Welcome to the Cath PCI Registry October 2021 case scenario, where we will review Sequence Number 7400, Indications for Cath Lab Visit, and Sequence Number 7405, Chest Pain Symptom Assessment. Our documentation is as follows. A 68-year-old female with a history of diabetes, hypertension, and renal insufficiency presents at 6 p.m. on April 22nd to the emergency room. She complains of chest pain with exertion for the last three weeks that is relieved with rest. Her cardiac workup shows an unremarkable ECG, but positive troponins, and she is diagnosed with NSTEMI. She has a coronary angiogram performed the following morning at 11 a.m. on the 23rd. It reveals a 90% mid-LAD lesion and a 60% large first OM lesion. IFR is performed on the first OM, and the result is 0.84, which is a positive result. She has successful PCI to both vessels performed on the following day, the 24th, after hydration therapy. The patient denies chest pain the day of PCI. Our question is, how is Sequence Number 7400, Indications for Cath Lab Visit, coded for the first Cath Lab Visit? Is it number one, ACS less than or equal to 24 hours and suspected CAD? Number two, ACS less than or equal to 24 hours and new onset angina less than or equal to two months? Or number three, ACS less than or equal to 24 hours, suspected CAD, and new onset angina less than or equal to two months? Please take a moment to review the documentation and the question before making your answer. And the answer is number three, ACS less than or equal to 24 hours, suspected CAD, and new onset angina less than or equal to two months. The rationale being that the end STEMI diagnosis supports coding ACS. The fact that she has no prior CAD greater than or equal to 50% or a history of an intervention to treat CAD supports coding suspected CAD. Angina that is new within the last three weeks and no prior history of angina or a CAD intervention supports coding new onset angina less than or equal to two months as well. The follow-up question is how is sequence number 7405 chest pain symptom assessment coded for the first cath lab visit? Is it number one, typical angina, number two, atypical angina, number three, non-anginal chest pain, or number four, asymptomatic? Please take a moment again to review the documentation and the question before providing your answer. And the answer is number one, typical angina. The rationale being that the patient's chest pain with exertion that's relieved with rest meets three out of three characteristics of typical angina and therefore supports the definition and abstraction of typical angina. The target value on current procedure is met. Continuing on with this scenario, we ask another follow-up question. This one being how is sequence number 7400 indications for cath lab visit coded for the second cath lab visit? Is it number one, ACS greater than 24 hours and stable known CAD, number two, ACS greater than 24 hours, new onset angina less than or equal to two months, number three, stable known CAD, or number four, ACS greater than 24 hours and suspected CAD? And the answer is number two, ACS greater than 24 hours and new onset angina less than or equal to two months. The rationale being that the patient's ACS was not yet treated in the first cath lab visit during the episode of care. An NSTEMI ACS diagnosis and new onset angina prior to the first diagnostic only procedure continues to support the reason prompting their PCI. The PCI performed greater than 24 hours after ACS diagnosis supports coding ACS greater than 24 hours. Finally, stable known CAD is not compatible with ACS. We continue with this case scenario with one final follow-up question. And this is how is sequence number 7405 chest pain symptom assessment coded for the second cath lab visit? Is it number one, typical angina, number two, atypical angina, number three, non-anginal chest pain, or number four, asymptomatic? And the answer is number one, typical angina. The rationale being here that the target value, value on current procedure is met. The presence of chest pain symptoms prompted the procedure. And those symptoms may be active on presentation or may not. Please abstract according to the documented symptoms that informed or led to the procedure. Chest pain symptom assessment selection applies to a diagnostic only coronary angiogram and then the subsequent PCI performed during the same episode of care. Key takeaways from this case scenario. Sequence number 7400, indications for cath lab visit is a select all data element. It is capturing the patient's symptoms and conditions that prompt the procedure. ACS, whether it's less than or greater than 24 hours, and anginal indications such as worsening angina, nuance at angina less than or equal to two months, continue to be applicable when a diagnostic only first procedure is followed by a PCI second procedure during the episode of care. With respect to sequence number 7405, chest pain symptom assessment, it is capturing the chest pain and anginal symptoms that prompted the procedure. The patient does not have to exhibit these symptoms when presenting for the procedure to support coding. As with indications for cath lab visit, chest pain symptom assessment continues to be applicable when the diagnostic only first procedure is followed by a PCI second procedure during the episode of care. Thank you for viewing the October 2021 cath PCI registry case scenario where we discussed sequence 7400, indications for cath lab visit, and sequence 7405, chest pain symptom assessment.

Cath PCI Registry

7400

7405

Indications for Cath Lab Visit

Chest Pain Symptom Assessment