Thank you for reviewing the AFib Ablation Registry Monthly Case Scenario for September 2021. This month's case scenario is focused on sequence number 4440, Attempt at Atrial Fibrillation Termination, Surgical Ablation. Our patient, Mr. Brown, is admitted for an AFib Ablation procedure. When abstracting the procedure, we find that Mr. Brown had an ablation two months ago, which was performed using a thoracoscopic approach and is back for a catheter-based endocardial ablation. The documentation states both ablation procedures are part of a hybrid convergent procedure. His past medical history includes multiple direct current cardioversions in the past, longstanding persistent AFib, ischemic stroke, hypertension, and prior MI. It is documented the current endocardial ablation was successful and pulmonary vein isolation as well as focal were used as strategies. Based on the documentation found, how will the history of a thoracoscopic ablation procedure be captured? Will it be captured as number one, pharmacologic cardioversion, number two, DC cardioversion, number three, catheter ablation, or number four, surgical ablation? Please review the documentation in question to determine the best answer. We will give you a few seconds to review. The answer is number four, surgical ablation. Based on the documentation from the provider, an ablation that is performed using a thoracoscopic approach will be captured as a surgical ablation, even if it is part of a convergent procedure. Convergent procedure is a combination of minimally invasive surgical treatment with catheter ablation to provide best results. The HEART team includes a cardiac electrophysiologist and a cardiothoracic surgeon who together perform ablation from inside and outside the HEART. As reviewed in last month's case scenario, both endocardial and outside the HEART ablations can be performed during the same procedure, but it can also be performed during different admissions or procedures. However, it will be captured in the registry only when the endocardial ablation takes place. The minimally invasive surgical part of the convergent procedure can be performed using a thoracoscopic approach, epicardial approach, or both. If documentation states only an epicardial approach was utilized, please code as catheter ablation in sequence 4425. If both approaches are documented as utilized, please code as both catheter and surgical ablation in sequence 4425 and 4440. Thank you for reviewing the AFib Ablation Registry Monthly Case Scenario for September 2021.

AFib Ablation

thoracoscopic ablation

catheter-based endocardial ablation

hybrid convergent procedure

surgical ablation