0620 - Sequence # 9146 | Significant Coronary Artery Dissection-0620 - Sequence # 9146

Video Transcription

This is the cath PCI case scenario for June 2020, sequence 9146, significant coronary artery dissection.  A 60-year-old female presents to the ED with crushing chest pain which started prior to arrival.  The ECG obtained shows acute infarct and the patient is immediately taken to the cath lab. The diagnostic cath reveals a significant spiral dissection of the OM1, most likely  secondary to a spontaneous coronary artery dissection, and a stent is placed. How is sequence 9146, significant coronary artery dissection, coded? No or yes?  Please take a few seconds to review the documentation and the question.  And the answer is no. Sequence 9146, significant coronary artery dissection, is coded yes when the dissection is observed to occur during the PCI procedure.  Spontaneous dissections and or dissections that are discovered or found during the cath would not be captured for sequence 9146.  Significant dissections are captured by the registry if they are grade C or higher and accompanied by the presence of ischemia or persistent contrast medium extravasations  not limited to these symptoms. When a dissection does not meet the definition of significant coronary artery dissection  but is treated with a stent or balloon, please enter this information in section J, lesions and devices.  The most severe obstruction caused by the dissection should be prescribed a percentage for sequence 8004, stenosis immediately prior to treatment.  Thank you for viewing the Cath PCI Registry Monthly Case Scenario for June 2020.

Video Summary

In this video, the case scenario is about a 60-year-old female who presents to the ED with severe chest pain. An ECG shows an acute infarct, and she is taken to the cath lab. The diagnostic cath reveals a significant spiral dissection of the OM1, which is likely due to a spontaneous coronary artery dissection. A stent is placed to treat the dissection. The video then asks whether sequence 9146, significant coronary artery dissection, should be coded. The answer is no because spontaneous dissections or those discovered during the cath are not captured for this sequence. The video concludes by mentioning that when a dissection is treated with a stent or balloon but does not meet the definition of significant, that information should be entered in the lesions and devices section. The most severe obstruction caused by the dissection should be assigned a percentage for sequence 8004, stenosis immediately prior to treatment.

Keywords

chest pain

ECG

acute infarct

spiral dissection

spontaneous coronary artery dissection