Welcome to the CAF PCI Registry Case Scenario, where we will be reviewing Sequence No. 7800, PCI Status. In this scenario, a 78-year-old male presents to the emergency department with a previous medical history of diabetes mellitus, hypertension, and CHF. The patient is awake, alert, and oriented, with a heart rate of 95, blood pressure 90 over 62, and is complaining of chest pain 8 out of 10, and is tachypneic. STEMI was found on the first ECG, and the cath lab team was activated. The patient was started on a heparin drip and given Berlinta 180 mg. Prior to arriving in the cath lab, the patient was noted to be pale and diaphoretic, confused, and complaints of increasing chest pain and the blood pressure decreased to 69 over 42. A dobutamine drip was started, and the patient was taken to the cath lab. En route to the cath lab, the patient became unconscious and pulseless. CPR for 15 minutes was performed, with return of spontaneous circulation. During the procedure, an impella was inserted, and PCI to the mid-LED was performed. Based on the documentation provided, how is Sequence No. 7800 PCI Status coded? Is it No. 1, elective, No. 2, urgent, No. 3, emergent, or No. 4, salvage? Please take a few moments to review the documentation before making your final selection. The answer is salvage. Here you will see the data definition for Sequence 7800 captures the status of the PCI. The status is determined at the time the operator decides to perform a PCI. But it has come to the registry's understanding that sites have found it challenging to apply the target value for Sequence 7800. As the target value for Sequence 7800 captures the highest value at the start of the procedure, the decision for PCI is to occur prior to taking the patient to the cath lab, as outlined by the target value, the highest value at the start of the current procedure. The start of the current procedure is determined by what is coded in Sequence 7000, procedure's start date and time. The definition for salvage in Sequence 7800 requires the patient to be in cardiogenic shock. Please make the following note in your data dictionaries. In an effort to clearly define when salvage is captured, the procedure is a last resort. The intent is to capture a patient who is in cardiogenic shock when the procedure begins. And this aligns with Sequence 7000, procedure's start date and time. In the previous scenario, prior to the start of the procedure, stemming was identified, the patient developed increasing chest pain with a significant drop in blood pressure, and a dobutamine drip was started, indicating the patient was in cardiogenic shock prior to the PCI. To A, within the last 10 minutes prior to the start of the case or during the diagnostic evaluation, the patient receives chest compressions for at least 60 seconds. In this scenario, documentation included while en route to the cath lab that the patient was pulseless and CPR was performed for 15 minutes with return of spontaneous circulation. Or to B, the patient was placed on unanticipated extracorporeal circulatory support prior to the intervention. In this scenario, the impella was inserted after the start of the procedure and therefore does not meet to B. But the patient did present to the cath lab in cardiogenic shock, meeting 1. Additionally, within the last 10 minutes prior to the start of the case, the patient had also received chest compressions for at least 60 seconds, therefore meeting 2A. Thus, the definition for salvage is met. Let's review some of the key points that help with coding PCI status. The decision for PCI in sequence 7800 occurs prior to taking the patient to the cath lab. The target value as the highest value at the start of the current procedure aligns with sequence 7000, procedure start date and time. Performing salvage PCI is not an intra-procedure decision. It is the driving force to performing the PCI. Prior to the start of intervention, the patient is placed on unanticipated extracorporeal support, meaning the extracorporeal support was unanticipated, unplanned, or unexpected. Cardiogenic shock or refractory cardiogenic shock that is ongoing at the start of the procedure and subsequently captured in sequence 7415, cardiovascular instability type, may help contribute toward coding salvage for sequence 7800, provided that the full definition is met. Thank you for viewing the cath PCI registry case scenario for sequence number 7800 PCI status.

PCI registry

hypertension

stent placement

ischemia

angiography

STEMI

cardiogenic shock

PCI salvage

Cath PCI registry

emergency procedure

PCI

Impella

salvage