Welcome to the STS-ACC TVT Registry Case Scenario, where we will untangle some tricuspid data elements involving the Society of Thoracic Surgeons Isolated Tricuspid Valve Surgery Risk Calculator. A site is expanding their transcatheter valve program and taking on replacing and repairing the tricuspid valve. While reviewing a tricuspid repair case, the abstractor notices the physician scanned their pre-procedure Society of Thoracic Surgeons Risk Calculator results into the medical record that assesses the patient's risk of operative mortality. Here they observe the patient's risk estimate of operative mortality at 39%. Our question is, will the risk calculator for isolated tricuspid valve surgery and its risk estimate of operative mortality be coded in sequence 13698, Society of Thoracic Surgeons Risk Score Type, and sequence 14271, Society of Thoracic Surgeons Risk Score Measurement? Number one, no. Or number two, yes. Please take a few moments to review the documentation before making your final determination. And the answer is no. Per the Data Dictionary, sequence number 13698, Society of Thoracic Surgeons Risk Score Type informs the abstractor that currently there is no risk score available for tricuspid procedures. As well, isolated aortic valve replacement, isolated mitral valve replacement, and mitral valve repair STS scores cannot be used for tricuspid procedures as they are not interchangeable. Therefore, this data element would be left blank. Coding in this manner will not allow sequence 14271, Society of Thoracic Surgeons Risk Score Measurement, to populate. Let's explain the reasoning for not capturing a risk score for tricuspid procedures using a visual. You can see here that version 3 of the TVT registry launched in 2021. At that time, when the Data Dictionary was finalized, there were no FDA-approved transcatheter tricuspid devices, only devices being used off-label in this space. But on February 1st of 2024, nearly three years later, the first FDA transcatheter tricuspid device was approved, which prompted the need for an isolated tricuspid valve surgery risk calculator, as the number of approved devices is expected to grow. However, as the new risk score calculator launched after version 3 went live, any updates to sequence numbers 136098 and 14271 will have to wait for a version upgrade. If your facility is planning on or already are performing transcatheter tricuspid procedures, it would be beneficial to become familiar with the isolated tricuspid valve surgery risk calculator, as it is not included in the ACSD operative risk calculator used for the aortic and mitral valves. Please watch this short video demonstrating navigation to the isolated tricuspid valve surgery risk calculator. Thank you for watching. Let's expand the scenario and ask another question. Can the patient's risk estimate of operative mortality, in this case 39%, be used to code sequence number 13-499, heart team reason for procedure? Number one, no. Number two, yes, if the heart team did not document a risk category. Or number three, yes, if the heart team did document a risk category. The risk score overrides it. Please take a few moments to review the documentation before making your final selection. And the answer is, number two, yes, if the heart team did not document a risk category of low, intermediate, high, or extreme, then the risk score can be used. Per the notes section of sequence number 13-499, it informs the abstractor that if the heart team did not document a risk category to consider patients based on the risk model developed by the Society of Thoracic Surgeons as noted below, low risk is considered less than 3%, intermediate risk is considered 3 to 7%, high risk is considered greater than or equal to 8%, and extreme risk includes technically inoperable, comorbid, and debilitated patients. Extreme does not have an STS risk score determination and would rely on documentation in the medical record that indicates the patient is technically inoperable, comorbid, and debilitated. So to clarify, if after history and physical assessment, shared decision making, reviewing risks and benefits, et cetera, the heart team indicates in the medical record the reason for the transcatheter procedure is due to the patient being low risk, then that is what an abstractor will code regardless of risk score results. While the focus of this case scenario is for tricuspid procedures, the same coding concept for sequence number 13.499 applies to all TVT procedures. Thank you for viewing the TVT registry case scenario.

transcatheter aortic valve replacement

femoral artery tear

emergency transfusion

bleeding metrics

major bleeding

tricuspid valve procedures

STS-ACC TVT Registry

risk scores

coding practices

risk calculator