Thank you for joining us for the August 22 case scenario. In this month's case scenario, we will be reviewing sequence 4095, hasp-led bleeding. In this scenario, an 81-year-old female has been admitted for an LAA occlusion procedure. The patient has a history of non-valvular atrial fibrillation for six years, which is documented or classified as persistent. At the time of admission for the procedure, the patient was only on Eliquis as an anticoagulant and has a documented history of a retinal hemorrhage in the past. The provider did not list the previous retinal hemorrhage or any other episode of bleeding as a reason for the left atrial appendage occlusion procedure. Based on the patient history of persistent non-valvular atrial fibrillation, sequence 4095 be coded. Please take a moment to review the documentation and question to determine the best answer. The answer is no. Based on the patient's history of retinal hemorrhage and being on Eliquis, an 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 a genetic predisposition, for example, von Willenbrand disease or genetic disorder, bleeding diathesis, which is a tendency to bleed or bruise easily, anemia, or a documented predisposition to bleeding while on an antiplatelet or anticoagulant medication. History of a major bleed meeting 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 history of non-valvular persistent atrial fibrillation, von Willenbrand disease, and was taking Eliquis at the time of the procedure? Sequence 4095 will be coded yes in this scenario. In this bonus question, the patient has von Willenbrand disease that was diagnosed at childhood. The documentation of the genetic disease alone is sufficient to code yes to sequence 4095 as it indicates a predisposition to bleeding. For our 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 HASS blood assessment to the patient. Their assessment awarded the patient a score of three using hypertension, bleeding, and the patient's age greater than 65. How would sequence 4095 be coded in this scenario? The answer to our bonus question number two is yes. In scenarios where providers document their own HASS blood assessments, if bleeding or predisposition to bleed were documented as included in the risk score, sequence 4095 will be coded as yes. Just to recap, these are the options we have for coding this element. Our first option is a provider documented HASS blood assessment in which bleeding is included as a condition to award a point to the risk score. With this option, yes can be automatically coded. If the provider has not documented their own HASS 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 this case scenario may include genetic predisposition, and the example of von Willenbrand disease was provided. Bleeding to diathesis, which is a tendency to bleed or bruise easily, anemia, or documented predisposition to bleed while on antiplatelet or anticoagulant medications would also qualify. Another option is a documented major bleeding event that meets at least one of the following criteria. Record hospitalization, hemoglobin level decreased by more than two grams per deciliter, or requiring a blood transfusion. Thank you for viewing the LAAO registries case scenario for August of 2022. We'll see you next month for the next installment of our HASS blood series.

LAA occlusion procedure

Eliquis

atrial fibrillation

bleeding

retinal hemorrhage