Welcome to the CAHPS PCI Registry Case Scenario for October 2020. This case scenario will review Sequence 7810, Level of Consciousness PCI, and Sequence 10117, Level of Consciousness Discharge. A 75-year-old female presented to the emergency room and was diagnosed with STEMI. Prior to going to the cath lab, the patient experienced V-fib arrest and CPR was initiated. Return of spontaneous circulation was achieved and the patient was alert upon arrival to the cath lab. The patient underwent a successful PCI to the culprit lesion, was transferred to the CCU, and transitioned to a telemetry floor. After arriving on the telemetry floor, the patient was found unresponsive by the nurse due to PEA. Resuscitative efforts were initiated, but return of spontaneous circulation was not achieved, and the patient ultimately expired. How is Sequence 7810, Level of Consciousness PCI coded for this scenario? Verbal, alert, unresponsive, or pain? Now is the time to review the documentation and question. The answer is A, alert, would be coded for Sequence 7810, Level of Consciousness PCI. When a patient has cardiac arrest prior to the cath lab visit, Sequence 7810 is coded with the Level of Consciousness after resuscitation at the start of the PCI procedure. In this case, the patient was alert at the start of the PCI. How is Sequence 10117, Level of Consciousness discharge coded for this scenario? Verbal, alert, unresponsive, or pain? Please take a moment to review the documentation and the question. The answer is, again, A, alert. This would also be coded for Sequence 10117, as it seeks to capture the highest value from the start of procedure to death, which in this scenario was alert. This data element would only be selected when the patient's discharge status, Sequence 10105, is coded deceased and one of the following was coded yes. Sequence 4630, Cardiac Arrest Out of Healthcare Facility, Sequence 4635, Cardiac Arrest at Transferring Facility, or Sequence 7340, Cardiac Arrest at This Facility. To review, the value of these two data elements is that for the patient with PCI, the registry can evaluate if there was a change in consciousness after the PCI procedure. It is important to understand the target values for both data elements. Sequence 7810, the value at the start of PCI. Sequence 10117, the highest value from start of procedure to death. Let's review Sequence 7810 and Sequence 10117. Example 1, patient is unresponsive at the start of PCI, however, two days later is alert. Unfortunately, 10 days after PCI, the patient expires. In this scenario, the highest value at the start of PCI is unresponsive, which would be coded in Sequence 7810. The highest value from start of procedure to death is alert, which would be coded in Sequence 10117. If Sequence 10117 were to be coded as unresponsive, this would trigger an error code because the target value, highest value from the start of the procedure to death, would not have been met. Example 2, patient is responding to painful stimuli at the start of the PCI procedure but becomes unresponsive after and expires. The highest value at the start of PCI is pain, which would be coded in Sequence 7810. The highest value from start of procedure to death is also pain, which would be coded in Sequence 10117. Thank you for viewing the CAHPS PCI Registry Monthly Case Scenario for October 2020. We appreciate your participation.

STEMI

CPR

PCI

PEA

consciousness