3/17/2014. NCDR-14 ICD Registry WS # 24 Case Scenarios Including Syndromes w/ Risk of Sudden Death. Objectives

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1 NCDR-14 ICD Registry WS # 24 Case Scenarios Including Syndromes w/ Risk of Sudden Death 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 Ventricular Fibrillation Admitted for initial ICD implant 8/23/13 Anterior MI 5/17/13 VFib arrest PCI to proximal LAD LVEF 30% NYHA I 1

2 Ventricular Fibrillation ARS Question: # 1 How will you code Ventricular Fibrillation? 1. VTach/VFib Arrest, seq VTach, seq / Hemodynamic Instability, seq & VT Type, seq. 4075, Sustained monomorphic & polymorphic VT 3. Both 1 & 2 Section F ICD Implant / Explant ICD Indication Sequence 6125 Admitted for initial ICD implant 8/23/13 Anterior MI 5/17/13 VFib arrest PCI to proximal LAD LVEF 30% NYHA I Physician documents ICD indication as Primary Section F ICD Implant / Explant ICD Indication Sequence 6125 ARS Question: # 2 How will you code this patient s ICD indication? 1. Primary due to physician documentation 2. Secondary due to the VFib arrest 2

3 One Epicardial Artery>=70% Confirmed by Angiography Sequence 4165 Ischemic Cardiomyopathy CABG 2005 MI 2012 Stents RCA & LAD 2012 Cardiac Cath reports not available One Epicardial Artery>=70% Confirmed by Angiography Sequence 4165 ARS Question: # 3 Does this patient have one epicardial artery >=70% confirmed by angiography? 1. No 2. Yes Syndromes w/ Risk of Sudden Death - Sequence 4100 NIDCM Cardiomyopathy ECG: SR w/ QT interval is 550 msec Admitting medication: Sotalol Spontaneous sustained VT 3

4 Syndromes w/ Risk of Sudden Death - Sequence 4100 ARS Question: # 4 How will you code Syndrome w/ Risk of Sudden Death, 4100 & Long QT Syndrome, 4105? 1. No 2. Yes Long QT Syndrome Congenital disorder w/ multiple genetic defects identified Most common LQT 1 - ion channel affected K+ - KVLQT1 or KCNQ1 LQT 2 - ion channel affected K+ - HERG, KCNH2 LQT 3 - ion current affected Na+ - SCN5A - highest risk of lifethreatening arrhythmias. Cardiac Na & K channelopathy Symptoms Most common - abrupt onset/ abrupt offset syncope Palpitations Torsade de pointes SCD 4

5 Distinctive T-Wave T Patterns in the 3 Major LQTS Genotypes J Am Coll Cardiol. 2008;51(24): doi: /j.jacc LQT1: : typical broad-based based T-wave T pattern (corrected QT [QTc] 570 ms) LQT2: : typical bifid T-wave T (QTc 583 ms) LQT3: : typical late-onset peaked/biphasic T-wave T (QTc 573 ms). Reprinted, with permission, from Moss et al. (17). Electrophysiology Study Sequence 5015 IHD w/ MI 2011 HF LVEF 22% PAF with Ablation 2011 Enrolled in IRASE AF clinical trial Electrophysiology Study Sequence 5015 ARS Question: # 5 How will you code EP Study? 1. No 2. Yes 5

6 Cardiac Rhythm(s) Sequence Admitted 1/28/14 for HF w/ NYHA III LVEF 15% Single chamber ICD to CRT-D Telemetry documentation SR w/ PAF; QRS duration 150 1/29/14 ECG = SR 1/30/14 - ECG pre-crt-d = AFib Cardiac Rhythm(s) Sequence ARS Question: # 6 How will you code Cardiac Rhythm? 1. AFib/Flutter, Sinus Rhythm, Both 1 & 2 QRS Duration Sequence 5060 Office note 2/12/14: Plan CRT-D NIDCM w/ NYHA II LVEF 20% ECG - SR w/ LBBB; QRS 126 ms Admitted 2/29/14 for CRT-D ECG SR; QRS 118ms 6

