Thank you for viewing this cath PCI registry case scenario. In this scenario, we will cover sequence 8020, lesion length. A patient was taken to the cath lab and documentation indicates a guide wire was inserted into the distal left anterior descending artery. However, the lesion was unable to be crossed after multiple attempts. The guide wire was removed and the procedure ended. The patient's medical therapy was adjusted prior to discharge with plans for follow-up in two weeks with cardiology. Our question, is there enough documentation to support coding sequence 8020, lesion length? Number one, no, or number two, yes. Please take a few moments to review the documentation prior to making your final selection. The answer is number one, no. There is not enough documentation to support coding sequence 8020, lesion length. So you may be wondering, well, what do I do? And our advice remains that in scenarios where no intracoronary device is used, it is best practice to obtain an estimate from the physician for coding purposes and then amending in the medical record accordingly. If clarification cannot be obtained, then the data element would be left blank. However, doing so consistently runs the risk of challenges in passing the DQR. The process of coding sequence number 8020, lesion length, when there is no explicit documentation found in the medical record, is hierarchical and should be applied as follows. First, it is best practice to obtain provider clarification as this is the most accurate depiction or estimate of the lesion that he or she can describe. If clarification is made, then amend the medical record for clarity and code accordingly. If clarification cannot be obtained and all efforts to obtain it are unsuccessful, then we next advise on using stent length. When a single stent is deployed to the lesion, code the length. When multiple stents are deployed in a lesion, use the total length of the stents deployed in the lesion, regardless of whether or not they overlap. If a stent was not deployed in the lesion, then we next advise on using the balloon length. When balloon angioplasty is performed to the lesion, code the length. When multiple balloon angioplasties are performed in a lesion, clarify with the physician as it is common for multiple balloons to be used to expand the same vessel segment. Lastly, if clarification cannot be obtained and all efforts to obtain it are unsuccessful, stents were not deployed and balloon angioplasty was not performed or multiple balloon angioplasties were performed, sequence 8020 lesion length would be left blank, running the risk of not being able to achieve a green DQR submission if done consistently. A patient who was brought to the cath lab for treatment of a CTO, or chronic total occlusion, in their mid-left anterior descending artery had three drug-eluting stents placed, one in their proximal left anterior descending artery, one in their mid-left anterior descending artery, and one in their distal left anterior descending artery. The stents did not overlap and sizes are as follows, a Resolute Onyx 2.25x18, a Resolute Onyx 2.25x22, and a Resolute Onyx 2.0x12. After stent placement, post-stent dilation was performed in the proximal left anterior descending with an NC-TREC 2.75x20, which was inflated twice at different nominal pressures. The abstractor is unable to get clarification on lesion length from the physician. How is sequence number 8020 lesion length coded for this scenario? Number one, 22 millimeter for the stent length of the mid-LED lesion. Number two, 72 millimeter, which includes the three stent lengths and the balloon length. Number three, 52 millimeters, including just the three stent lengths. Number four, 20 millimeters for the balloon length, or number five, leave blank. Please take a few moments to review the documentation prior to determining your final selection. The answer is number three, 52 millimeters, which includes three stent lengths. So there was admittedly a lot of distracting information in this scenario to make it more challenging. But if we break it down and remove the noise, we need to first understand that from the registry perspective, treated segments areas that are sequential to one another, as with a proximal mid and distal LED in this scenario, are coded as one lesion in sequence 8000 lesion counter with the segments identified in sequence 8001, the segment number. Overlapping stents are not required to support coding this way. And additionally, this is supported in FAQ ID 25028. So this will be coded in the lesion counter as number one with each segment coded in sequence 8001 segment number. And the lesion length will reflect the length of the lesion, including all applicable segments, which in this scenario is 52 millimeters. And now when we go back to our process graph, first, we know it is, and probably always will be, best practice to obtain provider clarification as this is the most accurate depiction or estimate of the lesion that is described. We know in this scenario that for whatever reason, clarification was not made. When clarification cannot be obtained and all efforts to obtain it are unsuccessful, we next advise on using stent length. As multiple stents were deployed in this lesion, we will use the total length of the stents, regardless if they overlap, which in this case is 52 millimeters, and the abstraction process for the data element stops. Thank you for viewing this CAF PCI Registry case scenario.

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