Welcome to the CAF PCI Registry October of 2022 case scenario where we will review sequence number 7835, STEMI or STEMI equivalent first noted. A 67-year-old female presents to the emergency department with pain to her right leg after a witnessed syncopal episode while rollerblading. She is unable to bear weight and there is an obvious deformity to her right lower extremity. The patient has no past medical history and takes no medications, denies chest heaviness or chest discomfort. However, she is pale and diaphoretic with nausea. The portable x-ray shows a right tib-fib fracture and a pre-op ECG is obtained, which is positive for STEMI and she is taken immediately to the CAF lab for PCI. How is sequence number 7835 STEMI or STEMI equivalent first noted coded? Number one, first ECG or number two, subsequent ECG? Please take a few moments to review the documentation and question prior to making your final selection. And the answer is number one, first ECG. Sequence number 7835 STEMI or STEMI equivalent first noted seeks to capture if a STEMI or STEMI equivalent was noted on either the first ECG or a subsequent ECG. Subsequent ECG would be coded if the STEMI is noted on an ECG subsequent to the patient's non-cardiac presentation. In the given scenario, the patient has a witnessed syncopal event while rollerblading. She is also pale, diaphoretic and experiencing nausea. When a patient has an atypical presentation, such as altered mental status, syncopal episode, fatigue with nausea, vomiting and diaphoresis, palpitations, et cetera, a screening ECG should be performed to rule out the worst case scenario or worst diagnostic option. These patients should be evaluated to make sure their atypical presentation and atypical symptoms are not cardiac in nature. If the first ECG identifies STEMI, then first ECG will be coded in sequence 7835. In the given scenario, the patient presents to the emergency department with a leg injury that was a result of a witnessed syncopal event and she is pale, diaphoretic and with nausea. Atypical symptoms that must be ruled out as cardiac in nature. Thank you for viewing the CAF PCI Registry Monthly Case Scenario for October of 2022, where we reviewed sequence number 7835, STEMI or STEMI-equivalent first noted.

CAF PCI Registry

October 2022

case scenario

67-year-old female

leg pain