Welcome to the STS-ACC TVT Registry Case Scenario, where we will review the coding of Sequence 9002, Intra and Post-Procedure Events Occurred, specifically for a genitourinary bleeding event. A 70-year-old male with a history of transurethral resection of the prostate presented for his transcatheter mitral valve repair procedure. While in pre-op holding, a Foley catheter was inserted, but with much difficulty. Gross hematuria was observed immediately, and a urology consult was obtained to evaluate. The plan was to perform a cystoscopy after the TVT procedure, while the patient was still under anesthesia. When in the procedure room, the Foley continued to drain bright red bloody urine. The cystoscopy was performed, which evacuated blood clots, and he had a hemoglobin drop of 3 grams. Our question, will this be coded as a genitourinary bleeding event? Number one, no. Or number two, yes. Please take a few moments to review the documentation before making your final selection. And the answer is number one, no. To code bleeding genitourinary as yes, in sequence 9002, intra- and post-procedure events occurred. There must first be documentation that the patient experienced a confirmed genitourinary bleeding event between the start of the procedure and until the next procedure or discharge. When this is clear, then there must be any of the following that also occurs between start of the procedure and until next procedure or discharge. And that would be a hemoglobin drop of greater than or equal to 3 grams per deciliter, or a transfusion of whole blood or packed red blood cells, or a procedural intervention or surgery at the bleeding site to reverse, stop, or correct the bleeding, such as surgical closures, exploration of the arteriotomy site, balloon angioplasty to seal an arterial tear, or an endoscopy with cautery of a GI bleed. In this scenario, the genitourinary bleeding that started in pre-upholding did not resolve and the symptoms remained, which was documented as bright red bloody urine noted in the Foley bag during the procedure. Thus, this is considered one continuous event that began pre-procedure and bleeding genitourinary would be coded as no. Let's clarify using a visual. You can see here that events are captured when they occur after the start of the TBT procedure until the next TBT procedure, if there is one, or discharge. The confirmed genitourinary bleeding event occurred prior to the target value and continued through the procedure based on the documentation supplied. Therefore, to reaffirm understanding as the genitourinary bleeding from pre-upholding did not resolve and the symptoms remained throughout the TBT procedure, this is considered one continuous event that began prior to the target value and bleeding genitourinary would be coded as no in sequence 9002 intra-post-procedure events occurred. Alternatively, if there had been some documentation noting the genitourinary bleeding from pre-upholding resolved and reoccurred after the start of the procedure, then bleeding genitourinary would be coded as yes, as the patient experienced a confirmed genitourinary bleeding event observed and documented in the medical record, and there was a drop in hemoglobin of three grams per liter or more and a procedural intervention surgery at the bleeding site to reverse stop or correct the bleeding to meet the target value. Thank you for viewing the TBT registry case scenario.

transcatheter aortic valve replacement procedure

stroke volume index

low flow

American Society of Echocardiography guidelines

thorough documentation

case study

genitourinary bleeding

transcatheter mitral valve repair

hemoglobin levels

documentation