Welcome to our educational opportunity for version 3.0 upgrade. In this learning activity, we will address data elements for mitral replacement procedures with an emphasis on new and updated data elements. For version 3.0, the registry has removed valve-in-valve from the module title. Sequence 13754, Mitral valve replacement type, is a parent field. Please collect all TMVR procedures that occur in the native valve, which may also be termed valve-in-MAC, mitral annular calcification, as a valve-in-valve, which can be a previous transcatheter valve or a surgical valve, or a valve-in-ring, which would be a previous surgical valve ring insertion. Sequence 14480, Bioprosthetic valve fracture attempted, is a child field of sequence 13754, TMVR type, and can only be coded when a valve-in-valve or a valve-in-ring is selected. Sequence 14480 would be coded as yes, even if the attempted balloon valve fracture is unsuccessful. For coding purposes, if pre-implant valvuloplasty or post-implant dilatation at lower pressure inflations up to four atmospheres is attempted, code no for this data element. If the previously implanted bioprosthetic valve was fractured during the procedure, even though balloon valve fracture was not planned, code yes. When a balloon valve fracture has been attempted or is successful, balloon valve fracture timing, sequence 14481, would be coded for either pre-implant, post-implant, or both. This is a select-all-that-apply data element. Sequence 14482 seeks to indicate if the valve was observed to be fractured. The documentation to support coding 14482 can be any one of the following three items. Identified fluoroscopically by either visualizing the waste of the balloon release and or the fractured valve ring, if the valve ring is radiopaque, by an audible snap, or by a sudden drop in balloon pressure in the absence of balloon rupture. When coding sequence 13756, transcatheter mitral valve replacement primary procedure indication, if more than one indication is documented, choose the most significant reason. This may require clarification with the physician to enable coding if there is no documentation to support coding. For sequence 13759, pre-implant balloon inflation performed, the definition is unchanged from version 2.1 and continues to refer to the performance of a valvuloplasty pre-implant of the mitral valve replacement. However, the child field of sequence 13760, significant hemodynamic deterioration after inflation, has added a definition for clarity. Sequence 13760 states to indicate a significant hemodynamic deterioration occurred after inflation. The patient would experience hypotension and pulmonary congestion because balloon inflation of the stenotic valve can cause severe mitral regurgitation. Sequence 13538, mitral valve device implanted successfully, is not a new data element for mitral valve replacement procedures and was formerly known as sequence 29225 in version 2.1. We wanted to point out that sequence 13538 has a new child field to determine the reason the mitral valve device was not implanted successfully. This is sequence 13541. This data element now has four selections that can be made when the mitral replacement device has not achieved successful implantation. These selections are device embolization, improper positioning or deploying, improper device sizing or other. Other would be coded when the definition of the three previous selections do not apply. There are a few updates and additions to section F for follow-up imaging for echocardiogram and 4DCT for transcatheter mitral valve replacement procedures. Sequence 13782, SAM present, represents a verbiage update from sequence 10375 in version 2.1. The acronym SAM stands for systolic anterior motion. The coding instructions and the target value have not changed from version 2.1. Next, LA volume, sequence 13787 and sequence 13788, LA volume index, have each had a not measured data element added. As with 2.1, only one of these data elements needs to be captured per procedure.

mitral replacement procedures

registry changes

valve-in-valve

attempted bioprosthetic valve fracture

follow-up imaging