Welcome to the STS-ACC TBT Registry Case Scenario. In this scenario, we're going to review how to capture low flow, which is anticipated to assist in determining if TAVR is an appropriate treatment modality for a patient. A 78-year-old female underwent a transcatheter aortic valve replacement procedure. Her one-month pre-procedure echocardiogram reported severe aortic stenosis, an aortic valve valve area of 0.10 centimeters squared, and an aortic valve mean gradient of 15 millimeters of mercury. In the pre-procedure note, the physician documents low flow. How is sequence number 13700 low flow coded in this scenario? Number one, no. Number two, yes. Number three, the aortic valve mean gradient is too high to determine. Or number four, not documented would instead be selected in sequence number 13701, low flow not documented. Take a few moments to pause here and review the documentation before making your final decision. And the answer is number four. Sequence number 13701 would be selected as low flow, defined as a stroke volume index of less than 35 milliliters per square meter and is not documented. The first rationale to discuss is that the registry is relying on the coding instructions being met. And as you can see, low flow is defined as a stroke volume index of less than 35 milliliters per meter squared. And in this scenario, a stroke volume index measurement was not documented. Secondly, data elements located under pre-procedure echocardiogram findings are capturing results from an echocardiogram that meet the coding instructions. To assure consistency in capturing these values, it was determined that rest echo results would be used as it is standard practice to obtain a pre-procedure echo. And in this scenario, a stroke volume index measurement was not documented on the echocardiogram. Now, let's address the elephant in the room. Why isn't physician documentation of low flow enough to satisfy coding in this data element? This was taken to the steering committee, who informed that the measurement of stroke of volume index is recommended in the 2017 American Society of Echocardiography Guidelines on Aortic Stenosis, the 2020 valve guidelines, and the 2017 appropriate use criteria. And while there are potentially multiple ways to document flow, the guidelines have settled on stroke volume index. Thus, without documentation of the stroke volume index, it would be difficult to determine whether certain TAVRs were done appropriately according to the AUC. Thank you for viewing the TBT registry case scenario.

SCS ACC TVT Registry

aortic valve re-intervention

TAVR procedure

78-year-old female

follow-up events

transcatheter aortic valve replacement

low flow

stroke volume index

American Society of Echocardiography guidelines

medical procedure documentation