Sequence 13504, HEARP Team Evaluation for Suitability for Surgical Replacement, replaces Sequence 6072, Evaluation of Suitability for Open AVR by Two Surgeons from Version 2.1. With the change to the National Coverage Determination, or NCD, in June of 2019, a face-to-face evaluation by two cardiothoracic surgeons is no longer required. The NCD now requires that as part of the HEARP Team assessment, both an interventional cardiologist and a cardiothoracic surgeon evaluate the patient face-to-face for the suitability of open heart valve replacement surgery and document the evaluation in the medical record. Sequence 13525, Delivery System Successfully Removed, is applicable to any transcatheter valve replacement procedure, aortic, mitral, or tricuspid. This data element seeks to identify if there was successful removal of the delivery system without causing an event to meet a definition in intra- or post-procedure events. Sequence 12153. Sequence 13498, Primary Transcatheter Aortic Valve Replacement Procedure Indication, replaces Sequence 6060 from Version 2.1. For Version 3.0, there are only two selections for Sequence 13498, which are aortic regurgitation and aortic stenosis, and if both are documented as the reason for the procedure, then the worst reason will be coded. This may be a point of physician education prior to the launch of Version 3.0 to avoid needing any physician clarification. Sequence 13501, Bioprosthetic Valve Fracture Attempted, is a child field of Sequence 13500 and can only be coded when a valve-in-valve procedure is selected. Sequence 13501 would be coded even if the attempted balloon valve fracture is unsuccessful. When coding, if the pre-implant valvuloplasty or post-implant dilatation uses lower pressure inflations, such as a hand inflation up to 4 atmospheres, please code NO. If the previously implanted bioprosthetic valve was fractured during the procedure, even though a balloon valve fracture was not planned, please code YES. When a balloon aortic valve fracture has been attempted or is successful, balloon valve fracture timing, Sequence 13502, would be coded for either pre-implant, post-implant, or both. This is a check all that apply data element. Sequence 13503 seeks to indicate if the valve was observed to be fractured. Documentation to support coding can include any one of the following three items. Fluoroscopically by visualizing the waste of the balloon release, by an audible snap, or by a sudden drop in the balloon pressure in the absence of balloon rupture. Sequence 13510, Embolic Protection Deployed, is now a separate data element in Version 3.0 and will not be captured in Device ID, Sequence 14485, or in Sequence 7066, Concomitant Procedures Performed. When an embolic protection device is attempted or successful, Sequence 13510 would be coded as yes and the embolic protection device ID would be entered in Sequence 13511 with the number from the device list. Sequence 13534, Device Capture and Repositioning Performed, would be coded as yes when any valve is repositioned even if the valve is manufactured to be repositioned. This data element is not seeking information for an adverse event, but is seeking to determine if any valve was repositioned during a transcatheter TAVR procedure. When a transcatheter valve is not repositioned during the case, Sequence 13534 would be left blank, and Sequence 13535, Device Capture and Repositioning Performed, not applicable, would be captured. When the valve does not have the ability to be repositioned, such as a SAPIEN 3, please code not applicable. Sequence 13536, Transcatheter Aortic Valve Replacement Device Implanted Successfully, replaces Sequence 6235, Device Implanted Successfully from Version 2.1 and is a parent field. Sequence number 6235, Device Success from Version 2.1 has been retired. Sequence 13536 seeks to determine if there is at least one valve correctly positioned in the proper anatomical location. If the procedure converts to open heart surgery due to valve failure, Sequence 13536 would be coded as no. If the procedure converts to open heart surgery for a complication other than valve failure, Sequence 13536 would be coded as yes. Sequence 13539 is a child field of Sequence 13536 and seeks to determine the reason that the Transcatheter Aortic Valve Replacement Device was not implanted successfully. There are four possible selections for this data element, device embolization, improper device positioning, improper device sizing, and other. Other would be coded for any documentation that does not fit the three previous selections.

HEARP Team Evaluation

surgical replacement

coding guidelines

transcatheter aortic valve replacement

implantation