Hello, everyone, and welcome to our case scenario for the month of August 2024. This month, we will be discussing a scenario based on the registry's intra- or post-procedure events. Mr. Jones was admitted for a planned AFib ablation procedure. His past medical history includes congestive heart failure, persistent AFib, for which several failed attempts at cardioversion have been made, prior MI, and hypertension. After a successful ablation procedure in which all pulmonary veins were isolated, Mr. Jones was transferred to the post-op area. In the post-op area, he complained of difficulty breathing with crackles on assessment. Mr. Jones was diagnosed with pulmonary edema. He was put on BiPAP and given diuretics and then transferred to the ICU for closer observation. Our question is, when abstracting the procedure based on the documentation shared, should heart failure sequence 9040 be coded as an intra- or post-procedure event? Number one, yes, or number two, no. Please take a moment to review the documentation in question before making your final answer. The answer is number one, yes. Sequence 9040, heart failure, will be coded if there was a new diagnosis of heart failure or if the patient experienced a decompensation of previously diagnosed heart failure. Based on the documentation, the patient experienced a decompensation of previously diagnosed heart failure. Bonus question number one. Based on the documentation shared, should respiratory failure sequence 9225 also be coded as an intra- or post-procedure event? Number one, yes, or number two, no. The answer is number two, no. Sequence 9225, respiratory failure, will be coded if there was a new diagnosis of respiratory failure. In this case, there was no diagnosis of respiratory failure documented. In order to code respiratory failure, mechanical ventilation is needed to support coding. If oxygen was delivered via a non-invasive mask, respiratory failure will not be coded as an event. Bonus question number two. Will Mr. Jones be included in the numerator of metric number four, which is now updated to be known as metric key 2765, the proportion of patients undergoing an atrial fibrillation procedure who experienced death or a major adverse event intra- or post-procedure and prior to discharge? Number one, yes, or number two, no. And the answer is number two, no. Based on the Registry's Executive Summary Measures and Metrics Companion Guide document located under Resources, Documents, and User Guide Documents, heart failure is not part of the events included in the metrics numerator. However, Mr. Jones will be part of the numerator in metric number nine, which will become metric key 2792, proportion of patients undergoing atrial fibrillation ablation procedure who experienced any adverse event intra- or post-procedure and prior to discharge. Heart failure is part of the events included in this metrics numerator. The Executive Summary Measures and Metrics Companion Guide document also includes the metric ID to metric key crosswalk table. We thank you for taking the time to review our latest case scenario.

AFib ablation procedure

pericardial effusion

tamponade

cardiac surgery

hemorrhage non-access site

pulmonary edema

heart failure

respiratory failure

adverse events