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Chest Pain-MI v3.1 Education
Treatment Strategy Cath Lab Visit
Treatment Strategy Cath Lab Visit
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Video Transcription
Treatment strategy cath lab visit is coded when sequence 1, 2, 3, 6, 0, patient type is STEMI, NSTEMI, or unstable angina. The selection of no performed at transferring facility seeks to capture patients who were transferred from another acute care facility where a coronary angiogram was performed between first medical contact and discharge. Sequence 1, 5, 5, 0, 0, non-STEMI patient-centered reason for delay in angiography seeks to capture specific documentation in the medical record within the first 24 hours after arrival, linking an issue or condition that originated from the patient causing the delay in angiography after arrival at this facility. This is not selected for facility healthcare system reasons that may have caused the delay. Some examples are documentation of the patient or family member delaying in providing consent for angiography or the patient is too unstable for angiography, such as cardiovascular instability, heart failure, or cardiogenic shock. Sequence 1, 5, 5, 3, 0, resuscitated pre-admitted STEMI patient-centered reason for delay in angiography seeks to capture specific documentation in the medical record within the first 120 minutes after resuscitation, linking an issue or condition that originated from the patient causing the delay in angiography. This is not selected for facility healthcare system reasons that may have caused the delay. Sequence 1, 5, 4, 9, 7, guess or performed at transferring facility results seeks to capture the results of the highest value of a coronary angiography performed either at this facility or at the transferring facility. When an angiography is performed at both this facility and the transferring facility, code the results from this facility in this data element. The results of the transferring facility's angiography will be captured in the prior testing section in sequence 1, 5, 4, 5, 8, anatomical imaging results. The available selections for sequence 1, 5, 4, 9, 7, yes or performed at transferring facility results are defined as follows. No CAD indicates the patient has clear coronary arteries and no disease was identified in any greater than two millimeter native or graft vessel. CAD indicates coronary atherosclerotic disease was identified in at least one greater than two millimeter native or graft vessel. Or unavailable is selected when the coronary angiography results are either not available or are unknown. Sequence 1, 5, 4, 9, 8, CAD type seeks to capture the highest value or highest level of coronary artery disease documented. It is important to note when the coronary angiography is repeated at this facility, the results of this facility's level of CAD is captured in this data element. The transferring facility's results will be captured in sequence 1, 5, 4, 5, 9 in the prior testing section. The following are definitions for CAD type. Please note only disease found in vessels greater than or equal to two millimeters is captured unless a vessel is less than two millimeters and is intended for PCI and or the patient's overall coronary anatomy is less than two millimeters. Non-obstructive indicates the disease is less than 50% in all coronary vessels and left main disease is less than 50%. Moderate indicates the disease is 50 to 69% in any coronary vessel defined as the left anterior descending, the left circumflex, the right coronary artery, and any of their branches. A true ramus branch greater than two millimeters. Any eye pass graft and left main disease less than 50%. Obstructive indicates the disease is greater than or equal to 70% in any coronary vessel defined as the left anterior descending, the left circumflex, the right coronary artery, or any of their branches. A true ramus greater than two millimeters. Any bypass graft and or left main disease greater than or equal to 50%. Non-obstructive indicates the CAD type of disease is not known. Differentiating 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.
Video Summary
The video transcript explains the coding and documentation requirements for different treatment strategies and patient conditions in a cath lab visit. It includes specific sequences and elements that need to be recorded in the medical record. These sequences capture information such as patient type, reasons for delays in angiography, and results of coronary angiography. The different CAD types and their definitions are also provided. It is important to accurately document and code these elements to ensure accurate reporting of the patient's condition and course of treatment. No credits were mentioned in the transcript.
Keywords
coding
documentation requirements
treatment strategies
patient conditions
cath lab visit
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