Hello, everyone, and welcome back to our bimonthly case scenario for December 2024. For this case scenario, we will look into coding a complication on a base procedure, left atrial appendage occlusion device insertion. In this scenario, an 83-year-old female presents for an LAAO procedure with a three-year history of non-valvular atrial fibrillation, refractory to chemical and electrical cardioversion, hypertension, and diabetes. The workup for the procedure was unremarkable. The LAAO procedure was successful, and the patient was moved to recovery. In the recovery room, the patient became hypotensive with a PEA, pulseless electrical activity arrest. A stat echo at bedside showed a large pericardial effusion and the LAAO device intact. A pericardiocentesis was performed. The patient remained hypotensive after pericardiocentesis, and a repeat echocardiogram showed the effusion had returned. At that point, the patient went to the OR for a pericardial window, which was successful. For the given scenario, what intra- or post-procedure events occurred would be captured in sequence 12153-9002? Would it be 1, pericardial effusion with tamponade requiring percutaneous drainage? Number 2, cardiac arrest? Number 3, other hemorrhage, non-intracranial? Number 4, both 1 and 2? Or number 5, all of the above? Please take a moment to review the documentation and the question before making your final answer. And the answer is number 4. Both pericardial effusion with tamponade requiring percutaneous drainage and cardiac arrest are captured in sequence 12153-9002. Documentation in the medical record accounts for the coding of the pericardial effusion with tamponade that required a pericardiocentesis and for the PEA cardiac arrest. Other hemorrhage non-intracranial would not be captured for the bleeding into the pericardial space as the bleeding is already accounted for by coding the pericardial effusion with tamponade requiring percutaneous drainage. Since the pericardial effusion events that required an intervention were added to the list of bleeding events, other hemorrhage does not have to be coded. Please remember that the pericardiocentesis and pericardial window are bleeding events and will require the in-hospital adjudication section of the data collection tool for bleeding to be completed. Based on the documentation, the pericardial effusion returned after the pericardiocentesis requiring a pericardial window. Our second question, should pericardial effusion requiring open cardiac surgery also be coded as an event? Number one, yes, or number two, no. And the answer is number one, yes. All events meeting the definition or criteria will be coded. In this case, both pericardial effusion with tamponade requiring percutaneous drainage and pericardial effusion requiring open cardiac surgery took place and therefore should be captured. In conclusion, based on the documentation shared, the events to be coded are cardiac arrest and both pericardial effusion with tamponade requiring percutaneous drainage and pericardial effusion requiring open cardiac surgery. Bonus question, so now that we have accounted for the coding for the cardiac arrest and the pericardial effusion and tamponade, where would the cardiac surgery for the pericardial window be coded? Number one, sequence 12153, 9002, vascular complications, under bleeding, or sequence number 14835, surgery in the discharge section of the data collection tool? And the answer is number two. In the discharge section of the data collection tool, sequence 14835, surgery will be coded as yes for the pericardial window. We thank you for taking the time to review our latest case scenario and we will see you for the next case scenario in February.

shared decision-making

LAAO registry

coding guidelines

evidence-based tools

patient consent

left atrial appendage occlusion

pericardial effusion

pericardiocentesis

pericardial window surgery

cardiac arrest