Welcome to the Case Scenario for the AFib Ablation Registry for the month of June 2024. This month, we're going to discuss a scenario based on the registry's intra- or post-procedure events. Mrs. Blue was admitted to our facility for a planned AFib ablation procedure utilizing pulmonary vein isolation as the strategy. During the ablation, after isolating three of the four pulmonary veins, Mrs. Blue's heart rate increased rapidly and hypotension was also noted. A pericardial effusion with tamponade was confirmed via TEE. Based on the size of the tamponade and the patient's symptoms, the decision was made to abort the procedure and emergently transfer Mrs. Blue to surgery. The question we have for you is, when abstracting the procedure based on the documentation shared, what intra- or post-procedure event should be coded? One, pericardial effusion resulting in cardiac tamponade, two, pericardial effusion requiring intervention, three, cardiac surgery unplanned emergent, or four, all the events listed, one, two, and three. Please take a moment to pause here and review the documentation and questions before making a final answer. The answer is number four, all the events listed, one, two, and three. All of the events listed as options will be coded as the criteria for each one of them was met. Pericardial effusion resulting in cardiac tamponade, sequence 9060, will be coded as the patient was diagnosed with a cardiac tamponade resulting from pericardial effusion. Pericardial effusion requiring intervention, sequence number 9065, will be coded as the patient required pericardiosynthesis or surgical intervention after being diagnosed with a new pericardial effusion, and cardiac surgery unplanned emergent, sequence number 9070, will also be coded based on the patient having an unplanned and emergent cardiac surgery during the episode of care. Another question, will hemorrhage non-access site also be coded as an event? Yes or no? The answer is number one, yes. Hemorrhage non-access site, sequence number 9080, will also be coded as the criteria was met. In order for the criteria to be met, the bleeding event must be associated with at least one of the following criteria, a hemoglobin drop of greater than or equal to three grams per deciliter, transfusion of whole blood or packed red blood cells, or a procedural intervention surgery at the bleeding site to reverse or stop or correct the bleeding, such as surgical closures, exploration of the arteriotomy site, balloon angioplasty to seal an arterial tear, and endoscopy with cartery of the GI bleed. In this case, the patient's bleeding event, being the epicardial effusion, met the criteria of procedural intervention or surgery at the bleeding site to reverse or stop or correct the bleeding by requiring the cardiac surgery. For more details on the coding of hemorrhage non-access site, you may refer to FAQ 24865. The Data Dictionary is currently being updated to include these criteria. We thank you for taking the time to review our latest case scenario.

April 2024

Registry inclusion criteria

Aflutter ablation procedure

AFib induction

Thorough documentation

AFib ablation procedure

pericardial effusion

cardiac tamponade

emergent cardiac surgery

coding and documentation