Thank you for reviewing the AFib Ablation Registry Monthly Case Scenario for August 2022. The case scenario will be focused on the coding of Haas blood bleeding found in sequence 4095. In this scenario, an 80-year-old female has been admitted for an AFib ablation procedure. The patient has a history of stroke, persistent AFib, uncontrolled hypertension, and a retinal hemorrhage. The patient has also developed symptomatic bradycardia while on antiarrhythmic medications, prompting the need for the ablation procedure. Based on the patient's documented history, how will Haas blood bleeding, sequence 4095, be coded? Number one, no, or number two, yes. Please review the documentation in question to determine the best answer. We will give you a few seconds to review. The answer is number one, no. Based on the coding instructions, the patient's history of retinal hemorrhage and being on Eliquis and anticoagulant is not sufficient documentation to code yes to this element. In order for this element to be coded, any of the following criteria must be met. Documented predisposition for bleeding. This may include genetic predisposition, for example, von Willenbrand disease, or a documented predisposition to bleed while on antiplatelet or anticoagulant medications. Also, history of a major bleed, meaning any one of the following criteria, required hospitalization, hemoglobin level decreased by more than two grams per deciliter, or requiring a blood transfusion. For our first bonus question, we will use the same basic documentation, but we will add a documented history of von Willenbrand disease. How would sequence number 4095 be coded if the patient had a documented history of von Willenbrand disease diagnosed in childhood? Sequence 4095 would be coded yes in this scenario. In this bonus question, the patient has von Willenbrand disease that was diagnosed in childhood. The documentation of a genetic disease or disorder that predisposes the patient to bleeding alone is sufficient to code yes to sequence 4095 as it indicates a predisposition to bleeding. For bonus question number two, we will again use the same basic information, but remove the history of von Willenbrand disease. In this scenario, we will add the fact that the provider documented their own HAS blood assessment of the patient. Their assessment awarded the patient a score of three using hypertension, bleeding, and the patient's age of greater than 65. How would sequence number 4095 be coded in this scenario? This bonus question would be coded as yes. In scenarios where providers document their own HAS blood assessments, if bleeding or predisposition to bleed were included in their documented risk score assessment, sequence 4095 will be coded as yes. Now just to recap, these are the options we have for coding this element. Our first option is a provider documented HAS blood assessment in which bleeding is included as a condition to award a point to this risk score. With this option, yes can be automatically coded. If the provider has not documented their own HAS blood assessment, we then must rely on the documented history of the patient. We can use documentation of the patient having a predisposition to bleed, which as we mentioned earlier in the case scenario, may include genetic predisposition and the example von Willenbrand disease or genetic disorder provided, bleeding diathesis, which is a tendency to bleed or bruise easily, anemia, or a documented predisposition to bleed while on antiplatelet or anticoagulant medications. Another option is a documented major bleeding event that meets at least one of the following criteria, required hospitalization, hemoglobin level decreased by more than two grams per deciliter or requiring a blood transfusion. Thank you for reviewing the AFib Ablation Registry monthly case scenario for August of 2022.

AFib Ablation Registry

coding Haas blood bleeding

sequence 4095

retinal hemorrhage

anticoagulant medication