Sequence 10205, Discharge Medications Prescribed, will now align with other registries such as CAF-PCI, ICD, chest pain MI, and AFib. Per the data dictionary, not prescribed medical reason is coded for sequence 10205 if the medication was not prescribed for discharge and there was a reason documented related to the medical issue or medical concern for not prescribing the medicine at discharge. General documentation of why the medication was not prescribed, such as physician documentation that the medication was contraindicated without supplying the exact contraindication, supports coding not prescribed medical reason. Not prescribed patient reason is coded when the medication was not prescribed post-procedure or for discharge and there was a reason documented related to the patient's preference at discharge. If there is no patient or medical reason documented and the medication was not prescribed at discharge, please code not prescribed, no reason, as the reason the medication was not prescribed will not be assumed. For sequence 10205, Discharge Medications Prescribed, documentation that is acceptable to support no medical reason should include a specific reason the medication was not prescribed. Examples of acceptable documentation include existing medical condition, such as renal disease, hypotension, angioedema, an aspirin intolerance or allergy to the medication, active bleeding, or oral anticoagulation therapy as pre-arrival medication, as medical exception to aspirin. For sequence 10205, Examples of Acceptable Documentation, continued, specific reasons for not prescribing one medication applies to the entire class. It gives the physician credit for addressing the medication and assumes the reason provided applies to the entire class of medication. As an example, documentation of no plavix due to bleeding risk supports coding no medical reason for all P2Y12 inhibitors. Sequence 10205, Discharge Medications Prescribed, continued, documentation that is acceptable to support no patient reason should include a patient-centered reason the medication was not prescribed. Examples include provider documentation that the medication was not prescribed due to documentation providing that the patient cannot afford the medication and therefore it was not prescribed, or documentation providing patient refusal of prescription and therefore it was not a discharge medication. Version 3 follow-up points to know are the follow-up time frame will be changed from 21-75 days to 23-75 days post-procedure, effective immediately with all follow-ups entered on or after 1-1-21. In addition, all follow-ups that are entered after 1-1-21 will be entered in Version 3 even if the procedure occurred in 2020 Q4 with Version 2.1. Sequence 11003, Method to Determine Follow-up Status, replaces Sequence 10005, Primary Method to Determine Status from Version 2.1. For Sequence 11003, we wanted to point out that the selection for clinic has been replaced in Version 3.0 with office visit. The selection for Centers for Medicare and Medicaid Services linked data is also new. We recommend that sites contact their facility billing department to see if there is an access to this resource. Sequence 11004, Follow-up Status, please note when coding 11004 in Version 3, the selection for withdrawn has been removed. The only selections for follow-up status for Version 3.0 will be alive, deceased, and lost to follow-up. Sequence 11007, Follow-up Cause of Death. From Version 2.1 to Version 3.0, there has been an increase in the number of selections for follow-up cause of death from 9 in Version 2.1 to 21 in Version 3.0. Other cardiovascular reason would be coded when the first six selections do not apply, but the cause is still cardiovascular. Other non-cardiovascular reason would be coded when the next 13 selections do not apply. For follow-up, a data element for follow-up residence, Sequence 13805, has been added to the TAVR module and will appear in the new tricuspid module. In Version 2.1, this selection was only available for mitral procedures, clip, and replacement, but will now become common to all modules. Sequence 13689, Follow-up 12-lead ECG performed. This is a parent field. When coding the follow-up ECG, the selections have changed from Version 2.1. In Version 3.0, Sequence 13689 will only ask if the Follow-up 12-lead ECG was performed. All ECG findings will be captured in Sequence 13621, Follow-up 12-lead ECG finding, which will be discussed in the next slide. Sequence 13621, Follow-up 12-lead ECG findings, is the child field to Sequence 13689, Follow-up 12-lead ECG performed. In this data element, we wanted to point out that the coding for pathologic Q-wave and new left bundle branch block are now separate selections, and this data element now can be coded with all or any selections that apply. Sequence 13692, 4D computed tomography performed, is a new data element related to valve replacement procedures only, TAVR, TMVR, and TTVP. The child fields for this data element are Sequence 13694, valve thrombosis noted, and Sequence 13695, leaflet dysfunction noted, also only apply to valve replacement procedures. The follow-up events will now be available in the Data Collection Tool. The definitions will be available in the Data Dictionary instead of referencing the Adverse Event Definition document. The adverse events that are available for coding for each procedure will only apply to that procedure.

Discharge Medications Prescribed

CAF-PCI

ICD

chest pain MI

AFib