Welcome to the STS-ACC TVT Registry Case Scenario for July of 2022. This month, we will review sequence number 7065, concomitant procedures performed type, intravascular lithotripsy, and PCI. An 88-year-old male patient with severe aortic stenosis, coronary artery disease, and peripheral vascular disease presents for an elective TBR. The providers are aware of his preexisting CAD and PAD. The patient has several severe calcifications in bilateral iliac and femoral arteries and a 90% lesion in his proximal right coronary artery. In view of the right iliac artery possibly posing a challenge to introduce the large 14th French sheath, lithotripsy is performed and a stent is placed in the proximal RCA before the TAVR procedure commences because of the possible technical difficulty it may pose if attempted later. After the 6th French sheath in the right femoral artery is exchanged for a 14th French sheath, the left femoral vein is accessed and a temporary pacing wire is inserted. Then, the TAVR procedure is performed without any complications. Our question is, how is sequence number 7065 concomitant procedures performed coded? Number one, no. Or number two, yes. Please take a few moments to review the documentation and the question prior to making your final selection. The answer is number two, yes. Sequence number 7065 concomitant procedures performed is coded yes and we capture the intravascular lithotripsy and PCI in sequence number 7066 concomitant procedures performed type. When another procedure or procedures that are not an inherent part of the transcatheter valve procedure are performed concurrently with the TVT procedure any time between entering and leaving the TVT procedure room, the definition for a concomitant procedure is met and is captured. Peripheral intervention would be selected from the dynamic list in sequence 7066 concomitant procedures performed type for the lithotripsy performed on the right iliac artery and PCI for stenting of the proximal RCA. Sequence number 7065 would be coded yes. For sequence number 7066, select peripheral intervention and PCI. When a procedure is performed and it is not in the dynamic list, select procedure type not listed. And a bonus question. Would a temporary pacemaker insertion be captured in sequence number 7065 and 7066? Number one, no. Or number two, yes. Please take a few moments to review the documentation and the question prior to making a final selection. The answer is number one, no. Per the direction of the TVT steering committee, a temporary pacemaker is not currently captured as a concomitant procedure as this is considered an inherent part of the procedure. This is also supported in FAQ ID number 25418. Would the peripheral intervention or lithotripsy be captured in sequence number 9002 into a post-procedure events occurred? Again, please take a few moments to review the documentation and the question before making your determination. And the answer is number one, no. Sequence number 9002, intra-post-procedure events occurred, is coded no for vascular surgery or intervention unplanned. When a vascular intervention is planned and performed prior to the start of the TVT procedure, as in this scenario, an intravascular lithotripsy of the right iliac artery would be coded as no for sequence 9002, intra-post-procedure events occurred, as the definition and target value are not met. Thank you for viewing the July 2022 STS-ACC TVT registry case scenario. We'll see you next month.

TAVR procedure

aortic stenosis

coronary artery disease

peripheral vascular disease

lithotripsy