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 PCI portion of the CVASC registry. After participation in this learning activity, the learner should be able to identify, discuss, and explore the sequence number elements in the PCI 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 would 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 homepage. Now buckle in for some educational time as we navigate the sequences in the registry. Sequence 10116, Cardiac Rehab Referral, is indicating if a cardiac rehab referral was provided on discharge. The program may include a traditional cardiac rehab program based on face-to-face interactions and training sessions, or may include other options such as home-based approaches. Cardiac rehab services have been shown to help reduce morbidity and mortality in persons who have experienced a recent coronary event, but these services are used in less than 30% of eligible patients. A key component to outpatient cardiac rehab program utilization is the appropriate and timely referral of patients, and generally the most important time for this referral to take place is while the patient is still hospitalized for a qualifying event or diagnosis. Yes would be coded when there is documented communication between the healthcare provider and the patient to recommend an outpatient cardiac rehab program, and either an official referral order was sent to the rehab program, all this information required for enrollment should be transmitted to the program and maintain HIPAA compliancy, or if there is documentation of patient refusal to justify why the information was not sent to the cardiac rehab program. So basically performance would be met and yes would be selected if steps 1 and either 2A or 2B are met. When neither criteria to select yes are evidence to have occurred, and there is no documented medical, patient, or healthcare system reason why such a referral was not made on discharge to satisfy the target value, no reason not documented would be coded. Additionally, reasons cannot be assumed nor correlated. Reasons must be explicitly documented. When a patient has been deemed by a medical professional to have a medically unstable life-threatening condition or has other cognitive or physical impairments that preclude cardiac rehab participation on discharge, no medical reason would be documented. When a patient has been discharged to a nursing care facility or a long-term care facility or the patient lacks medical coverage for cardiac rehab to satisfy the target value, no healthcare system reason would be coded. Keep in mind that reasons cannot be assumed nor correlated. In other words, to code no healthcare system reason documented, there must be explicit documentation making that connection. As an example, a cardiac rehab referral not provided due to a patient being discharged to a skilled nursing facility on discharge would support coding this. When the patient has no traditional cardiac rehab program available within a 60-minute travel time from their home or the patient does not have access to an alternative model of cardiac rehab delivery that meets all criteria, no patient-oriented reason would be coded. Keep in mind that reasons cannot be assumed nor correlated. In other words, in order to code no patient-oriented reason, there must be explicit documentation making that connection. For example, documentation stating cardiac rehab referral not provided due to no traditional cardiac rehab program available to the patient within a 60-minute travel time from their home would support coding this. Each CV ASC procedure pathway is assigned unique and specific discharge medications. The entire team, including ambulatory, surgery center, and office-based lab stakeholders thoughtfully and concisely appointed these medications to their respective pathway based on reporting needs and keeping in mind the need for a lean data set. So while the data dictionary lists every possible discharge medication that could be used within the entire registry, constraints are applied in the backend to allow certain medications to appear once a specific pathway is selected in the data collection tool. Thus, the easiest means to know which medications are captured for a single procedure is the data collection form. Additionally, discharge medications will only be made available for capture if the patient is alive at discharge or rather and they discharge anywhere other than another acute care hospital or leaving against medical advice. Discharge medications are controlled by the medication master file, which is managed by the NCDR. If additional medications need 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. Use 10205, discharge medications prescribed, is capturing if a certain medication was prescribed, not prescribed, or was not prescribed for either a medical or patient reason on discharge. Yes, would be selected if a certain medication was prescribed on discharge. No, no reason would be selected if a certain medication was not prescribed post-procedure or for discharge and there was no mention of a reason why it was not ordered within the medical documentation. No medical reason would be selected if a certain medication was not prescribed post-procedure or for discharge and there was a reason documented related to a medical issue or concern for not prescribing that medication. A medication that is acceptable to code no medical reason must include a specific reason the medication was not prescribed. Examples of acceptable documentation include physician documentation that the medication was not prescribed due to an existing medical condition, an intolerance or allergy to a medication, active bleeding, oral anticoagulation therapy as pre-arrival medication, as a medical exception to prescribing aspirin. Examples of acceptable documentation continued include specific reasons for not prescribing one medication would apply to the entire class. This gives the physician credit for addressing and assumes reasons provided applies to the entire class. As an example, documentation of no plavix due to bleeding risk supports coding no medical reason for all P2Y12 inhibitors. Another example of acceptable documentation continued includes general clinician documentation, patient contraindication without specifying the exact contraindication. As an example, documentation of patient has contraindication to aspirin supports coding no medical reason for aspirin. Documentation that is either absent or too generic or general is not acceptable to support coding. The physician's documentation may indicate a decision was made not to prescribe a specific medication, however, the reason or contraindication is not implicitly provided. No patient reason would be selected if a certain medication was not prescribed post-procedure or for discharge and there was a reason documented related to the patient's preference. If you are abstracting in the diagnostic coronary angiography only or PCI with or without coronary angiography pathway and have indicated a statin was prescribed on discharge, the category of the medication dose prescribed on discharge is captured in sequence 10207, discharge medication dose. The options include low, moderate, or high. The dose definitions came directly from the ACC AHA guidelines on the management of blood cholesterol and will be coded based on them, meaning if a torvastatin 40 milligrams was prescribed on discharge, high would be coded. The notes in the coding instructions further educate sites that if a statin dose prescribed is outside intensity category, this data element would be left blank. As an example, if simvastatin 5 milligrams was prescribed on discharge, this data element would be left blank. Additionally, if the statin dose prescribed overlaps two categories, sites will code the lower intensity category. If the medication dose category was coded as either low or moderate, sites will have the opportunity to indicate if there was either a patient or medical reason that a high dose statin was not prescribed on discharge.

CVASC Registry

sequence numbers

PCI portion

cardiac rehab referrals

discharge medications