The EP Device Implant Registry Case Scenario for December 2021 will review sequence number 14719, ventricular fibrillation. A 49-year-old male presents to the emergency department via EMS due to a sudden collapse with subsequent urinary incontinence and a treatment shock delivered from his Zoll LifeVest. His past medical history includes a STEMI with PCI to the proximal LAD that occurred one month earlier, resulting in a depressed EF of 40%. He is being treated for dyslipidemia and hypertension. The cardiologist evaluates the patient's LifeVest alert event and documents treatment shock delivered for a V-fib arrest. Per the cardiology consult, plan for a single-chamber ICD for secondary prevention for later today or tomorrow morning. The abstractor captures this episode of care by coding initial generator implant with a single-chamber ICD for secondary prevention. LVEF assessed is coded yes. Most recent LVEF is coded October 5th, 2021, and most recent LVEF is coded as 40%. Cardiac arrest is coded yes. Most recent arrest date is coded October 3rd, 2021. V-fib arrest is coded yes. V-tach arrest and bradycardia arrest are both coded no. Syncope is coded no. Coronary artery disease is coded yes. Prior MI is coded as yes, and most recent MI date is coded October 3rd of 2021. Coronary angiography is coded yes. Performed after the most recent cardiac arrest is yes. Results of angiography is coded as significant disease. Revascularization performed is coded yes. And revascularization outcome is coded complete revascularization. Based on the documentation in the medical record, data abstraction, and metric evaluation, will this patient meet the qualification for device-based therapy guideline recommendation for metric 26, number one, no, or number two, yes? Please take a few moments to review the question and possible answers. Based on the documentation in the medical record, data abstraction, and the metric evaluation of the data, this patient did not meet the numerator of metric 26. Let's take a closer look and see why. In this scenario, the selection of yes to V-fib arrest alone will not pull the patient into the numerator for metric 26. The intent of sequence number 14719, ventricular fibrillation, is to capture only ventricular fibrillation events not due to a reversible cause. Patients who have a documented V-fib arrest are coded yes in sequence 4235 with the date in sequence 4225, regardless if the V-fib arrest was due to a reversible cause or not. Sequence 14719 is coded yes only if the V-fib was not due to a reversible cause. The abstractor makes the changes based on the coding advice received from the NCDR EP implant device registry team and resubmits their data through the DQR. On the Monday morning after the weekend aggregation data refresh, the patient now meets the numerator for metric 26 with a class one level of evidence, a device-based therapy guideline recommendation. Thank you for viewing the EP device implant registry case scenario for December of 2021.

EP Device Implant Registry

Case Scenario

STEMI with PCI

device-based therapy

metric 26