Welcome to the December 2021 case scenario for the CAHPS PCI Registry, where we will discuss sequence number 7820, PCI for multivessal disease, and sequence number 7821, multivessal procedure type. The documentation is as follows. A 63-year-old female with a history of diabetes, hypertension, chronic renal insufficiency, and cardiomyopathy presents for an elective diagnostic coronary angiogram after undergoing a positive high-risk stress test. She has a pre-procedure creatinine value of 2.4. The angiogram results show a 90% proximal LAD stenosis, a calcified 80% lesion in her distal RCA, and mild diffuse disease throughout her circumflex artery. The patient is admitted with orders for hydration protocol to rest her kidneys. The interventionalist documents stage PCI to proximal LAD and distal RCA tomorrow. And PCI is, in fact, performed the following day. Our first question, how is sequence number 7820, PCI for multivessal disease, coded when the patient returns for their PCI procedure? Number one, no. Or number two, yes. Please take a moment to review the documentation and the question before considering your response. And the answer is number two, yes. The patient has CAD as evidenced by their 90% proximal LAD and 80% distal RCA stenosis. And therefore, the definition of multivessal disease greater than or equal to 70% stenosis and greater than or equal to two coronary vessels is met. Our follow-up question is, how is sequence number 7821, multivessal procedure type coded? Is it number one, initial PCI? Or number two, staged PCI? And the answer is number one, initial PCI, as this was the initial first PCI for the cath lab indication. While a staged PCI was documented in the provider's plan, the definition is not met. For purposes of the cath PCI registry, to meet the definition of staged, the PCI must be a subsequent planned PCI procedure after an initial PCI procedure. We return to our patient who underwent PCI for disease in their proximal LAD and distal RCA with the following update. The proximal LAD was treated with a drug-eluting stent, which results in 0% post-PCI stenosis and TIMIFLO of three. The distal RCA is wired, however, the interventionalist is unsuccessful in advancing a stent across the lesion. Out of concern for the patient's elevated creatinine, the decision is made to end the procedure, continue hydration protocol, and then bring the patient back the following day. Per documentation, PCI to proximal LAD was successful, but calcified distal RCA unable to be treated and planned for PCI to RCA again tomorrow, this time utilizing the shockwave intravascular lithotripsy device. Our next question is, how is sequence number 7820, PCI for multivessel disease coded for the second PCI during this episode of care? Number one, no, or number two, yes. Please take a moment to review the documentation and question before considering your response. And the answer is number one, no. The rationale being that this procedure is being performed because of a failed prior PCI of the 80% distal RCA lesion. None of the directives for coding yes apply to this patient scenario, and therefore no is coded. To clarify, those directives would have one code yes if this were the initial PCI for the cath lab indication, and the patient had obstructive disease in greater than or equal to two coronary vessels. And this is not met. Additionally, one would code yes if this were a subsequent planned stage PCI procedure of a vessel not treated during the initial procedure. And this criteria has not been met either. Let's take a moment to review the definition of staged PCI and what is required to support coding. Firstly, it must be a subsequent planned PCI procedure after an initial PCI for multivessel disease to support that it is staged. The second PCI performed must treat a vessel not attempted or treated during the initial procedure. The second PCI must occur within 90 days of the initial PCI procedure. And lastly, the patient must be stable, and that is they are not experiencing symptoms of recurrent or persistent ischemia, symptoms of heart failure, or electrical instability. Thank you for viewing the CAF PCI Registry Monthly Case Scenario for December of 2021.

CAHPS PCI Registry

diagnostic coronary angiogram

procedural coronary intervention (PCI)

multivessel disease

staged PCI