This is the CAF PCI registry case scenario for September of 2022, where we will discuss sequence number 5032, electrocardiac assessment results. A 70-year-old male presents to the hospital in cardiac arrest. He is placed on telemetry and found to be in pulseless ventricular tachycardia. CPR is performed and ACLS protocol is implemented and return of spontaneous circulation is achieved. A 12-lead ECG is then performed, which is diagnostic for anterior STEMI. The patient is transferred to the CAF lab for an emergent coronary angiogram, which reveals a 100% proximal LAD culprit stenosis, as well as a severely calcified 90% lesion in the patient's proximal and mid-RCA. A successful PCI is performed and a drug-eluting stent is deployed in the proximal LAD. The patient fully recovers from their cardiac event and is discharged home after three more days in the hospital. He then presents two weeks later for a staged PCI and receives an atherectomy to treat the calcified RCA lesion. The pre-procedure 12-lead ECG shows normal sinus rhythm. Our question is, how is sequence number 5032 electrocardiac assessment results coded for the staged PCI procedure? Number one, normal? Number two, abnormal? Or number three, uninterpretable? Please take a few moments to review the documentation and question before making your final determination. And the answer is number two, abnormal. The rationale is that electrocardiac assessments within the past 30 days are used to complete the electrocardiac assessment section, sequences 5032, 5034, and 5037, when the patient presents for their first procedure in an episode of care. Per the V5 data dictionary supplement with pending data element updates document, the target value update prioritizes capturing abnormal values when one is identified. The patient's ECG showing STEMI, which supports capturing the abnormal selection of ST deviation greater than or equal to 0.5 millimeters, is the last abnormal value and occurred within 30 days meeting this target value. Per the update to the target value in sequence number 5032 in the supplemental dictionary, the intent is to capture the last value between 30 days prior to the first procedure or previous procedure and current procedure, prioritizing the last abnormal value when there is one. To clarify, the target value for sequence 5032 EC assessment results is easier to understand when it's separated into two distinct thoughts. When the patient arrives for the first cath lab visit in a new episode of care, apply this portion of the target value, last value, abnormal, uninterpretable, or normal, between 30 days prior to the current procedure. When the patient presents at the cath lab after having a diagnostic coronary angiogram and or a PCI during the same episode of care, apply this portion of the target value, last value, abnormal, uninterpretable, or normal, between previous procedure and current procedure. For our bonus question number one, how is sequence number 5037 EC assessment method coded for the staged PCI procedure? Is it number one, ECG, number two, telemetry monitor, number three, Holter monitor, number four, other, or number five, none? Please take a few moments to review the documentation before making your final determination. The answer is number one, ECG. ECG is coded in sequence 5037 as this was the method used to identify the last abnormal value, STEMI, which supports ST deviation greater than or equal to 0.5 millimeters, and this was measured in sequence 5032, EC assessment results. For our bonus question number two, how is sequence number 5034 EC abnormality type coded for the staged PCI procedure? Is it number one, sustained VT, number two, ST deviation greater than or equal to 0.5 millimeters, or number three, both sustained VT and ST deviation greater than or equal to 0.5 millimeters? Please take a few moments to review the documentation before making your final selection, and the answer is number three. Both sustained VT and ST deviation greater than or equal to 0.5 millimeters are selected, and this is because the target value states that all values between 30 days prior to the first procedure or previous procedure and current procedure are captured. The definition for sustained VT is met as the patient required CPR to terminate the arrhythmia, and per FAQ number 24898, a diagnosis of STEMI also supports capturing ST deviation greater than or equal to 0.5 millimeters. Thank you for viewing the CAF PCI registry monthly case scenario for September of 2022.

cardiac arrest

CPR

ACLS protocol

STEMI

PCI