Thank you for reviewing the AFib Ablation Registry Monthly Case Scenario for July 2021. This month's case scenario is focused on sequence number 10200 and 10205, discharge medications. Our patient, Mr. Ed, was admitted for an AFib ablation procedure. His past medical history includes persistent atrial fibrillation, ischemic stroke, a documented contraindication to anticoagulants based on a history of bleeding while on warfarin and apixaban, and because of that contraindication and high risk for bleeding while on anticoagulants, a left atrial appendage occlusion procedure was performed six months prior to this ablation procedure to prophylactically treat the patient's risk of stroke without long-term anticoagulants. Mr. Ed's ablation procedure is successfully completed and he is discharged home on no anticoagulants the next day. Based on the documentation of Mr. Ed having a contraindication to anticoagulants, how will DOACs be coded in discharge medications? Will they be coded as number one, yes, prescribed, number two, no, no reason, number three, no medical reason, or number four, no patient reason? Please review the documentation and the question to determine the best answer. We will give you a few seconds to review. And the answer is number three, no medical reason. For the purpose of the AFib ablation registry, based on the documentation from the provider stating a contraindication to anticoagulants, this is sufficient to code all anticoagulants as no medical reason when coding sequence number 10200 and 10205 discharge medications. In order to code a specific medication or a group of medications as no medical reason, there must be a medical reason or contraindication documented explaining why the medication was not ordered. Medical reason is defined as a medical reason for an exception should be used in the presence of clinical contraindications such as a previous allergy, severe comorbidities resulting in a preponderance of potential risks over health benefits to a patient, or other extenuating medical circumstances in a patient's history. Based on the documentation, we can code DOACs as well as medications listed under anticoagulant medication category as no medical reason. Thank you for reviewing the AFib ablation registry monthly case scenario for July of 2021.

AFib Ablation Registry

monthly case scenario

Mr. Ed

AFib ablation procedure

left atrial appendage occlusion