Welcome to the CAF PCI registry case scenario, where we will be reviewing sequence number 7850, patient-centered reason for delay. A patient presented to the emergency department with chest pain, where an ECG revealed ST elevations in the anterior leads. The patient was emergently transferred to the CAF lab, where diagnostic imaging revealed multi-vessel disease. The interventionalist consulted with the cardiothoracic surgeons and produced a plan of action. Within minutes, the patient underwent balloon angioplasty of the culprit lesion and then was transferred to the operating room for coronary artery bypass grafting. Our question is, does obtaining a cardiothoracic surgeon consult due to the patient's disease constitute capturing a delay in sequence number 7850, patient-centered reason for delay? Number one, no. Or number two, yes. Please take a few moments to review the documentation before making your final selection. And the answer is, number one, no. Sequence number 7850, patient-centered reason for delay in PCI, is indicating if there was a patient-centered reason for delay in performing the percutaneous coronary intervention. This is defined as an issue or condition understood and documented to originate with the patient. In other words, the patient was blocking their own path to PCI. Additionally, having multi-vessel disease is not a barrier towards receiving PCI. As well, obtaining a cardiothoracic consult is not at the discretion, nor is it an issue that stems with the patient. Therefore, the definition is not met. As a general overview, sequence number 7850, patient-centered reason for delay in PCI, is indicating if there was a patient-centered reason for delay in performing the percutaneous coronary intervention. This is defined as an issue or condition understood and documented to originate with the patient. It is not associated with the healthcare system, facility, staff, or processes, et cetera. To warrant coding yes, the patient-centered reason must be identified in the first 90 minutes after arrival at this facility, or in the first 90 minutes after an in-house diagnosis of STEMI, and be responsible for affecting the time to PCI. If the issue is documented in the medical record and the effect on timing self-evident, it can be coded. If the effect on timing or delay to PCI is unclear, then there must be a specific documentation by a physician, APN, PA that establishes the linkage between the patient issue condition and the timing delay in PCI. If there is a patient-centered delay, the registry has the most common reasons as difficult vascular access, where the anatomy is tortuous, obstructive, or otherwise prohibitive to a vascular access device. This would not be selected when the operator is unable to gain access due to inexperience or device selection, et cetera, causing a delay in PCI. Or difficulty crossing the culprit lesion, where the anatomy is tortuous, obstructive, or otherwise prohibitive to guide wire or device. This would not be selected when the operator is unable to cross the culprit lesion due to inexperience or device selection, et cetera, causing an obvious delay in PCI. Or if the patient experiences a cardiac arrest or the need for intubation, causing an obvious delay in PCI. Or if there are patient delays in providing consent, causing an obvious delay in PCI. Or if there is an emergent placement of LV support device, causing an obvious delay in PCI. It is important to educate that after years of capturing this data element in the registry, we have not had to modify or add any additional selections to the field, as the current list has proven to capture the most common patient-centered delays. However, we know the list may not be all-encompassing, so the election of other is available for those rare scenarios where the patient and their condition is obstructive to the timing of PCI and a selection is not available. High-level examples include scenarios where the patient condition is contradictory to engaging in PCI. Where the patient may need diagnostic studies to rule out detrimental bleeding contradictory to anticoagulants or antiplatelets, such as obtaining a CT scan of the brain to rule out a hemorrhage. As well, a patient's clinical status may require emergent invasive interventions to be performed prior to engaging in PCI, such as symptomatic complete heart block requiring the interventionalist to place a temporary pacemaker before intervening on their culprit disease. And while these are patient-centered conditions, it is important to address that they are not always evident of delay. In these instances, there must be specific documentation by a physician, APN, or PA that establishes the linkage between the patient issue condition and the timing delay in PCI. Thank you for viewing the cath PCI registry case scenario.

TAVR procedure

STEMI

PCI

valvular intervention

major adverse events

Percutaneous Coronary Intervention

Patient-Centered Delays

Multi-Vessel Disease

Healthcare Providers

Accurate Documentation