Welcome to Lesson 5 of this learning activity titled Getting Acquainted with the V5 Dataset. The content in this lesson was developed by Cornelia Anderson and myself. I am Kate Malish and I will be narrating this lesson. The objectives for Lesson 5 of Getting Acquainted with the V5 Dataset include Discuss V5 Dataset Rationale and Purpose, Locate Coding Resources, Identify Parameters for Coding. Section I is completed for attempted and performed PCI procedures. The registry defines PCI as the introduction of a guide wire into the body for the purpose of mechanical revascularization. Here you capture the status of the PCI procedure and whether the PCI is being performed after a surgical consult was obtained. All data elements are coded to coding instructions and target value. We encourage you to familiarize yourself with the definitions. For example, PCI status includes thorough data definitions which must be met with documentation. If the patient suffered cardiac arrest at any time leading up to the PCI, you may capture when hypothermia was induced and the highest level of consciousness the patient achieved after cardiac arrest and at the start of PCI. If a patient is having PCI in the presence of multivessel disease, you may code this in Sequence 7820, then specify in the child field whether this PCI is the initial PCI for multivessel disease or a staged PCI. The PCI indication is coded with the highest value which prompted the PCI procedure and should correlate to what is coded in Sequence 7400, Indications for cath lab visit. When select STEMI selections are coded in Sequence 7825, we ask for the date and time which symptoms persisted longer than 10 minutes and prompted the patient to seek medical treatment. You may code full dose thrombolytics administered and the date and time they were started. Finally, the physician can specify the syntax score for the patient. When this is not documented, please code unknown. This chart, located in the V5 Data Dictionary supplement with pending data element updates, is a helpful tool to determine appropriate coding of Sequence 7400 and Sequence 7825. As you can see, the shaded areas correspond to the highest value coded in Sequence 7400, which is then coded in Sequence 7825. This portion of Section I delves deeper into the acute STEMI patient. Sequence 7835 captures whether the STEMI was diagnosed from the first ECG performed or not until a subsequent ECG was performed. Patients transferred into your facility for immediate PCI for STEMI are captured here, as well as the date and time of first device activation. When there is a patient-centered reason which delayed PCI, it is captured in Sequence 7850 and 7851. Our second group of medications captured in the data collection tool is found in Section I. Medications which were administered within 24 hours prior to and during the PCI procedure are coded here. Medications may be captured up until the patient leaves the cath lab procedure room. The details of the intervention are captured in Section J, Lesions and Devices. The focus is on the area treated. Each area treated is captured as a lesion, and all segments within the area are coded. As an example, if the med RCA is treated and stenting continues into the distal RCA, this is coded as one lesion, as these are sequential segments. The highest percent stenosis of sequential segments is coded in Sequence 8004. Included in the registry's resource documents is a coronary artery segment diagram, which has proven helpful to participants in identifying the appropriate segment for coding. The term post-intervention is used to relay when the residual stenosis and TIMI flow would be evaluated during the procedure. At the conclusion of capturing all the lesion-specific information, any coronary artery device utilized during the procedure is captured here. In this section, if the guide wire doesn't cross the lesion, such as a failed attempt on a chronic total occlusion, then this concludes data capture for the PCI procedure. However, when the guide wire does cross the lesion, you will then code the child fields in Sequence 8024-8026. The registry captures intra- and post-procedure events after each cath lab visit. You will continue to capture all events until the patient is discharged. Section K captures events which occurred between start of current procedure and until the next cath lab procedure or discharge. Six types of bleeding events are captured when an observed bleed occurs, along with at least one criteria listed in the data definition. The final episode of cardiac arrest is located here when it occurs during or after a cath lab procedure. Finally, a stroke is specified as either ischemic, hemorrhagic, or undetermined. More thorough definitions for these sequences are provided in the V5 Data Dictionary Supplement with pending data element updates. When a transfusion occurs, additional information is requested that will provide a clearer picture of the patient's status post-procedure and the impact of PCI and or surgery. This concludes Lesson 5 of Getting Acquainted with the Cath PCI Registry V5 Dataset. Thank you for your participation.

V5 dataset

PCI procedures

coding resources

multivessel disease

STEMI selections