7 QRS Duration Sequence 5060 ARS Question: # 7 How will you code QRS duration? 1. Office ECG 2/12/14 implant decision QRS 126 ms 2. Pre-procedure ECG 2/29/14 - QRS 118ms Section F Implant / Explant ATP or Shock Therapy Sequence Admitted for generator change Device interrogation ATP - appropriate & successful x 2; inappropriate x 1 Shock - No Section F Implant / Explant ATP or Shock Therapy Sequence ARS Question: : # 8 How will you code the ATP and Shock therapy? 1. ATP/Shock Therapy, 6205, Yes, ATP/Shock Therapy Appropriate, 6210, Yes, ATP Therapy Successful, 6215, Yes and Shock Therapy Successful, 6220, Yes. 2. ATP/Shock Therapy, 6205, Yes, ATP/Shock Therapy Appropriate, 6210, No. 3. ATP/Shock Therapy, 6205, Yes, ATP/Shock Therapy Appropriate, 6210, Yes, ATP Therapy Successful, 6215, Yes and Shock Therapy Successful, 6220, No. 7

8 Section E Procedure Information Procedure Type Admitted for this procedure Facility captures All Patient population ERI ICD replaced w/ PPM Patient - declined further ICD therapies Section E Procedure Information Procedure Type ARS Question: # 9 How will you capture the procedure type? 1. Initial Generator Implant 2. Generator Change 3. Leads Only 4. Not captured in the ICD Registry Submission Populations 2 options for submitting data to ICD Registry All Patient population CMS Only population Based on decision by your administration Only one submission type chosen per quarter 8

9 Section I Discharge Medications Discharge Medications Prescribed Admitted for upgrade ICD to CRT-D D/C instructions: resume pre-op meds New prescription Apixaban (Eliquis) Physician documented ARB D/C due to hyperkalemia ACE I not prescribed Section I Discharge Medications Discharge Medications Prescribed ARS Question: # 10 How will you code ACE, ARB and Apixaban? 1. ACE, Contraindicated; ARB, Contraindicated; & Apixaban, as Warfarin 2. ACE, No; ARB, Contraindicated; and Apixaban, as Warfarin 3. ACE, Contraindicated; ARB, Contraindicated; & Apixaban is not captured Episode of Care Pain at ICD implant site Pocket revision Adhesions addressed Pocket deepened No changes to device or leads 9

10 Episode of Care ARS Question: # 11 How will this episode of care be captured? 1. Leads Only 2. Generator Change w/ same generator information for implant /explant 3. Do not capture this episode of care Resources Resources / Documents Data Dictionary Submission Population Resources / Meeting Minutes Resources / FAQ s Monthly RSM Calls Call ncdr@acc.org Reporting an All Patient population Must submit all patients who receive an ICD/CRT-D (initial or generator change) for primary or secondary prevention indications, regardless of the insurance payor. Pages 1 to 5 of the data collection form must be completed for all patients. Must submit all leads data (including the status of all existing leads that have ever been associated with an ICD/CRT-D, either reused, abandoned or previously abandoned)? Must submit all lead revisions (repositioned, extracted, etc ), including the status of all existing leads that have ever been associated with an ICD/CRT-D, (reused, abandoned or previously abandoned) as a Leads Only episode of care (in Section C answer ONLY sequences 4110 and 4125; Section D is left blank; complete Sections A, B, E, G, H, and I) The CMS population will automatically be included when the All Patient population is submitted. Facilities will receive a Premier Outcomes Report with an Executive Summary and Metrics (available via the online Dashboard) The dashboard provides facilities the ability to perform patient level metric drill downs. 10

11 Reporting a CMS Only population At a minimum, this population must be submitted in order to meet the CMS Federal Mandate. Must submit all patients who receive an ICD/CRT-D (initial or generator change) for primary prevention purposes who are insured by Medicare. NOT required to submit leads data. Leads Only episodes of care for lead revisions are NOT required. Must complete pages 1 to 3 and 5 of the data collection tool for both initial generator implants and generator changes. Facilities will receive a Limited Outcomes Report (available on the Dashboard) and will NOT be included in the Executive Summary and Metrics. Facilities will NOT have the ability to perform patient level metric drill downs. 11