The June 2024 case scenario for the EPDI Registry will review inclusion and exclusion criteria. An 81-year-old female with a history of a CRTD implanted 15 years ago for heart failure was unresponsive to guideline-directed medical therapy. She has a history of ischemic cardiomyopathy, hyperlipidemia, and hypertension. Three months ago, she had multiple episodes of inappropriate shocks, and the fidelis lead was found to be fractured. A shared decision-making discussion occurred where all options were discussed to determine how to best proceed with the fractured lead. It was decided to turn off the fidelis lead, the defibrillation portion of the CRTD device, and maintain biventricular synchrony only. Today, she presents via EMS to the ED, alert and oriented post-V-fib arrest. There was no identifiable reversible cause for the V-fib arrest. The patient now wants to have the defibrillation portion of the device restored. A shared decision discussion ensues, and the best course of action decided by both EP and the patient is to implant a subcutaneous ICD for secondary prevention in addition to the CRTD device. The patient is discharged with a successfully implanted subcutaneous ICD, and the CRTD remains for resynchronization therapy. The question we have for you, is this episode of care included in the EP device implant registry, number one, no, or number two, yes? Please take a moment to select the best possible answer from the available options. The answer is yes, this episode of care is included in the registry. The EP device implant registry is device-based, and the patient had an ICD device qualifying lab visit per the inclusion criteria document. Facilities that choose to submit ICDs must submit all ICD and CRTD initial implants, explants, and a generator change procedure. Question number two, how is sequence number 7010 procedure type coded? One, initial generator implant. Two, generator change. Three, generator explant. Or four, lead only. Take a moment to select an answer from the available options. Sequence number 7010 procedure type is a generator change. Once a patient has had an ICD implanted, then every subsequent ICD device will be coded as a generator change. This is regardless of whether the patient currently has an ICD implanted or not. Question number three, how would we code sequence number 7630 for the CS or LV lead? One, not attempted. Two, successfully implanted. Three, previously implanted. Or four, implant unsuccessful. In this scenario, the patient had a previously implanted CRTD. The patient received inappropriate shocks due to the fractured defibrillating lead. Through multiple shared decision-making discussions, the final joint decision is made to implant a subcutaneous ICD in addition to the existing CRTD that is functioning as a CRTP. All leads associated with any previous or current ICD are captured as new, reused, abandoned, or previously abandoned. Sequence number 7630, coronary sinus or left ventricular lead, seeks to capture the LV status of the LV lead via the coronary sinus. Although the coronary sinus lead is not associated with the newly implanted subcutaneous ICD device, it is associated with an ICD device. All leads associated with an ICD device, now or at any time in the past, are captured when the lead currently exists in the body during the most recent device procedure. To recap, in this scenario, a subcutaneous ICD device is implanted in addition to the previously implanted CRTD, which remains. Once an ICD has been implanted, then all subsequent ICDs are coded a generator change in sequence 7010, procedure type. All new and existing leads associated with an ICD are coded as new, extracted, abandoned, and or reused in sequence number 7745, existing lead status. The Coding Guide for Procedure Type and Lead Capture is available in the Resources link located in the Documents tab and under the heading of User Guide Documents. Thank you for viewing the EP Device Implant Registry's June 2024 case scenario.

hypertrophic cardiomyopathy

CRT-D device implant

ventricular tachycardia

cardiac guidelines

device implantation

EPDI Registry

fractured lead

subcutaneous ICD

defibrillation

generator change