The June 2024 case scenario reviews Sequence No. 15453, Risk Stratification, and its related Sequence No. 15454, Risk Stratification Not Documented, as well as Sequence No. 15479, Risk Stratification Performed at Transferring Facility. A 75-year-old male presents via EMS due to chest discomfort. The EMS ECG was negative for STEMI. Upon arrival, the ED physician read the EMS ECG as non-emergent, ordered troponins per protocol, and a repeat ECG. The patient's history includes hypertension, high cholesterol, diabetes, and multiple coronary stents. The ED physician documented a heart score of 7 after a review of the repeat negative ECG and troponin values. The patient is transferred to a PCI-capable facility after consulting with the patient's cardiologist. At the receiving facility, a coronary angiogram was performed for the end STEMI diagnosis, which revealed a slow flow in the right coronary artery with multiple instant restenosis and a TEMI flow rate of 2. A cardiothoracic surgeon was consulted, who documented a Syntax score of 21. The patient underwent coronary artery bypass graft surgery as the treatment of choice and was discharged on day five. So question one, how is sequence number 15453 risk stratification coded? Is it 1, low, 2, intermediate, 3, high, or 4, blank? Please pause here and take a few moments to review and make your selection. The answer is number three, high. There is documentation by the ED provider of the first facility using the heart score as the risk assessment tool to assist in the evaluation of the patient, which meets the target value of sequence number 15453. Therefore, sequence number 15454, risk stratification not documented, is not selected. Question number two, how is sequence 15479, risk stratification performed at transferring facility, coded? Number one, not selected, or number two, select? Again, take a few moments to pause here to make your selection. The answer is number two. Sequence number 15479, risk stratification performed at transferring facility, is selected. The TIMIFLOW score is widely used methods for the assessment of coronary artery flow and acute coronary syndromes. Syntax score is an angiographic tool to help cardiologists, interventionalists, and surgeons to grade the complexity of coronary artery lesions. The TIMIFLOW scores and syntax scores did not meet the coding instructions and were not captured. There is documentation by the ED provider of the first facility using the heart score as the risk assessment tool to assist in the evaluation of the patient which meets the coding instructions of sequence number 15479, risk stratification performed at transferring facility. Question number three, would the case be part of the measure of risk score stratification for inSTEMI? Number one, no, or number two, yes. Pause here to make your selection. Please access the version 3.1 executive summary measure and metrics companion guide and review the details. We can identify that this case has met the denominator exception of risk stratification performed at the transferring facility. The answer is number one, no. Question number four, would the case be part of the measure of early invasive strategy for high risk inSTEMI? Number one, no, or number two, yes. Again, please take a few moments to make your selection. This case has also identified that it has met one of the denominator exclusions of the transferred from outside facility. The answer is no. Thank you for viewing the chest pain in my registry June 2024 case scenario.

heart issues

myocardial infarction

low ejection fraction

ARNI medication

coding process

June 2024 case scenario

75-year-old male

chest discomfort

coronary artery bypass graft surgery

heart score assessment

heart score

risk stratification

STEMI

timely interventions