This is the Cath PCI case scenario for July of 2021, sequence number 4560, currently on dialysis, and the interim post-procedure event, new requirement for dialysis. A 68-year-old male with a history of chronic kidney disease presents to the emergency department via EMS when he woke up in the morning experiencing shortness of breath and chest discomfort with increasing nausea and vomiting for the past week. The ECG shows changes from a previous ECG, but is negative for STEMI. Labs show elevated biomarkers due to a history of chronic kidney disease, but physician documents cannot rule out NSTEMI. Creatinine is 2.9 milligrams per deciliter. Diagnostic Cath shows an 80% stenosis of the proximal circumflex. Due to concerns of the patient's kidney disease, the procedure is stopped with plans to return later for PCI to the proximal circ. Dialysis is initiated after the diagnostic Cath for a creatinine of 3.2 milligrams per deciliter, worsening GFR and patient symptoms. Two days later, the patient returns to the Cath lab for PCI to the proximal circumflex, and the patient's post-procedure creatinine is 3.2 milligrams per deciliter. The question is, how is sequence number 4560 currently on dialysis coded for the PCI procedure? Is it number one, no, or number two, yes? Please take a few moments to review the documentation and the question before making your selection. And the answer is no, the rationale being currently on dialysis is only assessed once at the episode of care level and must be known prior to the first Cath lab visit. Dialysis started after the diagnostic coronary angiography procedure and prior to the PCI procedure. Therefore, the target value of any occurrence between birth and the first procedure in this admission is not met. How will new requirement for dialysis as an intra- and post-procedure event in sequence 9001 be coded for the PCI procedure? Number one, no, or number two, yes? Again, please review the documentation before making your selection. And the answer is number one, no. The target value of any occurrence between start of procedure and until next procedure or discharge is not met. Dialysis was started after the diagnostic coronary angiography procedure and prior to the PCI procedure. This brings us to our next question. Is the patient eligible for metric number 39 PCI in-hospital risk-adjusted acute kidney injury for all patients? Is it number one, no, the patient is currently on dialysis? Number two, no, the patient has chronic kidney disease and an elevated creatinine? Or number three, yes, the patient had a PCI procedure? Again, the documentation for your review before you select a response. And the answer is number three, yes. The patient meets the model eligibility as they had a PCI procedure. Another question. Will the patient be an observed AKI for metric number 39 PCI in-hospital risk-adjusted acute kidney injury for all patients? Is it number one, no, the patient is currently on dialysis? Number two, no, the patient already has chronic kidney disease and an elevated creatinine? Or number three, yes, the patient has chronic kidney disease and an elevated creatinine? Is it number one, no, the patient is currently on dialysis? Number two, no, the patient already has chronic kidney disease? Or number three, yes, the patient has an increase in serum creatinine from baseline pre-procedure to post-procedure of greater than or equal to 0.3 milligrams per deciliter? Please take a few moments to review the documentation before making your selection. And the answer is number three, yes, the patient has an increase in serum creatinine from baseline pre-procedure to post-procedure of greater than or equal to 0.3 milligrams per deciliter. The risk model will assess patient variables that are predictive of AKI. And when reviewing the patient level drill down, this can be appreciated by reviewing the patient's predicted probability of AKI. When reviewing your facility data, remember that some patients are expected to have AKI based on their risk factors. Therefore, it is important to evaluate the incidence of observed AKI in relation to the expected AKI and reported as the OTE ratio or observed to expected ratio. The observed expected AKI ratio provides insight into your facility experience compared to the registry. If the OE ratio is greater than one, then the facility experienced more AKI than expected. If the ratio is equal to one, then the facility had the same number of AKI as expected. If the OE ratio is less than one, then the facility experienced less AKI than expected. Thank you for viewing the cath PCI registry monthly case scenario for July of 2021. Sequence number 4560, currently on dialysis and intra and post-procedure event, new requirement for dialysis.

Cath PCI registry

case scenario

chronic kidney disease

percutaneous coronary intervention

emergency department

shortness of breath

dialysis

PCI