Welcome, and thank you for joining this learning activity titled CVASC Registry Education to Sequence Numbers. This is a learning activity with focused education on the sequence numbers in the ICD portion of the CVASC registry. After participation in this learning activity, the learner should be able to identify, discuss, and explore the sequence numbered elements in the ICD portion of the registry. This presentation includes many elements at once and is provided as baseline education. In addition to this education, the user can search individual portions of this presentation by accessing individual videos using the search functionality provided. We thank you for choosing the American College of Cardiology's CVASC registry, and we'd like to welcome you to the team. If you have any questions after watching these educational resources, please let us know via the Contact Us feature on your registry home page. Now, buckle in for some educational time as we navigate the sequences in the registry. Sequence 4150, Prior Left Ventricular Ejection Fraction Assessed, is indicating if a left ejection fraction percentage has been assessed in the last 12 months prior to the start of the procedure. This is coded for all device types. If a diagnostic test is not available in the medical record, then a stated LVEF measurement can be used if there is a date affiliated with it to confirm it was performed in the last 12 months. If a date is not affiliated with the LVEF measurement, it cannot be used for coding as it is not certain the target value would be met in those scenarios. Sequence 4155, Most Recent LVEF Date, is indicating the date the most recent left ventricular ejection fraction was assessed as documented by a physician or noted on diagnostic testing in the last 12 months prior to the start of the procedure. If only the year is known, then please code 0101 and insert that known year. If the specific year is unknown in the current record, the year may be estimated based on timeframes found in prior medical record documentation. For example, if the patient had Most Recent LVEF documented in a record from 2011, then the year 2011 can be utilized and coded as 01-01-2011. Sequence 4160, Most Recent LVEF Percent, is indicating the left ventricular ejection fraction cited by the implanting physician as the indication for the ICD in the last 12 months prior to the start of the procedure. In the absence of a physician-cited LVEF, indicate the most recent LVEF that was assessed via any means, so LV gram, echo, MRI, CT, or nuclear testing. This is going to be entered as a percentage in the range of 1 to 99. If a percentage range is reported, you're going to code the lowest number of that range. So if the provider documents that the Most Recent LVEF is 50 to 55 percent, you're going to code 50 as that's the lowest. An LVEF measurement that is reported as less than or greater than will be coded to the nearest whole number. So if there is documentation that says the LVEF is less than 40, then 39 would be coded and vice versa. If it's greater than 40, then 41 percent would be coded. When a numeric value is not associated with the ejection fraction, then the clinician must be consulted and the numeric value documented in the medical record in order to code. Sequence 6030, pre-procedure hemoglobin, is capturing the last or most recent lab or point of care hemoglobin value 30 days prior to the start of the current procedure. This element can be captured up to the hundredth place or two places after the decimal. However, if you have a hemoglobin that reports to the thousandth place or three places after the decimal, then simply truncate or drop that value. As an example, if the level is reported as 10.328 grams per deciliter, then you would code 10.32 and simply drop the 8. Lastly, if a hemoglobin level was not drawn to meet the target value, select sequence 6031 hemoglobin not drawn. Sequence 6025, pre-procedure blood urea nitrogen, or BUN, is capturing the last or most recent lab or point of care value between 30 days prior to the start of the procedure. This element is captured as a whole number. However, if you have a value that reports to a decimal, then please truncate or simply drop the decimal values. As an example, if the level is reported as 13.32 milligrams per deciliter, then code 13 and drop the 0.32. Lastly, if a blood urea nitrogen level was not drawn to meet the target value, then you would select sequence 6026 blood urea nitrogen not drawn. Sequence 6035 pre-procedure sodium is capturing the last or most recent lab or point of care value between 30 days prior to the start of the current procedure. This element is captured as a whole number. However, if you have a value that reports to a decimal value, simply truncate or drop the decimal values. As an example, if the level is reported as 125.32 milliequivalents per liter, then you would code 125 and drop the 0.32. Lastly, if a sodium level was not drawn to meet the target value, then you would select sequence 6036 sodium not drawn. Sequence 15694 procedure room entry date and time is indicating the date and time the patient entered the procedure room. Sequence 7000 procedure start time is indicating the date and time the procedure started to the nearest minute. The start time of the procedure is the time that the skin incision vascular access or its equivalent was made to start the procedure. Sequence 7005 procedure end