CV ASC Registry Education-ICD Pathway Procedure History’s Child Fields 4305, 4310, 4315, 4320

Video Transcription

The ICD pathway has additional child fields for certain procedure history data elements used to inform metrics and appropriate use criteria. We will review them here.  If the patient underwent a coronary angiography procedure prior to the first procedure in  this admission, sequence 4305 would be captured if it was performed after the patient's most recent cardiac arrest event.  Sequence 4310, results of angiography, is coded independent of the one performed after a cardiac arrest if one was performed after a cardiac arrest.  In short, it's just capturing the most recent results of the most recent angiography. If the results of the most recent angiography indicate the patient is not a candidate for  revascularization of their significant coronary artery disease, then non-revascularizable significant disease would be coded.  If the results of the most recent angiography indicate there was less than 50% stenosis in the left main coronary artery and less than 70% stenosis in all other major coronary  artery branches that were 2mm in diameter or larger, then no significant disease would be coded.  If the results of the most recent angiography indicated the patient had 50% or worse stenosis  in the left main coronary artery and or 70% or worse stenosis in any major coronary artery 2mm in size or more, then significant disease would be coded.  If it is noted that the patient had significant disease on their most recent coronary angiogram,  then sequence 4315 gives sites the opportunity to indicate if an attempt at revascularization was performed.  The intent of this data element is to evaluate the status of the arteries and or bypass grafts at the time of the implant.  If it is noted that the patient had revascularization performed, then sequence 4320 wants to identify the outcome.  If the attempt at revascularization resulted in residual stenosis of less than 50% in all  revascularizable diseased coronary arteries, then complete revascularization would be coded.  If the attempt at revascularization reflects that not all revascularizable diseased coronary arteries resulted in less than 50% residual stenosis, then incomplete revascularization  would be coded.

Video Summary

The ICD pathway includes child fields for procedure history data. Sequence codes like 4305 and 4310 capture information from prior coronary angiography procedures to assess candidacy for revascularization. Results determine if significant disease is present based on stenosis levels in major coronary arteries. Sequence 4315 records revascularization attempts, while 4320 evaluates the outcome. Complete revascularization is coded for less than 50% stenosis in all diseased arteries, while incomplete revascularization is noted for residual stenosis above 50%. These codes provide insight into the patient's cardiac status and treatment efficacy following procedures.

Keywords

ICD pathway

procedure history data

coronary angiography procedures

revascularization

stenosis levels