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 permanent pacemaker 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 permanent pacemaker 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 homepage. Now buckle in for some educational time as we navigate the sequences in the registry. 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 leafless 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, leafless 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 leafless 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 leafless 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 leafless 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 practitioner 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. 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 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 ROV 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 is 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 14739, his left bundle lead, is indicating if it was implanted unsuccessfully, previously implanted, successfully implanted, or not attempted during the current procedure. Sequence 7635, 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 1 and be incremented by 1 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 implant 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 lead's 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 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. Each CV ASC procedure pathway is assigned unique and specific events. The entire team, including ambulatory, surgery, center, and office-based lab stakeholders, thoughtfully and concisely appointed these events to the 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 event that could be used within the registry, constraints are applied in the backend to allow certain events to appear in the specific pathway when using the data collection tool. Thus, the easiest means to know which events are captured for a single procedure is the data collection form. Sequence 9001, intra- or post-procedure events, is indicating if the event occurred between the start of the procedure and the next procedure or discharge. While this data element is shared with our hospital registries, where multiple procedures may occur during one episode of care, the ASC registry is initially built to handle one pathway per episode of care. Thus, the target value for an ASC is better understood if written any occurrence between start of procedure and discharge.

CVASC Registry

sequence numbers

permanent pacemakers

procedure types

device implantation

data collection