Welcome to the Cath PCI Registry May 2022 Case Scenario. This month, we will cover sequence number 7400, Indications for Cath Lab Visit. A 63-year-old male experienced unexplained, abrupt, severe substernal chest pain and diaphoresis while doing yard work. The ambulance arrived and performed a 12-lead ECG indicative of STEMI. STEMI alert was called to the nearest PCI-capable facility. He was taken directly to the Cath Lab where a culprit proximal LAD lesion received PCI. Another 80% lesion of the mid-RCA was observed. However, the decision was made to bring him back for a staged PCI. He went to the CCU for two days without incident and received another PCI before he was discharged home. Can ACS greater than 24 hours be captured in sequence 7400, Indications for Cath Lab Visit, for the second Cath Lab Visit? Number one, yes. Or number two, no. Please take a few moments to review the documentation prior to making a final selection. And the answer is number two, no. Sequence 7400, Indications for Cath Lab Visit, is capturing all patient symptoms or conditions prompting the Cath Lab Visit that meet the target value. It is not coded on what is learned during or after the procedure. Additionally, it is the registry's perspective that once the patient receives PCI for any indication, that event is considered over and only new symptoms or conditions will be captured that led to the subsequent PCI procedure. So how is sequence 7400, Indications for Cath Lab Visit, coded for the second Cath Lab Visit? It is coded based on what is documented after the PCI leading up to the subsequent Cath Lab Visit. So not here or here, but here. And what we now know is the patient still had a lesion in his mid-RCA. However, reported no angina even though his activity was minimal. So how is sequence number 7400, Indications for Cath Lab Visit, for the second Cath Lab Visit? Please take a few moments to review the data collection form prior to making a final selection on how to code sequence 7400. And the answer is stable known CAD. It is understood the patient in this scenario was taken back to the Cath Lab for stable known CAD as the patient's symptoms or condition prompting the Cath Lab Visit was known coronary artery disease greater than or equal to 50% in a vessel that is stable for sequence number 7400, Indications for Cath Lab Visit. Let's encompass sequence number 7825, PCI Indication, into the scenario for the second Cath Lab Visit as these data elements are closely linked. First, please make sure you are using the V5 Data Dictionary Supplement with pending data element updates as this resource document has additional coding instructions to assist participants available via Cath PCI Registry, Resources, Documents, V5 Data Collection Documents, and the title V5 Data Dictionary Supplement with Pending Data Element Updates. Page 8 hosts this nice visual resource that identifies which PCI indications may be appropriate for selection based on what was coded in sequence number 7400. In this scenario, we know our patient's second lab visit indication was for stable known And you can see here, either stable angina or CAD without ischemic symptoms are the only appropriate selections for the PCI indication. So the question becomes, will stable angina or CAD without ischemic symptoms be coded in sequence 7825, PCI Indication, for the second Cath Lab Visit? Please take a few moments to review prior to making a final selection on the coding of sequence number 7825, PCI Indication. And CAD without ischemic symptoms will be coded in sequence number 7825, PCI Indication, as the PCI was performed for known coronary artery disease and there are no symptoms of ischemia, either typical angina and or ST segment elevation. Thank you for viewing the May 2022 Cath PCI Registry Case Scenario. We'll see you next month.

Cath PCI Registry

STEMI

proximal LAD lesion

mid-RCA lesion

ACS greater than 24 hours