Thank you for joining us for the June 2022 case scenario. In this month's case scenario, we will be reviewing sequence number 4055, Haas blood hypertension uncontrolled. For this month and the next several months, we will be reviewing the Haas blood elements for a more in-depth look to aid with coding. We are excited to bring you this series. In this scenario, a 75-year-old male presents for a left atrial appendage occlusion procedure with a history of hypertension, which is treated with a daily beta blocker of which the last dose was taken the morning of the procedure, a previous ischemic stroke with no residual symptoms and a three-year history of persistent non-valvular atrial fibrillation refractory to chemical and electrical cardioversion. The patient's pre-procedure documented blood pressure was 170 over 92 at 0900 and 165 over 88 at 0930. The patient was taken to the procedure room at 10 a.m. Based on the pre-procedure assessment and documented history, how will sequence number 4055, Haas blood hypertension be coded? 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. Sequence number 4055 would be coded as yes based on the pre-procedure systolic pressures being over 160 despite taking antihypertensive medication the morning of the procedure. Based on the Haas blood definition, hypertension uncontrolled is defined as systolic pressure greater than 160 millimeters of mercury despite medical therapy. It may also be documented or diagnosed as hypertension resistant to medical therapy. The target value for sequence 4055 is any occurrence between 30 days prior to the procedure, meaning the documentation used to code this element, documented diagnosis, or blood pressure readings must be within 30 days prior to the start of the procedure. Blood pressure readings after procedure start time, including the time of the incision, vascular access, or its equivalent cannot be used. In this case, we have two systolic pressure readings greater than 160 prior to the start of the procedure despite medical therapy, which meets criteria for yes to be coded when combined with the documentation of hypertension and the treatment of hypertension. This Haas blood element can be coded with these options. A provider documented Haas blood assessment with hypertension documented as a condition used to award the patient a point in the assessment. In this case, systolic pressures do not have to meet criteria, provider documentation is sufficient to code yes. Or a documented history or diagnosis of uncontrolled hypertension or hypertension resistant to medical therapy within the target value. Or systolic pressures meeting criteria, criteria being systolic pressure more than 160 millimeters of mercury despite medical therapy within the target value. In this bonus question, we will use the same patient information, but in this scenario, the patient has no documentation in the medical record of a history of hypertension and is not on any medications for the treatment of hypertension. Because of the pre-procedure recorded blood pressures greater than 160 millimeters of mercury, how would this patient be coded for sequence number 4055, Haas blood hypertension uncontrolled? The answer is no. In this scenario, Haas blood uncontrolled hypertension would not be captured as the patient has no documented history of hypertension and is currently not being treated for hypertension. Per the supporting definitions in the data dictionary for sequence number 4055, uncontrolled hypertension is defined by the Haas blood risk model as a systolic blood pressure greater than 160 millimeters of mercury despite medical therapy to lower the patient's blood pressure. Thank you for viewing the LAAO registries case scenario for June of 2022. We'll see you next month for our second Haas blood case scenario in this series.

hypertension

uncontrolled hypertension

left atrial appendage occlusion procedure

ischemic stroke

persistent atrial fibrillation