This is the Cath PCI case scenario for September of 2021. We will review heart failure and how it is captured throughout the registry. Our scenario involves a 64-year-old female who presents to your facility with complaints of shortness of breath and chest tightness, which her physician has classified as anginal equivalence. Her HNP states she has hypertension, New York Heart Association class II, and new onset angina, which started two weeks ago. Current medications are corvetolol, 12.5 milligrams twice daily, hydrochlorothiazide, 25 milligrams daily, and lisinopril, 10 milligrams daily. The patient undergoes a nuclear stress test, which is positive, with high risk of ischemia. This prompts her physician to admit her and schedule a cath lab visit for the next morning. Based on the documentation so far, how is sequence number 4001, heart failure, coded? No or yes? Here is your documentation and question for review. And the answer is number two, yes. For FAQ 24888, yes is coded in sequence 4001, heart failure, when a New York Heart Association class is documented in the medical record and meets the target value of any occurrence between birth and current procedure. In the patient's HNP, the physician documented New York Heart Association class II as part of her history. In instances where the physician provided the patient's New York Heart Association class, but the formal diagnosis of heart failure is missing in the medical record, the documented New York Heart Association class supports coding yes to sequence 4001, heart failure, because the New York Heart Association classification system is specifically used for defining the severity of heart failure symptoms. The morning after being admitted, our patient goes to the cath lab. She is currently stable with no complaints of shortness of breath or chest tightness. Her diagnostic coronary angiography reveals a 90% stenosis in the mid-circumflex and a left ventricular EF of 30%. The physician treats the circumflex by placing a drug-eluting stent in the mid-portion. Now, based on the documentation we have so far, how is sequence number 7410 cardiovascular instability coded? Number one, no, or number two, yes? Here's the documentation and question for your review. And the answer is no. Per documentation, this patient was stable with no complaints at the start of the cath lab visit. Therefore, the target value of on current procedure is not met. Regarding acute heart failure symptoms as an instability type, a low EF alone does not support coding this selection. And 7410 cardiovascular instability seeks to capture when the patient has persistent ischemic symptoms, cardiogenic shock, ventricular arrhythmias, symptoms of acute heart failure or hemodynamic instability that are present on arrival to the cath lab and or those symptoms that are actively being managed with pharmacological or mechanical support. Medications that are administered on a scheduled basis is equivalent to being managed, but this is not an acute treatment strategy. Post-PCI, our patient reports an increase in shortness of breath with an inability to lay flat. Her physician orders LASIK's 40 milligrams IV, which is administered twice daily until she is discharged two days later. Per the discharge summary, patient has CAD, heart failure with reduced EF, and hypertension. Her discharge medications are altered to replace hydrochlorothiazide with LASIK's 40 milligrams every morning. Our last question for this scenario is, how is sequence number 9002 intra post-procedure events for heart failure coded? Number one, no, or number two, yes. Here is your documentation and question for review. And the answer is number two, yes. Heart failure as an intra and post-procedure event in sequence 9002 seeks to capture when the patient experiences new onset or acute recurrence of heart failure, which necessitates new or increased pharmacologic therapy. The key here is that the patient receives new or increased pharmacologic therapy. IV LASIK's is new pharmacologic therapy and yes will be coded to heart failure as an intra and post-procedure event in sequence 9002. And the event date and time would be the date and time the patient receives the LASIK's. In summary, heart failure is captured three times in the data collection tool. Section D pre-procedure in sequence 4001, on procedure in section G cath lab visit in sequence 7410, 7415, and intra post-procedure in section K intra post-procedure events in sequence 9001 and 9002. Sequence 4001 captures a history of heart failure which has been diagnosed by either documentation of heart failure or a documented NYHA class prior to the current cath lab visit. Sequence 7410, cardiovascular instability, and the child field sequence 7415, the instability type, captures instability in the form of acute heart failure symptoms that are present at the start of the cath lab visit. Finally, sequence number 9002 captures a new or acute recurrence of heart failure experience between cath lab visit and either next cath lab visit or discharge, which required new or increased pharmacologic therapy. To clarify further, if acute heart failure is not present at the start of the procedure, then any new occurrence or reoccurrence will be captured as an intra or post-procedure event as this target value begins with the start of the procedure. If acute heart failure is present at the start of the procedure, then any new occurrence can only be post-procedure since at the start of the procedure, it was already identified as an ongoing event and could therefore not also be a new recurrence or reoccurrence. We encourage you to visit and review recorded presentations located on the cath PCI registry learning center page that offer additional education on cardiovascular instability and how to apply the target value correctly. Thank you for viewing the cath PCI registry monthly case scenario for September 2021.

Cath PCI case scenario

heart failure

registry

nuclear stress test

Cath lab visit