The LAAO case scenario for July of 2021 is focused on procedure aborted and reason in sequence number 7295 and 7296. These element numbers were changed to sequence numbers 14831 and 14832 in our newer version, version 1.4. A 68-year-old female presents to the procedure room for an LAAO procedure with a past documented history of paroxysmal atrial fibrillation, TIA times 1, and hypertension. The patient is prepped and central venous access was obtained through the right femoral vein. However, after multiple attempts, the provider was unable to cross the septum. At this point, the procedure was stopped with a tentative reschedule in approximately one month. How would this procedure be coded? Number 1 cancelled or number 2 aborted? Please take a few moments to review the documentation and the question. This procedure will be coded as aborted. Sequence number 7295, procedure aborted, will be coded as yes. In this scenario, the intervention or procedure was stopped after the central venous access was obtained, meeting the coding instructions. Once the patient enters the procedure room, which is the time the registry captures as procedure start time, the procedure has already started and everything that happens after this point will be captured. If the procedure is stopped at any time between procedure start time and the gaining of central venous or epicardial access, the procedure will be coded as cancelled. After the point of obtaining either central venous or epicardial access, a procedure that stops for any reason is considered aborted for the purpose of the LAAO registry, regardless of if a device has been deployed. Based on the scenario presented, how would sequence number 7296, procedure aborted reason, be coded? Based on the scenario, our best option will be to code as catheterization challenge. The reason for coding catheterization challenge instead of coding anatomy not conducive for implant is that anatomy not conducive for implant is referring to the actual left atrial appendage anatomy, not the septal anatomy. We also have documentation of a catheter or access system not being able to be deployed based on issues with access, in this case, the transeptal access. The coding of catheterization challenge as the reason for the procedure being aborted will also ensure the patient is not included in metric number 6, proportion of patients with a major complication, either intra or post-left atrial occlusion procedure and prior to discharge. Metric number 6 will include aborted procedures in which any of the six reasons listed in the numerator are coded. The reasons are device retrieval, transcatheter or surgical, decompensation in patient condition, device associated thrombus developing during procedure, device related, or unanticipated patient condition. Some additional information, when a procedure is coded as aborted, the system will expect an access system to be coded, and if an aborted procedure is submitted without an access system coded in sequence number 7270, the system will give the submission an error, error number 6530. If the procedure was stopped after gaining central venous or epicardial access and prior to an access system being used, please default to coding the following, Watchman single curve 14 French access system for an intended Watchman implant, FinderWertz .025 for an intended lariat use, or Amplatzer TorqueVue 4580 for an intended Amplatzer implant. You may also refer to FAQ number 24703 for more information. Thank you for viewing the July case scenario regarding the coding of sequence number 7295 Procedure Aborted and sequence number 7296 Procedure Aborted Reason. We'll see you next month.

LAAO case scenario

sequence numbers

aborted

catheterization challenge

left atrial appendage