This is the CATH PCI case scenario for November 2020. Sequence 9275, packed red blood cell transfusion. A 55-year-old female with a history of chronic kidney disease and chronic anemia secondary to lupus presented to the emergency department complaining of increased fatigue, shortness of breath for the past several days, and new symptoms of chest heaviness and pressure. The ECG was negative for STEMI. The chest x-ray was also unremarkable. Biomarkers were negative, but the hemoglobin was 8.0 grams per deciliter. Because of a strong family history of coronary artery disease and the patient's symptoms on presentation, she was admitted to the hospital for observation. The admitting orders included one unit of packed red blood cells to be transfused in the morning for the patient's anemia. However, later that evening, the patient complained of 10 out of 10 chest pain. A subsequent ECG was still negative for STEMI, but the patient was sent to the CATH lab for acute coronary syndrome, and the transfusion was then administered. The diagnostic coronary angiography revealed a 60% stenosed proximal LAD, and PCI was performed with balloon angioplasty, followed by a bare metal stent placement. The patient's recovery was unremarkable, and she was discharged two days later. How is Sequence 9275, Packed Red Blood Cell Transfusion, coded? No or Yes? Please take a moment to review the documentation and the question. And the answer is number two, Yes. Sequence 9275 captures when there was a transfusion of packed red blood cells any time between start of procedure and until next procedure or discharge. Whenever Yes is coded to Sequence 9275, the child data fields are now relevant and will be completed. When coding Sequence 9277, Transfusion PCI, the target value clarifies this data field is only addressed if the transfusion occurred between the start of the procedure and 72 hours after the procedure. In the given scenario, a transfusion was administered after the start, meeting the target value. However, the Notes section clarified to code No if the pre-procedure hemoglobin was less than or equal to 8 grams per deciliter. Because the transfusion did not occur during or after surgery, No is coded to Sequence 9278, Transfusion Surgery, within 72 hours. Because transfusions post-PCI are associated with an increased risk of adverse outcomes, including in-hospital stroke and mortality, Metric 25, Transfusion Post-PCI, provides insight into the percentage of PCI procedures where transfusions were administered, thus helping hospitals monitor potential overuse. In this particular scenario, the patient is not included in Metric 25 because their pre-procedure hemoglobin is 8 grams per deciliter, therefore excluding them from the denominator. Thank you for viewing the CAHPS PCI Registry Monthly Case Scenario for November 2020. For more information, visit www.cahps.com.

chronic kidney disease

anemia

emergency department

PCI

transfusions post-PCI