After indicating that the patient has a history of non-ischemic cardiomyopathy, sequence 4205, non-ischemic cardiomyopathy timeframe, is asking essentially how long has it been since they were initially diagnosed, whether it was less than three months or three months or more. If this type of documentation is not present, then physician clarification is warranted. Otherwise, this data element would be left blank. If guideline-directed medical therapy was not attempted on the patient, then not attempted would be selected. In sequence 4210, non-ischemic cardiomyopathy guideline-directed medical therapy maximum dose, the registry wants to know if the patient with non-ischemic cardiomyopathy has been on guideline-directed medical therapy for at least three months. Please make note that this type of documentation is the responsibility of the clinician and cannot be determined by the abstractor based on a list of medications. This type of therapy is individualized but typically should include some combination of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker and beta blocker therapy, which are adjusted to target doses as tolerated. In certain patients, diuretics may be needed or adjusted to control fluid retention. Even in other cases, patients may need aldosterone antagonists, hydrolazine, and nitrates. Patients who are going to receive substantial benefit from medical treatment alone usually show some clinical improvement during the first three to six months. Medical therapy is also assumed to include adequate rate control for tachyarrhythmias such as atrial fibrillation. Therefore, it is recommended that guideline-directed medical therapy be provided for at least three months before any planned reassessment of LV function to consider device implantation. Acceptable documentation includes guideline-directed medical therapy, maximum, optimum, appropriate dose, medical therapy, or medical management for cardiomyopathy. As well, a discussion in the medical record regarding medications as it relates to the patient's cardiomyopathy is acceptable for documenting guideline-directed medical therapy. Other acceptable statements include good neurohormonal therapy managed appropriately on heart failure medications, failed medical management of heart failure, and so on. Please work with your clinicians to determine a process of documentation that will allow for the coding of this element for all generator procedures. A statement regarding maximum guideline-directed medical therapy for three months or more should be considered as something to be incorporated as a smart phrase within the facility's electronic record environment. The selections for coding sequence 4210 non- ischemic cardiomyopathy guideline-directed medical therapy maximum dose include yes for three months, not documented, not attempted, and inability to complete. If the patient has been on guideline-directed medical therapy maximum dosing for at least three months, then yes for three months would be coded. If there is no documentation of guideline-directed medical therapy maximum dosing, then not documented would be selected. Sequence 4205 non- ischemic cardiomyopathy time frame and sequence 4210 non- ischemic cardiomyopathy guideline-directed medical therapy maximum dose will populate when a history of non- ischemic cardiomyopathy is captured. In scenarios where the patient was unable to continue their guideline-directed medical therapy maximum dosing for three months or where the patient is on guideline-directed medical therapy but it has been less than three months, then inability to complete would be selected. Without a definitive time frame documented or the ability to determine the time frame from the medical record, inability to complete would be the appropriate selection. This selection would also include patients started on guideline-directed medical therapy but it has been less than three months due to patient refusal, an allergy or an absolute contraindication.

non-ischemic cardiomyopathy

guideline-directed medical therapy

medication regimen

clinical improvement

device implantation