The EP device implant registry case scenario for May of 2022 will review intra or post procedure events and metric 35. This 78-year-old female was admitted for complete heart block with a temporary pacer implanted. The next day, the patient went to the EP lab for placement of a micro leadless pacer. During the implant, the patient became agitated, resulting in inadequate thresholds. Therefore, the device was recaptured. During the second attempt, the patient became agitated again, dislodging the temporary pacemaker wire which was quickly repositioned. The oxygen saturation was noted to be dropping. Respiratory assistance was initiated and the micro leadless pacemaker was successfully implanted. While the clinician was removing the introducer catheter, the patient had a cardiac arrest and CPR was initiated. A stat echo was performed, revealing a pericardial effusion and pericardiocentesis was performed. Despite all efforts, the patient remained pulseless and resuscitation efforts ceased. Our question is, how are cardiac tamponade and cardiac perforation coded? Is it number one, sequence number 9055, cardiac tamponade is coded yes? Number two, sequence number 9010, cardiac perforation is coded yes? Or number three, both one and two? Please take a few moments to review the documentation and the question before considering your response. The answer is number three. Both cardiac perforation and tamponade are coded as yes. Additionally, sequence 9000, cardiac arrest is coded yes. Unfortunately, despite all efforts, the patient remained pulseless and resuscitation efforts ceased. Therefore, sequence 10120, death during the procedure, is also coded yes. Per the data dictionary, cardiac perforation, sequence number 9010, is coded yes. Cardiac perforation may or may not be symptomatic and may or may not be self-healing. It can be documented by migration of pacing or defibrillator leads to the epicardial surface resulting in pain and or hypotension, pericardial effusion, cardiac tamponade, failure to capture, capture of the diaphragm, phrenic nerve, or intercostal muscles of sufficient magnitude to require repositioning. This is coded yes for any occurrence between the start of the procedure and until the next procedure or discharge. Based on the coding instructions and target value, the definition for cardiac tamponade was met as there was fluid in the pericardial space resulting in cardiac arrest and requiring pericardiocentesis. Our bonus question is how many times is the patient included in the numerator of metric 35? Number one, twice, number two, once, or number three, four times? The answer is number two, once. When looking at detail line number 11931, please note that the patient is only included in the numerator one time, even though four events occurred during the procedure. Let's review the criteria for metric 35 in the Executive Summary Measures and Metrics Companion Guide for version 2.3. The patient is included only once in the numerator of metric 35, as it is specific to the patient and a discharge status of deceased or any major adverse event. No matter how many events occur in one procedure, it is only counted once in the numerator, which is signified by the or statement in the numerator algorithm. Of note, the denominator is based on each successful initial generator implant or generator change. Therefore, if a patient has an initial implant followed by a generator change in the same episode of care, the patient will be listed in the denominator twice. Thank you for viewing the EP Device Implant Registry case scenario for May 22, which highlights intra or post-procedure events and metric 35.

EP device implantation

micro leadless pacer

cardiac arrest

pericardial effusion

resuscitation efforts