Welcome, and thank you for taking the time to review the April case scenario, which will review EP device implant inclusion and related data elements, sequence 7010 procedure type and sequence 15781 co-implant device. A 75-year-old female was admitted for shortness of breath and a heart rate in the low 40s. She has a history of MI on December 20, 2020, with a stent placed to the proximal RCA. The initial ECG revealed a heart rate of 48 with nonspecific intraventricular block. The current left ventricular ejection fraction is 35%, and persistent weakness is associated with dizziness. Throughout the evening and night, the telemetry monitor reveals episodes of severe bradycardia. The electrophysiologist was consulted, and the shared decision was reached to place a cardiac resynchronized therapy device to improve her symptoms. After multiple attempts to insert a coronary sinus lead, and then switch to obtain his or left bundle area pacing that did not result in an acceptable reading, only a dual chamber permanent pacemaker was inserted. Overnight was uneventful, and after further discussion, the patient and family agreed to an additional procedure to insert a left ventricular endocardial pacemaker. Our question is, my facility has elected to submit all procedures. Is this episode of care abstracted in the EPDI registry? Number one, no, or number two, yes. Please note, if the facility chooses not to submit permanent pacemaker procedures, then this question is not applicable. Please take a moment to review the documentation before selecting an answer from the available options. And the answer is number two, yes. Per the inclusion criteria document, the decision to submit all procedures includes all permanent pacemakers and or permanent pacemaker leads for the submission population. How is sequence 15781 co-implant device coded for the second lab visit? Number one, no, or number two, yes. Please take a few moments to review the documentation before selecting an answer from the available options. The answer is number one, no. The intent of sequence 15781 co-implant device is to capture additional devices that were implanted in the same lab visit. In the current scenario, the first lab visit involved only a dual pacemaker being implanted after failed attempts to implant a coronary, sinus, LV, his, and left bundle lead. A second device was not implanted. For the second lab visit, a left ventricular endocardial pacemaker was implanted per the clinical trial specifications. However, the LVEP was the only device implanted on the second visit. To code yes to sequence 15781 co-implant device, the devices must be implanted in the same lab visit. This is from the direction of the steering committee. Therefore, in this scenario, no is coded in sequence 15781 co-implant device for both lab visits. Our question number three is how is the LVEP implant procedure coded in sequence 7010 procedure type for the second lab visit? Number one, generator change. Number two, generator explant. Number three, initial generator implant. Or number four, lead only. Please take a few moments to select an answer from the available options. The answer is number one, generator change. Anytime a pacemaker has been implanted, then every subsequent pacemaker device will be coded as generator change, regardless of whether the permanent pacemaker device is currently implanted or, as in this scenario, where two permanent pacemakers are implanted into the body. The same rationale applies to ICD devices as well. EPDI version 3 coding guidance on procedure type and pathway can be found on the resource page within user guide documents. Thank you for viewing the EP device implant registries April 2025 case scenario.

device embolization

leadless pacemaker

bradycardia

heart block

pacemaker dislodgement

dual-chamber pacemaker

left ventricular endocardial pacemaker

myocardial infarction

cardiac resynchronization