For sequence 13319, indicate if a dibutamine challenge was performed. A dibutamine challenge is a type of stress echocardiography that can distinguish between true severe versus pseudo-severe aortic stenosis and has a target value of any occurrence between 12 months prior to arrival and start of the first procedure. Sequence 13319 is a parent field for sequence 13320, flow reserve present, and for sequence 13321, aortic stenosis type, which we will discuss in the next few slides. This data element was added to the full dataset for use in evaluation for AUC to determine if it is appropriate to perform an aortic transcatheter procedure on a patient with pseudo-severe aortic stenosis. When the dibutamine challenge is coded as yes, the next question will be, is flow reserve present? Sequence 13320 would be coded as yes if there is an increase in the stroke volume index of greater than or equal to 20% as a result of the dibutamine challenge. This data element was added to the full dataset for use in evaluation for AUC to determine the appropriateness of performing an aortic valve transcatheter procedure on a patient with flow reserve present. Sequence 13321 seeks to indicate the aortic stenosis type documented on the dibutamine challenge. Truly severe aortic stenosis is defined as an aortic valve area less than or equal to 1 cm2 and Vmax peak aortic jet velocity greater than 4 mps at any flow rate. When aortic stenosis is not documented and clarification with the physician is unavailable, leave sequence 13321 blank and code sequence 13325 aortic stenosis type not documented.

dibutamine challenge

evaluating patients

aortic stenosis

true severe

pseudo-severe