The EP Device Implant Registry case scenario for November 2021 will review discharge medications, specifically angiotensin II receptor blocker neprilysin inhibitor. An 89-year-old African-American male is admitted for a CRTD. He has a longstanding history of hypertension, hyperlipidemia, two myocardial infarctions, the first in 2019, and most recently in July 2021, resulting in ischemic cardiomyopathy. His most recent evaluation of his symptomatic cardiomyopathy revealed a New York Heart Association class of three and an EF of 30% despite guideline-directed medical therapy. At discharge, the clinician documents, patient is unable to tolerate ACE and ARB. He is to continue the home medications at their current dose consisting of carvetolol, aspirin, furosemide, simvastatin, and clopidogrel. Our question is, how is angiotensin receptor neprilysin inhibitor coded in sequence 10205, discharge medications prescribed? Is it number one, yes, prescribed? Number two, not prescribed, no reason? Number three, not prescribed, medical reason? Or number four, not prescribed, patient reason? Please take a few moments to review the documentation and the question. The answer is number three, not prescribed, medical reason. In this scenario, the clinician documents at discharge, patient is unable to tolerate ACE and ARB. He is to continue the home medications at their current dose consisting of carvetolol, aspirin, furosemide, simvastatin, and clopidogrel. We know from this documentation that ACE inhibitor and ARB are both abstracted as no medical reason. However, what is the rationale for coding no medical reason for angiotensin receptor neprilysin inhibitor with the documentation provided? Let's review why. Intresto is a fixed-dose combination medication that contains an ARB and neprilysin inhibitor secubitril. Documentation of a contraindication to prescribing an ARB is sufficient to code angiotensin-2 receptor blocker neprilysin inhibitor as no medical reason. This coding advice is supported in FAQ 25337. With clear documentation in the medical record of a contraindication or medical reason for not prescribing angiotensin receptor blocker at discharge, how is angiotensin receptor neprilysin inhibitor coded? The answer, no medical reason, is coded for sequence 10.205, discharge medications prescribed. Angiotensin receptor neprilysin inhibitor is a combination drug containing an angiotensin receptor blocker. With a medical reason or medical concern for not prescribing an ARB, please code both ARB and ARNI as no medical reason. To further clarify coding, ACE inhibitor is coded no, no reason when the documentation only support a contraindication to an ARB. ACE inhibitors are different medication class and do not have an impact on how ARNI is coded. Documentation in the medical record of a contraindication to an ACE inhibitor supports the coding for ACE inhibitors only. A medical reason or concern for specifically not prescribing an ARNI cannot be applied to an ARB nor an ACE inhibitor. This documentation would only support the coding of no medical reason for ARNI. No, no reason is coded for ARB and ACE inhibitor without documentation to support a reason why they were not prescribed. This is supported in FAQ 25369. Question, when there is a medical reason for not prescribing angiotensin 2 receptor blocker naprilicin inhibitor, can no medical reason be coded for the medication class of angiotensin 2 receptor blocker in addition to ARNI? The answer, no. Angiotensin 2 receptor blocker naprilicin inhibitor is a combination drug and a medical reason for not prescribing an ARNI cannot be ascribed to an ARB. This documentation would only support the coding of no medical reason in sequence 10-205. Discharge medication prescribed for ARNI. No, no reason is coded in sequence 10-205 discharge medication prescribed for ARB as there is no documentation to support a reason why it was not prescribed. Thank you for viewing the EP device implant registry case scenario for November 2021, which highlights discharge medications, specifically angiotensin receptor naprilicin inhibitor.

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