Thank you for joining us for the May 2022 case scenario. Today we will be discussing metric 5, proportion of left atrial appendage occlusion procedures successful, excluding those procedures canceled. Since metric 4 was reviewed in last month's case scenario, we wanted to continue the trend of how a successful LAAO procedure is coded when excluding procedures that are canceled. In this scenario, a 75-year-old male presents with a three-year history of non-valvular atrial fibrillation, an unsuccessful atrial fibrillation ablation one year ago, an ischemic stroke and multiple electrical and pharmacologic cardioversions over the last three years. The TEE performed prior to gaining access identified a large left atrial thrombus. The procedure was terminated prior to central venous access being obtained. Our question, would this patient appear in metric 5, proportion of left atrial appendage occlusion procedures successful, excluding those procedures canceled? Is it number one, no? Or number two, yes? Please review the documentation and question to determine the best answer. We will give you a few seconds to review. Would the patient appear in metric 5, proportion of left atrial appendage occlusion procedures successful, excluding those procedures canceled? The answer is no, as this metric will not include anyone in the numerator or the denominator who has a procedure coded as yes in sequence 7040, procedure canceled. When sequence 7040 is coded as yes, the patient will not be included in either the denominator or the numerator for metric 5. A patient who does not appear in metric number 5 does not reflect negatively on the facility, as the facility will be aware that these patients were canceled based on TEE results or other factors and not based on factors related to the main LAAO procedure. This metric was designed to give you more information to the facilities about their patient population and their processes. When comparing the denominators for metric 4, proportion of left atrial appendage occlusion procedures successful, and metric 5, there may be a difference, as metric 4 denominator all LAAO procedures entered into the registry without exception, and metric 5 denominator will not include any cases where sequence number 7040, procedure canceled, is coded as yes. This screenshot comes from the outcomes report companion guide and shows the numerator inclusion for metric 5. We know from the documentation that the patient did have a canceled procedure. When a canceled procedure is identified, the patient will be automatically excluded from the numerator denominator, and the patient will not appear in the metric. The rest of the numerator inclusion criteria, which is procedure aborted, cardioversion to open heart surgery, outcome of device, and residual leak at device margin, will not factor into inclusion of the patient in the metric, but will affect their inclusion into the numerator. For our bonus question, we will be using the same patient information, but a different insertion outcome. In this scenario, a Watchman device was successfully inserted. The device was coded as deployed released, and the procedure was not canceled, aborted, or converted to open heart surgery. The device margin residual leak was coded not assessed in sequence number 7306. Since the procedure was not canceled, would the patient appear in the numerator for metric 5? Proportion of left atrial appendage occlusion procedures successful, excluding those procedures canceled. The answer is no. We know that the patient did not have a canceled or an aborted procedure. The patient did not convert to open heart surgery, and the device was coded as deployed released. The device margin residual leak was coded as not assessed, which does not meet the numerator inclusion criteria. The patient would appear in the denominator, but not the numerator for metric 5. When the post-implant device margin leak is not documented in the patient's medical record, we advise to refer to the implanting provider or any other documentation from the procedure, including the post-implant TEE, to confirm if, in fact, this measurement was not performed. Thank you for viewing the LAAO Registries Case Scenario for May of 2022. We'll see you next month.

metric 5

left atrial appendage occlusion

canceled procedures

numerator

denominator