The EP Device Implant Registry Case Scenario for June of 2022 will review Sequence 4310, Results of Angiography. A 54-year-old male presents to the emergency department for sudden onset of chest pain. A STEMI is diagnosed and primary PC performed to the left anterior descending coronary artery to both the proximal and mid portions. The diagnostic angiogram reveals additional coronary artery disease, an 80% RCA occlusion, 70% proximal OM1 occlusion, and 100% total chronic occlusion to the bifurcating OM2 branch. He is discharged on day four. Five days later, he is readmitted with shortness of breath and chest pressure. A STEMI is diagnosed and primary PCI is performed to the right coronary artery. Two days later, the patient experiences V-fib arrest and return of spontaneous circulation, prompting a third coronary angiography. The diagnostic coronary angiogram reveals the RCA and LAD stents are widely patent. The first diagonal branch is 95% stenosed, proximal diffused stenosis that was not amenable to PCI and no intervention was performed. An EP consult is obtained and on day five, a single chamber ICD is implanted for secondary prevention. The patient continues to experience angina with chest pressure and shortness of breath with anterior ECG changes. Patient has another coronary angiogram where the distal LAD is now 70% stenosed with a balloon angioplasty performed. The first diagonal branch remains 95% stenose and is not amenable to PCI. Our question is, how is sequence number 4310 results of angiography coded? Is it number one, no significant disease, number two, significant disease, or number three, non-revascularizable significant disease? Please take a moment to review the documentation, the question, and possible answers prior to making your selection. The answer is number three, non-revascularizable significant disease. The intent of sequence number 4310 is to capture the results of coronary angiography performed closest to the start of the device procedure as the status of the patient's myocardial perfusion is being evaluated. The target value should be the last occurrence prior to the start of the procedure. In this scenario, there were three coronary angiograms prior to the device. The most recent coronary angiography results are used to code the data element, results of angiography. The most recent diagnostic coronary angiography results prior to the single chamber ICD implant reveal the RCA and LAD stents were widely patent. The first diagonal branch was 95% stenosed with proximal diffuse stenosis that was not amenable to PCI with no intervention performed. Non-revascularized significant disease is defined as the patient is not a candidate for revascularization of their significant coronary artery disease. This is coded when at least one significantly diseased artery is not revascularized for a stated reason. In this scenario, the documentation of the artery was not amenable to PCI supports coding of non-revascularizable significant disease. Let us review the scenario and the guideline evaluation. This patient scenario meets a class one level of evidence A recommendation as the V-fib arrest was deemed not due to a reversible cause. Let's see how the AUC criteria evaluates this scenario. To locate the AUC indication for this scenario, table 1.1 provides indications for the scenario of CAD where a V-fib event was associated with an acute MI or an MI occurring within 48 hours of the V-fib. The AUC evaluation of this scenario will assign indication number six, which evaluates obstructive CAD with coronary anatomy not amenable to revascularization with either a maybe appropriate with a score of five or appropriate with a score of seven, depending on the patient's LVEF. Thank you for viewing the EP device implant registry case scenario for June of 2022.

angiography

case scenario

STEMI

coronary artery disease

PCI