Patient Evaluation Non-Invasive Testing During This Episode, Version 3.1 Training. Sequence 15460, Shared Decision Making, seeks to capture the healthcare provider's shared evidence-based information about the alternative treatment options available and consider the patient's values and preferences in the decision-making process for NSTEMI, unstable angina, and low-risk patient types. Patients are an important part of the heart team's decision-making. Making a final decision on a treatment plan requires an informed patient as part of the whole heart team. Patients need to be invited to play an active role in learning about their condition and weighing the treatment options. Shared decision-making is an encounter where the provider and the patient share information. The provider offers various options and describes their risks and benefits, and the patient expresses his or her preferences and values. Per the 2021 AHA, ACC, ASE, CHEST, SAEM, SCCT, and SCMR Guidelines for the Evaluation and Diagnosis of Chest Pain, one of the top 10 takeaway messages for the evaluation and diagnosis of chest pain was number four, shared decision-making. Clinically stable patients presenting with chest pain should be included in the decision-making. Information about the risk of adverse events, radiation exposure, costs, and alternative options should be provided to facilitate the discussion. A statement by the provider that a shared decision-making encounter occurred is sufficient for coding sequence 15460, shared decision-making, as yes. The use of a shared decision-making tool would allow for the coding of sequence 15460, shared decision-making, as yes. Using a SMART phrase within the facility's EHR system regarding shared decision-making is sufficient for coding sequence 15460, shared decision-making, as yes. Shared decision-making is captured in this section but is not limited to the non-invasive test. Therefore, if or when a shared decision-making encounter is documented within the target value, yes is coded. Sequence 15470, ischemia evaluation method, seeks to capture the first stress method used for ischemia evaluation between arrival at this facility and discharge. This is a dynamic list of testing methods where a stress component is used to assess for ischemia. Stress testing includes both exercise and pharmacologic methods. Sequence 15579, ischemia evaluation order date and time, seeks to capture the date and time of the first imaging with stress that was ordered between arrival at this facility and discharge. Please do note, if more than one test was ordered at your facility, note the date and time of the first imaging with a stress component that was ordered. Sequence 15471, ischemia evaluation performed date and time, seeks to capture the date and time of the first imaging with stress that was performed between arrival at this facility and discharge. Please note, if more than one test was performed at your facility, note the date and time of the first imaging with stress that was performed. Sequence 15472, ischemia assessment results, seeks to capture the results of the first test with a stress component between arrival at this facility and discharge. The selection of negative for ischemia assessment results is defined as follows. The exercise stress test without imaging results revealed the ECG was normal or not suggestive of ischemia. The stress echocardiogram test results revealed no change in wall motion during the procedure. The stress nuclear test results revealed no myocardial perfusion defects. The stress imaging with CMR test results revealed no myocardial perfusion defects. The selection of positive for ischemia assessment results is defined as follows. The exercise stress test without imaging results revealed the echocardiogram was suggestive of ischemia. The stress echocardiogram test results revealed changes that reflected wall motion abnormalities during the procedure. The stress nuclear test results revealed one or more stress-induced myocardial perfusion defects, and the stress imaging with CMR test results revealed one or more stress-induced myocardial perfusion defects. The selection of indeterminate for ischemia assessment results indicates the study or test results were uninterpretable. They cannot be considered positive or negative. Sequence 15581, cardiac CTA performed, seeks to capture the cardiac CTA performed between arrival at this facility and discharge. The selections for cardiac CTA performed are defined as follows. Yes indicates the test was performed. No no reason indicates the test was not completed. There is neither a medical nor patient reason documented explaining why it was not completed. To code no medical reason or no patient reason, there must be clear documentation of a reason related to the patient's medical issue or concern or the patient and or family's preference explaining why it was not completed. Sequence 15580, cardiac CTA ordered, date, and time seeks to capture the first cardiac CTA that was ordered at your facility. Please note, it is the date and time the first order for CTA was written. Sequence 15582, cardiac CTA performed, date, and time seeks to capture the first cardiac CTA that was performed at your facility. Please note, it is the date and time the first CTA was performed. Sequence 15473, cardiac CTA results, seeks to capture the results of the first cardiac CTA performed between arrival at this facility and discharge. The selections for cardiac CTA results are defined as follows. No CAD indicates the patient has clear coronary arteries and no disease was identified in any native or graft vessels greater than two millimeters. Non-obstructive CAD indicates all coronary vessels, including the left main, are less than 50%. Moderate CAD indicates 50 to 69% occlusion in any coronary vessel defined as left anterior descending, left circumflex, and right coronary arteries and any of their branches. A true ramus branch greater than two millimeters, any bypass graft, and left main disease less than 50%. Obstructive CAD indicates greater than or equal to 70% occlusion in any coronary vessel defined as the left anterior descending, the left circumflex, and the right coronary arteries and any of their branches. A true ramus branch greater than two millimeters, any bypass graft, and left main disease greater than or equal to 50%. Please note, only disease found in vessels greater than or equal to two millimeters is captured unless the vessel is less than two millimeters and is intended for PCI and or the patient's overall coronary anatomy is less than two millimeters. Indicating between non-obstructive and moderate CAD types. The left main coronary artery must have less than 50% stenosis, then if all other coronary vessels have less than 50% stenosis, code non-obstructive. If any other coronary vessel has 50 to 69% stenosis, code moderate.

patient evaluation

non-invasive testing

ischemia

cardiac CTA

test results

shared decision-making

stable chest pain