedure. After arriving to the recovery area, Mr. Oliver starts complaining of abdominal and lower back pain. The patient's groin access site is assessed and shows no signs of hematoma or bleeding. After the patient's symptoms continue, a CT scan is performed, which reveals a small retroperitoneal bleed. The patient is hemodynamically stable, and the decision is made to closely monitor the patient in case a more invasive treatment is required. Mr. Oliver's vital signs are stable and lab values show a hemoglobin level of 10.2, pre-procedure level was 12.0. After CT performed the following morning showed no active bleeding, his vital signs continued to be stable, and his hemoglobin level showed no changes at 10.2. Mr. Oliver continued to be closely monitored and was discharged home 2 days after the procedure. Based on the documentation shared, when abstracting the procedure into the data collection tool, how will you code the patient's retroperitoneal bleed post-procedure event? Will it be coded as an access site bleeding requiring transfusion, hematoma at access site, hemorrhage non-access site, or no event will be coded? Please review the documentation in question to determine the best answer. The answer is number four, none. For the purpose of the AFib ablation registry, Mr. Oliver's retroperitoneal bleed would be coded as a hemorrhage non-access site event in sequence 9080 if the bleed meets any of the criteria necessary. The AFib ablation registry has updated the definition and criteria in the coding of a hemorrhage non-access site event. To qualify, the hemorrhagic event must be associated with any of the following criteria, a hemoglobin drop of equal or greater than three grams per deciliter, a transfusion of whole blood or packed red blood cells, or a procedural intervention or surgery at the bleeding site to reverse or stop or correct the bleeding, such as surgical closures, exploration of the arteriotomy site, balloon angioplasty to seal an arterial tear, endoscopy with cautery of a GI bleed. Based on the documentation provided, Mr. Oliver's hemoglobin did not drop by three or more grams per deciliter, did not require a transfusion of whole blood or packed red blood cells, and it did not require a procedural intervention or surgery to reverse or stop the bleeding. Therefore, it did not meet the criteria necessary to be coded as an event. This coding update is not yet reflected in the Registry's Data Dictionary document. However, you may also refer to FAQ number 24865 for all details. Some additional information. If Mr. Oliver's retroperitoneal bleed had met any of the criteria listed and was coded as a hemorrhage non-access site event, would Mr. Oliver be included in metric four, proportion of patients undergoing afib ablation who experienced major adverse events post-afib ablation and prior to discharge? Yes or no. The answer is number two, no. Based on metric four's algorithm detailed in the Outcome Report Companion Guide document, pages 21 to 22, hemorrhage non-access site is not an event included in the metrics numerator and if coded will not add this patient to the metrics numerator and count as a major adverse event. The only events that would add a patient to metric four's numerator are the ones listed in the numerator boxes. Please refer to the Outcome Report Companion document for the list. Thank you for reviewing the afib ablation registry monthly case scenario for May 2021.

Mr. Oliver

AFib-A-Flutter ablation procedure

abdominal pain

lower back pain

retroperitoneal bleed