Hello, everyone, and welcome back to our bimonthly case scenario for August of 2024. For this scenario, we will examine how to code an intra or post-procedure event, occurrence of pneumonia in sequence 12153-9002, and then determine if the diagnosis of pneumonia will qualify for inclusion in metric 6, metric key 13-270. In this scenario, a patient was admitted for a planned left atrial appendage occlusion procedure and had a 24-millimeter Watchman successfully implanted without a complication during the procedure. On post-procedure day two, the patient developed chest pain with 12-lead ECG changes of 3 millimeters ST elevation in leads V2 and V3. The patient was immediately taken for a diagnostic catheterization, which showed a 95% proximal left anterior descending coronary artery stenosis. The patient received a stent to the proximal LED with 0% residual stenosis. On day four post-procedure, the patient developed a temperature of 101 degrees Fahrenheit, started having a productive cough, and the patient's O2 decreased to 92% on room air. A chest X-ray showed a right lower lobe pneumonia. Our question, would pneumonia be coded as an intra or post-procedure event in sequence 2153-9002? Is it no or yes? Please take a moment to review the documentation and question before making a final answer. Based on the target value for sequence number 12153-9002 of any occurrence between start of procedure and until next procedure or discharge, the terminology of until next procedure refers to another LAAO procedure only. Other surgeries or procedures are not considered a next procedure for the registry. The diagnosis of pneumonia two days post-procedure would be captured as an event in sequence number 12153-9002. In this slide, the data abstraction shows that a 24-millimeter Watchman device was implanted successfully using a percutaneous approach, and the procedure was not coded as aborted in sequence 14831. Further documentation shows that pneumonia was coded in sequence 12153-9002, intra or post-procedure events occurred. The discharge section shows sequence 14836, percutaneous coronary intervention, is coded as yes. Our bonus question number one, using the same documentation and patient data, will the diagnosis of pneumonia include the patient in the numerator for metric 6, metric key 13270, proportion of patients with a major complication, either intra or post-procedure and prior to discharge? The answer is no. The rationale is that for the LAAO registry, a diagnosis of pneumonia that occurs either during or after an LAAO procedure and up until discharge is not considered a major complication that would pull the patient into the numerator for metric 6, metric key 13270. Additionally, the procedure was not coded as procedure aborted in sequence 14831. In this screenshot for the numerator inclusion criteria for metric 6, metric key 13270 from the Measures and Metrics Companion Guide, there are many diagnoses that will pull the patient into the numerator. Pneumonia is not among them. Additionally, it is important that sequence number 14831, procedure aborted, is coded as no because if it was coded as yes and the reason in sequence 14832 is coded with any of the selections listed in the numerator inclusion criteria, the patient would be included in the numerator, even if one of the many diagnoses is not met. We thank you for taking the time to review our latest case scenario. We'll see you for the next case scenario in October.

coding procedures

atrial fibrillation termination

catheter ablation

left atrial appendage occlusion

procedure timing

pneumonia diagnosis

left atrial appendage occlusion procedure

Watchman device implantation

coronary artery stenosis treatment

accurate coding and documentation