date and time is indicating the ending date and time at which the operator breaks scrub at the end of the procedure. If more than one operator is involved in the case, then use the date and time the last operator breaks scrub for the last time. When this information is not documented, please code the time the patient left the procedure room. However, the expectation is that sites will work with their colleagues to obtain scrub break time as this will more accurately reflect throughput at the procedural level and assure consistency in data capture across the registry. Sequence 15695 procedure room exit date and time is indicating the date and time the patient exits or leaves the procedure room. Sequence 15607 procedure type is indicating all procedures that were performed between start of procedure and end of procedure. The ASC registry was initially built to handle one pathway per episode of care. Thus, while this is a select all field, the only selections that can be selected together during one lab visit are diagnostic coronary angiography and percutaneous coronary intervention. All others are mutually exclusive of one another. When the passage of a catheter into the aortic root or other great vessels for the purpose of angiography of the native coronary arteries or bypass grafts supplying native coronary arteries occurs during the lab visit, diagnostic coronary angiography is the appropriate selection. When there is placement of an angioplasty guide wire, balloon, or other device such as a stent, atherectomy, brachytherapy, or thrombectomy catheter into a native coronary artery or coronary artery bypass graft for the purpose of mechanical coronary revascularization during the lab visit, percutaneous coronary intervention is the appropriate selection. To go back and emphasize, as soon as an angioplasty guide wire is inserted into the body, PCI performed or attempted is the appropriate selection. When the patient already has a device and is receiving a generator that is an upgrade or a change from one that was previously implanted, generator change is the appropriate selection. To provide some context to the definition, we have provided some procedural examples. When the patient already has a non-novel permanent pacemaker and is undergoing implantation of a novel pacemaker, which includes a CRTP, a leadless pacemaker, or a HIS left bundle pacemaker, then generator change would be selected. When the patient already has an ICD-CRTD and is undergoing implantation of another ICD-CRTD, then generator change would be selective. When the patient already has a novel permanent pacemaker and is undergoing implantation of another novel permanent pacemaker, which include CRTP, leadless pacemaker, or HIS left bundle pacemaker, then generator change would be selected. To review inclusion criteria, the ASC Registry is currently accepting data for novel pacemaker procedures. Novel pacemakers include the CRTP, the leadless pacemaker, or the HIS left bundle pacemaker. When the patient already has a device and is having the generator removed without re-implant of another generator during the current procedure, generator explant is the appropriate selection. To provide some context to the definition, we have provided some procedural examples. When the patient has a novel permanent pacemaker, which includes the CRTP, the leadless pacemaker, or the HIS left bundle pacemaker, and is undergoing implantation of a non-novel pacemaker, then generator explant would be selected. When the patient has an ICD-CRTD and is undergoing implantation of a non-novel permanent pacemaker, then generator explant would be selected. When the patient has a novel permanent pacemaker, ICD, or CRTD, and is undergoing explantation with no re-implantation of a device, generator explant would be selected. When the patient is receiving a permanent pacemaker or ICD-CRTD device for the first time during the current procedure, initial generator implant is the appropriate selection. To provide some context to the definition, we have provided some procedural examples. When the patient is undergoing implantation of their first novel permanent pacemaker, which includes the CRTP, the leadless pacemaker, or the HIS left bundle pacemaker, initial generator implant would be selected. When the patient is undergoing implantation of their first ICD-CRTD, then initial generator implant would be selected. When the patient has an ICD or CRTD and is undergoing implantation of a novel permanent pacemaker then initial generator implant would be selected. When the patient has any prior permanent pacemaker and is undergoing implantation of their first ICD CRTD initial generator implant would be selected. Shared decision-making is a patient-centered conversation where the clinician and patient together map out the best course of action based on patient preferences as it relates to the clinical evidence. It is a process in which both the patient and the physician or non-physician practitioners such as a PA, NP or clinical nurse specialist contribute to the medical decision making process and agree on treatment decisions. This has shown to increase the knowledge and satisfaction regarding care, define clearer goals for treatment and to align health decisions with patient values. When there is clear documentation in the medical record that a shared decision-making discussion occurred then yes is coded for sequence 14732 shared