Thank you for viewing the CAF PCI registry case scenario. In this scenario, we will cover sequence 78-45 first device activation date and time. A STEMI patient was taken immediately to the CAF lab. The cardiologist attempted to wire a lesion in the right posterolateral branch, however was unsuccessful. After review of the left coronary films, the focus turned toward a distal LAD lesion that received thrombectomy, followed by PCI successfully restoring flow and resolving ST elevations. The question is, what date and time would be used to code sequence 78-45 first device activation date and time? Would it be the date and time of number one, guide wire insertion of the RPL lesion, number two, thrombectomy of the distal LAD lesion, or number three, stent insertion of the distal LAD lesion? Please take a few moments to review the documentation prior to making your final selection. The answer is number two, thrombectomy of the distal LAD lesion. Sequence 78-45 first device activation date and time is indicating the time the first device was activated, regardless of type of device, and to use the earliest time from the following, the time of the first balloon inflation, the time of the first stent deployment, or the time of the first treatment of a lesion, angiojet or other thrombectomy, aspiration device, laser, rotational atherectomy, et cetera. If a lesion cannot be crossed with a guide wire or device, and thus none of the above apply, then you are to use the time of guide wire introduction. So in this scenario, as a lesion, the distal LAD was crossed, criteria number four cannot be used to support coding. So that leaves us with the earliest time of criterias number one, two, and three. And as the distal LAD received thrombectomy first, the date and time would be coded in sequence 78-45, first device activation date and time. A 68-year-old female presented to the emergency department via ambulance with complaints of chest pain. Her workup included an ECG that demonstrated ST elevations, and she was taken immediately to the cath lab. The cardiologist felt the culprit was a graft to the proximal LAD, so it was ballooned multiple times. However, no flow was restored. The cardiologist then turned to an occluded graft, feeding the distal RCA that received PCI successfully, restoring flow, and resolving ST elevations. So the question now is, what date and time would be used to code sequence number 78-45, first device activation date and time? Would it be the date and time of balloon angioplasty of the graft to the distal RCA restoring flow, the stenting of the graft to the distal RCA restoring flow, or the balloon angioplasty of the graft to the proximal LAD without restoring flow? Please take a few moments to review the documentation prior to making your final selection. And the answer is number three, balloon angioplasty of the graft to the proximal LAD that did not restore flow. To review again, sequence number 78-45 is indicating the time the first device was activated, regardless of type of device used, and to use the earliest time from the following, time of the first balloon inflation, time of the first stent deployment, or time of the first treatment of the lesion. If a lesion cannot be crossed with a guide wire or device, and thus none of the above would apply, then use the time of guide wire introduction. But as you'll see on the next slide, in this scenario, as both lesions were crossed, criteria number four cannot be used to support coding. And again, that leaves us with the earliest times of criteria number one, two, and three. And as the proximal LAD received balloon angioplasty first, albeit unsuccessfully, this date and time would be coded in sequence number 78-45, first device activation date and time. Additionally, it's important to note that this is a process measure about the timeliness of treatment. It's not a clinical outcomes measure based on TIMI flow or clinical reperfusion. It does not matter whether the baseline angiogram showed TIMI 3 flow or if the final post-PCI angiogram showed TIMI 0 flow. What is being measured is the time of the first mechanical treatment, not the time when flow was or was not restored. Thank you for viewing the CAF PCI registry case scenario.

emergency department

chest pain

difficulty breathing

ST elevation

heart failure