This is the April 2021 case scenario for the EP Device Implant Registry, formerly known as the ICD Registry. We will review sequence 14719 ventricular fibrillation. A 59-year-old male is admitted for single-chamber ICD for primary prevention. His past medical history includes STEMI with V-fib arrest that precipitated a drug-eluting stent to the proximal LAD, ischemic cardiomyopathy with a left ventricular ejection fraction of 35 to 40 percent, and guideline medical therapy for greater than three months. Recently, the patient complains of dizziness and palpitations with increased fatigue. A ZOXT monitor patch reveals frequent occurrences of non-sustained VT, and a repeat echo reveals a further reduced LVEF of 25 percent, despite guideline-directed medical therapy. In this scenario, how is sequence 14719 ventricular fibrillation coded, no or yes? Please take a moment to review the documentation and the question. The correct answer is number one, no. The intent of sequence 14719 is to capture ventricular fibrillation not due to a reversible cause. In this scenario, the V-fib arrest was due to an abrupt occlusion of the proximal LAD, which was reversed once reperfusion occurred. Additionally, the clinician has documented the ICD indication is primary prevention. Now that we have determined the ventricular fibrillation is coded no as it was due to a reversible cause, the proximal LAD occlusion, how is V-fib arrest coded? Sequence 4220 prior cardiac arrest and sequence 4235 V-fib arrest are both coded as yes. Per the coding instructions of prior cardiac arrest, you are to indicate if the patient experienced cardiac arrest due to arrhythmia and V-fib arrest, you are to indicate if the cardiac arrest was a result of ventricular fibrillation. The coding instructions are met. Both are coded as yes, regardless of whether the arrest was due to a reversible cause or not. The coding instructions of both data elements remain the same in version 2.2. In this scenario, the non-sustained VTAC visualized on the Xeo XT monitor is the only VT event captured with the most recent date coded. The ventricular fibrillation is coded no as the V-fib arrest was due to a reversible cause. Thank you for viewing the EP Device Implant Registry Case Scenario for April 2021.

EP Device Implant Registry

ventricular fibrillation

medical history

patient

non-sustained VT