Welcome back to our bi-monthly case scenario for June of 2024. For this case scenario, we're going to examine how to code an atrial fibrillation termination and a catheter ablation in the same lab visit as a left atrial appendage occlusion procedure. In this scenario, a patient was admitted for a planned pulmonary vein isolation ablation, a PVI procedure for atrial fibrillation and a Watchman procedure during the same lab visit. The PVI was completed first by one physician and then a second physician performed the left atrial appendage occlusion procedure with a Watchman. The patient never left the room and was under anesthesia uninterrupted for both procedures. The patient had a history of persistent non-valvular atrial fibrillation, hypertension, diabetes and previous GI bleeding. The patient has made a request for this procedure as they had a previous history of GI bleeding and would prefer to not be on long-term anticoagulants. There was a previous history of a failed AFib catheter ablation and two previous DC cardioversions for AFib that lasted less than six months each. Both the atrial fibrillation catheter ablation and the left atrial appendage occlusion procedures were completed successfully. Let's start with the most basic questions and progress to some more involved questions concerning this scenario. Question number one, since the patient in this scenario entered the procedure room and started the atrial fibrillation ablation procedure first, how is sequence number 4410, attempt to atrial fibrillation termination, captured? No or yes? Please take a moment to review the documentation and question before making a final answer. As sequence number 4410 has a target value of any occurrence between birth and the procedure and the ablation occurred prior to the start of the LAAO procedure, sequence number 4410 would be coded as yes. So now that sequence number 4410 is coded as yes, how are the previous types of AFib termination coded with the patient history of two cardioversions, a catheter ablation in the past and the current catheter ablation during the same lab visit as the left atrial appendage occlusion? Sequence 4425 has a target value of any occurrence between birth and the procedure. Since the patient has had at least two DC cardioversions in the past, sequence number 4420, DC cardioversion, would be coded as yes. The previous history of the catheter ablation and the catheter ablation taking place before the current procedure would allow for sequence number 4425 to be coded as yes. Once that is coded, the most recent catheter ablation date, sequence number 4430, would be coded as the same date as the procedure. A bonus question. How is sequence number 7000, procedure start date and time, coded since the patient had a catheter ablation procedure prior to the start of the LAAO procedure? Is sequence number 7000 coded for the time the patient enters the procedure room or the time documented in the procedure log that the ablation procedure ends? For purposes of the registry, code the time documented in the procedure log of when the ablation procedure ended. So now that we know when to code the procedure start date time, how is sequence number 7005, the procedure end date and time, coded? Is it when the patient leaves the procedure room or when the last physician breaks scrub for the last time? The answer is number 2, when the last physician breaks scrub for the last time. This is supported in the notes section of the coding instructions in the data dictionary. How is sequence number 14855 coded when the patient has an atrial fibrillation ablation completed in the same lab visit as the LAAO procedure, no or yes? The answer is yes. This is supported in the coding instructions for sequence number 14855, which states to collect any procedure selection listed in the data element that was performed during the same lab visit as the current LAAO procedure. Sequence number 14857 would be coded as a-fib ablation. Please keep in mind when coding sequence number 14857, if more than one procedure occurs that meets the selections, all would be captured as this is the select-all-that-apply data element. We thank you again for taking the time to review our latest case scenario. See you for the next one in August.

LAAO device

dislodged

second procedure

device systemic embolization

episode of care

atrial fibrillation termination

catheter ablation

left atrial appendage occlusion

pulmonary vein isolation ablation

Watchman procedure