Welcome to the CAF PCI Registry case scenario, where we will be reviewing sequence number 7045, Diagnostic Coronary Angiography Procedure. A patient with a past medical history of hypertension and diabetes presents with chest pain on exertion. STEMI was ruled out, and the patient was admitted for stable angina. During the hospital stay, the patient had a stress test that was positive for ischemia, so they went to the CAF lab, where findings revealed a proximal RCA lesion of 80% and a mid-LAD lesion of 60% to 70%, prompting the placement of a drug-eluting stent to the proximal RCA. The patient was discharged in stable condition without complaints of chest pain and a plan for medical management for treatment of the mid-LAD. However, the patient returned three weeks later for failed medical management, presenting with complaints of chest pain on exertion. The patient returned to the CAF lab, where an IFR resulted positive in the mid-LAD, and a drug-eluting stent was placed. The question is, how is sequence number 7045, Diagnostic Coronary Angiography Procedure, coded for the second CAF lab visit? Number one, yes, or number two, no. Please take a few moments to review the documentation before making a final selection. And the answer is yes. In this scenario, the patient returned to the CAF lab following failed medical management. This return CAF lab visit captures the Diagnostic Coronary Angiography Procedure meeting the target value on current procedure. Let's review the data definition of a Diagnostic Coronary Angiography. The coding instructions define it as the passage of a catheter into the aortic root or other great vessels for the purpose of angiography of the native coronary arteries or bypass grafts that supply the native coronary arteries. For the registry, a Diagnostic Coronary Angiography Procedure is captured when the study is to evaluate at least one vessel during the procedure. In here, the notes section instructs the user to code yes when PCI is performed during the same CAF lab visit and coronary angiography is understood to reflect the patient's initial evaluation within the last 30 days as the intent is to identify when a CAF was performed to make a diagnosis. And in this scenario, the patient returned to the CAF lab within the last 30 days for a change in clinical status, meaning the patient was stable and now returned three weeks later with chest pain, indicating this is the initial evaluation to diagnose new disease or worsening disease due to the failure of medical management and symptoms. When there is a change in the patient's clinical symptoms prompting a visit to the CAF lab, the understanding of the return visit is that the coronary disease burden was re-evaluated to make a diagnosis. But let's go even further. The intent of sequence 7045 is to identify when a diagnostic CAF was performed during the lab visit to evaluate if there is disease burden. This may be a new assessment within 30 days or due to a change in the patient's status. Again, in this scenario, the patient returned to the CAF lab within the last 30 days for a change in clinical status, meaning the patient was stable and now returned three weeks later with chest pain, indicating this is the initial evaluation to diagnose new disease or worsening disease due to the failure of medical management and symptoms, and yes would be coded. Let's look at the notes section of the coding instructions. The instruction is to code no if the patient presents for a staged PCI. However, while not applicable to this scenario, we would like to review further for educational purposes. A staged PCI is one that is a subsequent planned PCI procedure that is performed after an initial PCI for multivessel disease. As well, the second PCI must be performed on a vessel not treated during the initial procedure. The second PCI must occur within 90 days of the initial PCI procedure. And lastly, the patient is stable without any symptoms of recurrent or persistent ischemia, heart failure, or electrical instability. While reviewing this case, you will find that the patient had multivessel disease found on the initial CAF lab visit, and only one vessel was treated, the proximal RCA. The plan was for medical management on the additional vessel, the mid-LED. Instead, this patient returned for a CAF lab visit due to chest pain, indicating a change in clinical status, recurrent symptoms of ischemia. Therefore, the second CAF lab visit was not a staged PCI. To provide one more general review of sequence number 7045, diagnostic coronary angiography is defined as the passage of a catheter into the aortic root or other great vessels for the purpose of angiography of the native coronary arteries or bypass grafts that supply the native coronary arteries. Code yes when PCI is performed during the same CAF lab visit, and coronary angiography is understood to reflect the patient's initial evaluation within the last 30 days, as the intent is to identify when a CAF was performed to make a diagnosis. Code no if the patient presents for a staged PCI. Code yes when a patient's change in clinical status requires a diagnostic reassessment or a patient who returns to the CAF lab with acute symptoms that suggest a change in their CAD status. Thank you for viewing the CAF PCI registry case scenario.

percutaneous coronary intervention

patient-centered delays

multi-vessel disease

ST elevations

accurate documentation

hypertension

angiography

stent placement

ischemia

stable angina