decision-making. Please work with your providers to determine a process of documentation that will allow for the coding of shared decision-making as this cannot be left to the interpretation of the abstractor or the ASC registry. A statement by the provider that a shared decision-making encounter occurred is sufficient for coding. The use of a shared decision-making tool would allow for the coding of this data element as well and additionally using a smart phrase within the facility's EHR system regarding shared decision-making is sufficient to code shared decision- making as yes in addition to easing the burden of documentation and data abstraction. It is important to note that shared decision-making and informed consent are not the same. It may be helpful to watch the informative video available by going to CardioSmart.org and selecting the video hyperlink. Sequence 7020 pre-market clinical trial is indicating if the ICD or permanent pacemaker procedure is part of a clinical trial excluding post-market surveillance trials. Sequence 7015 ICD indication is captured on initial ICD CRTD generator implants and generator changes. Determination of primary versus secondary prevention is the responsibility of the implanting physician and must be documented in the current medical record. Regarding secondary prevention, if the abstractor is unable to clarify with the clinician but they know the patient has survived one or more cardiac arrests or sustained ventricular tachycardia not due to reversible cause, then the abstractor can code secondary prevention. For instance, let's say the patient has had an episode of sustained ventricular tachycardia or V-fib arrest that has clear documentation that the event was not due to a reversible cause. If this is not clearly documented in the medical record, we would ask that you clarify with the implanting physician and have the documentation included in the medical record. Additionally, when talking about primary prevention, when there's documentation that the patient meets the SCD HEFT MATIT 1 or MATIT 2 criteria for ICD implant, this is sufficient documentation for the capture of primary prevention because these were primary prevention trials. Those patients receiving an ICD on current procedure will have a primary tachycardia indication or reason for getting the defibrillator, but if they receive an ICD, we also want to know if they require permanent pacemaking due to a bradycardic indication, which would be a secondary reason for an ICD device. Sick sinus syndrome, symptomatic bradycardia, symptomatic sinus node dysfunction, sick sinus syndrome, symptomatic tachybrady syndrome, complete heart block, mobitz type 2, 2 to 1 AV block, and or chronotropic incompetence are bradycardic indications that would support coding yes for this data element. Sequence 14731, reason pacing indicated, is indicating the reason for pacing when there is a bradycardic indication present. This is a multiple select field so capture all that apply. We have provided some common documentation examples that we have seen that would be used to support coding certain reasons for pacing indicated selections. As an example, anticipated requirement of 40% or more RV pacing would be coded when the plan is to perform an AV node ablation prior to or after a CRT implantation, or the patient has intrinsic complete heart block, or when there is a statement by the clinician indicating the CRT is being implanted due to worsening heart failure despite optimal guideline directed maximum therapy. AV node ablation would be coded if there's some documentation when the plan is to perform an AV node ablation prior to or after their CRT implantation. Chronotropic incompetence would be coded when pharmacological rate control is documented by the clinician. Complete heart block intrinsic would be coded when the patient has an intrinsic complete heart block, and heart failure unresponsive to guideline directed maximum therapy would be selected when there is a statement by the clinician indicating the CRT is being implanted due to worsening heart failure despite optimal guideline directed maximum therapy. Sequence 7620 device implanted is indicating if a device was implanted during the current procedure. Sequence 7625 final device type is indicating the device type that was implanted at the completion of the procedure. Sequence 7630 coronary sinus left ventricular CS or LV lead is indicating if the coronary sinus left ventricular lead was implanted unsuccessfully, previously implanted, successfully implanted, or not attempted during the current procedure. Sequence 14739 his left bundle lead is indicating if it was implanted unsuccessfully, previously implanted, successfully implanted, or not attempted during the current procedure. Sequence 607635 implant device ID is indicating the assigned identification number associated with the implanted device. The devices that are collected in your application are controlled by the device master file which is managed by the NCDR. When a device is not listed, select the notify the NCDR of new or missing defibrillators or pacemaker devices hyperlink located under the technology downloads within the resources menu to submit a request. Complete the form and click the notify button and the NCDR will review the device information and add the device to the download files as necessary. When additional devices are added for capture, the NCDR will