Welcome to the STS-ACC TBT Registry May 2022 case scenario. This month, we will review sequence number 9002, Intra-Post-Procedure Events Occurred Permanent Pacemaker. An 84-year-old male patient with a history of incomplete left bundle branch block who is asymptomatic presents for TAVR. An hour after the TAVR procedure, while in the recovery room, he becomes hemodynamically unstable with hypotension and heart rate in the low 30s. A complete heart block is confirmed by EKG on the monitor, and the patient is taken to the cath lab for an emergent temporary pacemaker insertion, followed by a permanent pacemaker implantation the next day. There were no additional complications. A question, would the permanent pacemaker implantation be captured in sequence number 9002, Intra-Post-Procedure Events Occurred Permanent Pacemaker? Number one, no. Or number two, yes. Please take a few moments to review the documentation and the question prior to making a final selection. And the answer is number two, yes. When a patient develops a new dysrhythmia, meeting an indication for pacemaker between start of procedure and until next procedure or discharge, permanent pacemaker will be coded as yes in sequence number 9002, Intra-Post-Procedure Events Occurred. Per Steering Committee Chair Review, pre-existing dysrhythmias, including right bundle branch block, incomplete left bundle branch block, first degree AV block, left atrial fascicular block, and bifascicular blocks that were not an indication for permanent pacemaker before the TVT procedure, cannot be used as an exemption to this coding advice. Thank you for viewing the May 2022 STS ACC TVT Registry Case Scenario. See you next month.

TAVR procedure

hemodynamically unstable

complete heart block

temporary pacemaker insertion

permanent pacemaker implantation