3/17/2014. WS # 3 ICD Registry Case Scenarios with Structural Abnormalities. Objectives. Denise Pond BSN, RN
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1 WS # 3 ICD Registry Case Scenarios with Structural Abnormalities Denise Pond BSN, RN The following relationships exist related to this presentation: No Disclosures Objectives Discuss specific coding instructions for data elements in the ICD Registry Demonstrate knowledge of data abstraction through interaction with the ARS Discuss relationships between data definitions and medical documentation (V2) with metrics to identify fall outs via ARS Syncope - Sequence 4045 Admitted for generator change Loss of consciousness w/ immediate recovery after appropriate shock therapy Spontaneous monomorphic VT NYHA III LVEF 15% NIDCM 1
2 Syncope - Sequence 4045 ARS Question: # 1 How will you code Syncope, seq No 2. Yes Ventricular Tachycardia - Sequence 4065 Admitted for diagnostic work-up for syncope Possible initial ICD implant Diagnostic Cath Results Coronaries Normal Sustained monomorphic VT while engaging the RCA LVEF 55% EP Study Induced sustained monomorphic VT Ventricular Tachycardia - Sequence 4065 ARS Question: # 2 How will you code Ventricular Tachycardia, seq. 4065? 1. No 2. Yes 2
3 NIDCM / Other Structural Abnormalities Non-compaction of left ventricle Cardiomyopathy HF w/ NHYA III Torsades Syncope NIDCM / Other Structural Abnormalities ARS Question: # 3 How will you code non-compaction of left ventricle? 1. Nonischemic Dilated Cardiomyopathy, seq LV Non-compaction syndrome, seq Both 1 & 2 Other Structural Abnormalities: 4205 LV Non-compaction Syndrome 4218 LV Non-compaction Syndrome Rare - classified by AHA as own disease entity in 2006 Common in children but also seen in adults Thought to be due to embryonic arrest of compaction of myocardial fibers during late stages of myocardial development Non-compacted portion of least 2x s thicker normal compacted myocardium Characterized by prominent ventricular myocardial trabeculations & intertrabecular recesses Multiple forms of LVNC primary form associated with electrophysiologic abnormalities and arrhythmias LVNC associated with congenital heart defects such as VSD, ASD, pulmonary stenosis Clinical manifestations: heart failure, arrhythmias or thromboembolism causing stroke. Often misdiagnosed as hypertrophic or dilated cardiomyopathy. 3
4 Section G Lead Assessment Existing Lead Status - Sequence 7080 Lead revision - new RV lead implanted Existing RV lead Pace - oversensing Shock - reused RA lead - reused Intra procedure, with catheter placement Sustained monomorphic VT Terminated with 300 millisecond burst New RV lead dislodgement / repositioning prior to close required repositioning. Section G Lead Assessment Existing Lead Status - Sequence 7080 ARS Question: # 4 How will the Existing RV Lead be captured? 1. Normal, Abandoned 2. Abnormal, Abandoned 3. Normal, Reused 4. Abnormal, Reused Section H Intra and Post Procedure Events Coding of Intra Procedure Events Lead revision - new RV lead placement Existing RV lead Pace - oversensing Shock - reused RA lead - reused Intra procedure, with catheter placement Sustained monomorphic VT Terminated with 300 millisecond burst New RV lead dislodgement / repositioning prior to close 4
5 Section H Intra and Post Procedure Events Coding of Intra Procedure Events ARS Question: # 5 Which Intra Procedure Events will be coded? 1. Cardiac Arrest 2. Dislodgement 3. Cardiac Arrest and Dislodgement 4. None of the above Lead Assessment or Post Procedure Event Existing Lead Issue Initial ICD implant 1/10/2014 Discharged home 1/11/2014 Re-admitted 1/24/2014 w/ hemothorax due to migratory RV lead Thoracic surgeon removed RV lead & stabilized patient Lab visit 1/26/2014 RA lead removed (damaged during thoracic surgery) New RA and RV leads implanted Lead Assessment or Post Procedure Event Existing Lead Issue ARS Question: # 6 How will you capture the migrated RV lead? 1. Cardiac perforation, /10/14 episode 2. Cardiac perforation, /24/14 episode 3. Perforation, /24/14 episode 4. Both 2 & 3 5. Both 1 & 3 Cardiac Perforation 8015 Perforation
6 Need a Helping Hand Resources / Documents Data Dictionary Resources Meeting Minutes FAQ s Monthly RSM Calls Call ncdr@acc.org 6
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