update the master file. For ACC data collection tool users, these updates occur automatically. For third-party vendor tool users, the list is made available for downloading and uploading into the application from the ASC registry website under resources with the label technology downloads. Sequence 7640 implant device serial number is indicating the serial number of the implanted device. If this information is not available in the medical record, it can be retrieved by calling the manufacturer or contacting your device representative. Sequence 7650 reasons for generator replacement is indicating the reason or reasons for the generator replacement. Please select all that apply. Sequence 7660 device explanted is indicating if the previous device was explanted, not explanted, or previously explanted. Sequence 7675 explant device ID is indicating the assigned identification number associated with the explanted device. The devices that are collected in your application are controlled by the device master file which is managed by the NCDR. When a device is not listed, select the notify the NCDR of new or missing defibrillators or pacemaker devices hyperlink located under technology downloads within the resources menu to submit a request. Complete the form and click the notify button and the NCDR will review the device information and add the device to the download files as necessary. When additional devices are added for capture, the NCDR will update the master file. For the ACC data collection tool users, these updates occur automatically. For third-party vendor tool users, the list is made available for downloading and uploading into the application from the ASC registry website under resources with the label technology downloads. Sequence 7680 explant device serial number is indicating the serial number of the explanted device. If this information is not available in the medical record, it can be retrieved by calling the manufacturer or contacting your device representative. Sequence 7665 prior generator explant is indicating the date the device was explanted. If only the year of the device explanted is known, please code 0101 and insert that known year. If the specific year is unknown in the current record, the year may be estimated based on timeframes found in the prior medical record documentation. For example, if the patient had a device explanted documented in a record from 2011, then the year 2011 can be utilized and would be coded as 01-01-2011. Sequence 7710 lead counter functions as a counter allowing sites to add leads or remove erroneous leads. This is a software assigned lead counter and should start at one and be incremented by one for each new or existing lead documented. Sequence 7715 lead identification is indicating if the lead is a new or existing lead. All new leads placed or existing leads extracted, abandoned, or reused should be identified in the lead section. Sequence 7740 existing lead and plant date is indicating the date the existing lead was initially implanted. If only the year of the implant is known, please code 0101 and insert that known year. If the specific year is unknown in the current record, you can estimate it based on documentation found in prior documentation. As an example, if the patient had a lead implant documented in a record from 2011, the year 2011 can be utilized and would be coded as 01-01-2011. Sequence 7745 existing lead status is indicating the status of the existing lead. If the existing lead was extracted in whole or part and removed, select extracted. If the existing lead was left in situ, abandoned, and not reused, select abandoned. If the existing lead was left and reused, select reused. Sequence 7720 lead identification number is indicating the assigned identification number for new or existing leads placed, reused, extracted, or abandoned during the BPDI procedure. The leads devices that are collected in your application are controlled by the lead device master file, which is managed by the NCDR. When a lead is not listed, select the notify the NCDR of new or missing defibrillators or pacemaker devices hyperlink located under technology downloads within the resources menu to submit a request. Complete the form and click the notify button and the NCDR will review the lead information and add the device to the download files as necessary. When additional leads are added for capture, the NCDR will update the master file. For ACC data collection tool users, these updates occur automatically. For third-party vendor tool users, the list is made available for downloading and uploading into the application from the ASC registry website under resources with the label technology downloads. Sequence 7725 lead serial number is indicating the manufacturer's serial number of the lead. If this information is not available in the record medical record, it can be retrieved by calling the manufacturer or contacting your device representative. Sequence 7735 lead location is indicating the location of the lead being assessed in the lead counter. These are the selections for lead location. Each definition is available in the data dictionary and we encourage you to read through them and become familiar with the terminology. Please take a few moments if needed to read through this slide.

CVASC Registry Education

sequence numbers

ICD portion

left ventricular ejection fraction assessments

coding rules

accurate documentation