Thank you for viewing the IMPACT Registry October 2022 case scenario, where we will discuss Section N, intra and post-procedure events. A 38-year-old female with a past history of a ROS procedure at age 13 for severe aortic bicuspid stenosis presents to the emergency department with syncopal episodes, chest pressure, and dyspnea on exertion. Resulting studies reveal severe RVPA homograft stenosis. The patient is taken to the cath lab for TPVR and balloon angioplasty of the RVPA homograft. Left femoral access is obtained for the procedure. Post-procedure, there is documentation of swelling, bruising, and a hematoma to the access site. The next day, the hematoma has increased in size with documentation of a pulsatile mass noted to the femoral access site. A STAT ultrasound is obtained, which demonstrates a pseudoaneurysm that is treated with ultrasound-guided thrombin injection. Our question is, how is sequence number 8145, other events coded? Number one, no. Or number two, yes. Please take a few moments to review the documentation and the question before making your final answer. And the answer is number one, no. When a pseudoaneurysm at the percutaneous entry site is treated with ultrasound-guided thrombin injection, this is not an other event. Sequence number 8145, other events, is coded if and when the patient has an event that is not articulated in sequence number 8000 through sequence number 8140. Our follow-up question, how is sequence number 8140, other vascular complications requiring treatment coded? Number one, no. Or number two, yes. Please take a few moments to review the documentation and question before making your final response. And the answer is number two, yes. Other vascular complications requiring treatment seeks to capture if the patient experienced any other vascular complications at the percutaneous entry site that required treatment or intervention. In the given scenario, the left femoral procedural access site required an ultrasound-guided thrombin injection to treat the documented pseudoaneurysm. Another question, how is sequence number 8090, bleeding event, coded? Number one, no. Or number two, yes. Again, please take a few moments to review the documentation and question before making your final answer. And the answer is number one, no. The definition parameters for capturing a bleeding event in the given scenario is not met. In the given scenario, the patient has a documented hematoma at the procedural access site. However, it was not associated with an observed drop in hemoglobin at any time or a blood transfusion. While the patient undergoes an ultrasound-guided thrombin injection to treat the aneurysm or hematoma at the access site, an ultrasound-guided thrombin injection does not qualify as a procedural intervention or surgery at the bleeding site to reverse, stop, or correct the bleeding. Thank you for viewing the IMPACT Registry Monthly Case Scenario for October of 2022, where we discussed intra- and post-procedure events.

aortic bicuspid stenosis

syncopal episodes

RVPA homograft stenosis

pseudoaneurysm

IMPACT Registry