The LAAO case scenario for July focuses on sequence 7035, indication for LAAO occlusion. This element number changed to sequence number 14837 in the new version 1.4. A 78-year-old female was admitted for an LAA occlusion procedure. The clinician documents a history of hypertension, persistent non-valvular atrial fibrillation, and an LVEF of 39%. The CHADS score is 2, and the CHADS-VAS score is 5. Physician documentation states the procedure is being performed based on the patient's history of labial INR values while on anticoagulation. The nursing assessment indicates the patient no longer wants to take warfarin. Based on the documentation provided, how is indication for LAA occlusion coded? Number one, increased thromboembolic stroke risk. Number two, patient preference. Number three, labial INR. Or number four, two and three. Please take a few moments to review the documentation and question. The answer is number three, as this is the only indication documented by the clinician. An increased thromboembolic stroke risk cannot be determined by the abstractor based only on the documentation of CHADS-VAS score of 5, nor can patient preference be coded based on nursing documentation. Please consult with the clinician if the risk score or other documentation in the medical record does not clearly align with coding an LAAO indication selection under sequence 7035. The abstractor coded the labial INR as the indication for the LAA occlusion procedure. The CHADS-VAS score is determined by coding a history of hypertension in sequence 4020, LV dysfunction in sequence 4015, female in sequence 2060, and age of greater than 75, which is determined by date of birth in sequence 2050. This results in a score of 5. The CHADS score is determined by coding a history of hypertension in sequence 4020 and age of greater than 75, which is determined by date of birth in sequence 2050. This results in a CHADS score of 2. Valvular atrial fibrillation sequence 4380 is coded as no. Our question is, based on the documentation and coding, will this patient be included in the numerator of metric 3? Please take a few moments to review the documentation and the question. The answer is number 2, yes. The patient must have one of the three criteria listed in addition to valvular atrial fibrillation coded as no in sequence 4380. In our scenario, the patient has a CHADS-VAS score of 5, and valvular atrial fibrillation sequence 4380 is coded no, meeting the numerator criteria. All metric information regarding the rationale, numerator, and denominator are available in the Outcome Report Companion Guide document for the in-hospital metrics, which are numbers 1 through 9. To locate this document, select Resources, and then Documents. Scroll down to User Guide Documents and download the Outcome Report Companion Guide. Thank you for viewing the July case scenario regarding the coding of indication for LAA occlusion.

LAA occlusion

coding indication

sequence 7035

labial INR

CHADS-VAS score