This is the CAF PCI Registry November 2021 case scenario where we will discuss the coronary anatomy section, specifically sequence number 7505, native vessel with stenosis greater than or equal to 50%, sequence 7507, vessel segment, and sequence 7508, native stenosis. Our scenario goes as follows. A 68-year-old male with a history of hypertension, CAD, and a AAA repair has recently undergone some pre-procedure testing, including a coronary calcium score, which indicated calcium deposits in the patient's left circumflex and left main arteries. The patient now presents for an elective diagnostic angiogram and possible PCI. The patient has a known occluded mid-RCA that receives collateralization from the left circumflex and is therefore not assessed during the procedure. Angiogram findings show a 30% distal left main stenosis, an osteoproximal circumflex 40% stenosis, and a confirmed LVEF of 35%. Our first question, how is sequence number 7505, native vessel with stenosis greater than or equal to 50% coded based on the information provided? Please take a moment to review the documentation and question before providing your answer. The answer is number two, yes. The qualitative quantitative crosswalk supports the documentation of occluded supports capturing a 100% stenosis. Per the notes section of the coding instructions, it is acceptable to use prior cath lab visit information as long as there have been no changes in coronary anatomy. Lastly, there is no expectation that a known occluded vessel would be reassessed during a subsequent coronary angiogram. We return to our patient with a known occluded RCA and distal left main and osteoproximal circumflex disease with an update. The decision is made to perform a high risk PCI with impella support. During the PCI, plaque embolizes and the proximal circumflex is briefly occluded. The operator successfully dilates the proximal occluded segment with a balloon and restores vessel patency. A drug eluting stent is deployed. Our next question is, how are sequence number 7507 and 7508 coded for the osteoproximal circumflex segment? Is it number one, 7507 leave blank and 7508 leave blank? Number two, sequence 7507 code proximal circumflex and 7508 40%? Or number three, code 7507 proximal circumflex and sequence 7508 100%? Please take a moment to review the case details before considering your selection. And the answer is number three, proximal circumflex with a stenosis of 100%. The target value for sequence 7507 and 7508 is the last value between six months prior to the current procedure and current procedure. The current procedure is understood to encompass both the diagnostic and PCI portions of the procedure and is reflective of all events that transpired during the cath lab visit. As the proximal circumflex stenosis worsened during the procedure from a 40% stenosis during the diagnostic portion to being 100% occluded during the PCI, this supports capturing 100% in sequence 7508. Per FAQ number 24990, it may be necessary to code a different value than what was originally identified during the diagnostic portion of the procedure, such as instances where a stenosis worsens during PCI, as in the situation of a plaque shift. Thank you for viewing the Cath PCI Registry Monthly Case Scenario for November 2021.

CAF PCI Registry

case scenario

hypertension

CAD

AAA repair