Welcome to the CAF PCI Registry June 2025 case scenario. This case scenario will discuss and review metric key 4934, PCI in-hospital risk-standardized rate of bleeding events, all patients. Our documentation is as follows, a 56-year-old male arrives to the facility by EMS with a diagnosis of STEMI and cardiogenic shock. He is taken immediately to the CAF lab after a brief triage in the emergency department where a dopamine drip was started at 10 mics per kilogram per minute. The diagnostic coronary angiogram reveals an 80% stenosis in the proximal LAD. The cardiologist places an impella and proceeds with emergent PCI. The patient's pre-procedure hemoglobin was 12.4, which was coded in sequence 6030. After successful PCI to the LAD, the patient is transferred to the ICU. There are no observed signs of bleeding, however, the next day the hemoglobin drops to 8.2, which is coded in sequence 8505. While there are still no signs of bleeding, the patient is transfused with two units of packed red blood cells. Our first question is, are there any intra- or post-procedure bleeding events coded in sequence 9002? Number one, no. Or number two, yes. Please take a moment to review before making your final determination. And the answer is no. There was no observed and documented bleed, therefore, no data definition of any bleeding event is met. Question number two, how is sequence 9275, packed red blood cell transfusion, and the child fields, number of units transfused, and transfusion PCI coded? Number one, no. Number two, yes. Two units, and no. Or number three, yes, two units, and yes. Please take a moment to review before making your final selection. The answer is number three, yes to red blood cell transfusion, two number of units transfused, and yes to transfusion PCI. The patient was transfused with two units of packed red blood cells the day after PCI, thereby meeting the target value of any occurrence between start of procedure and until next procedure or discharge. Then, because the patient was transfused within 72 hours of the PCI procedure, yes is coded in sequence 9277, transfusion PCI. How are sequences number 7420, ventricular support, and 7422, mechanical ventricular support coded? Number one, no. Or number two, yes, and yes. Please take a moment to review before making your final selection. And the answer is number two, yes to ventricular support, and yes to mechanical support. The documentation provides that Impella was inserted during the cath lab procedure, therefore the coding instructions and target value are met for both data elements, and yes is coded. Our next question is related to criteria in metric key 4934, PCI in-hospital risk standardized rate of bleeding events. At the patient level, does this patient have any exclusions? Number one, no. Or number two, yes. Please take a moment to review before making your selection. And the answer is number one, no. The patient had a PCI procedure during the episode of care. The patient did not die on the same day of procedure, and the patient did not undergo CABG during his episode of care. All eligibility is met at the patient level. At the procedural level, does this patient have any exclusions? Number one, no. Or number two, yes. Please take a moment to review before making your final selection. And the answer is number one, no. The patient had only one PCI procedure during his episode of care. Therefore, it was considered the index PCI. All eligibility is met at the procedure level. Our next question, per the metric key 4934, PCI in-hospital risk standardized rate of bleeding events, does this patient qualify to meet the definition of an observed bleed? Please take a moment to review before making your selection. And the answer is yes. As you can see, only one of the five outcomes needs to be met for the patient to be considered an observed bleed. The patient did not have a bleeding event within 72 hours, a hemorrhagic stroke, or tamponade. Therefore, outcomes number one, two, and three are not met. Although the patient did have a greater than four gram per deciliter drop in hemoglobin from pre-procedure to post-PCI, from 12.4 to 8.2. They did not have a pre-procedure hemoglobin of 16 or more, and a mechanical ventricular support device was used, as coded in sequence 7422. Therefore, outcome five is not met. However, the patient did receive a transfusion 72 hours post-PCI and had a pre-procedure hemoglobin of greater than eight. Therefore, this outcome is met. Remember, only one of the five outcomes needs to be met to be considered an observed bleed in Metra-Key 4934. This concludes the June case scenario reviewing Metra-Key 4394, PCI in-hospital risk-standardized rate of bleeding events.

NSTEMI

PCI

thrombectomy

myocardial infarction

coding guidelines

bleeding events

STEMI

cardiogenic shock

Impella