Question: Any recommendations
on how to code the following case with respect to bypass and cross
clamp time/ method?
Pt undergoing repair of thoracic-abdominal aneurysm.
Notation of L heart bypass by perfusionist… Arterial cannulation
of descending aorta.. Arterial cannulation of femoral artery.. Clamps
placed above and below thoracic-abdominal aneurysm.. Cross clamp
time = perfusion time (36min)… No oxygenator. STS Reply: Classify the patient as on pump, other
for cannulation.
Question: Seq# 520, version 2.52
Do we code intra spinal use of steroid chronic immunosuppression?
STS Reply: The definition states "any form
of immunosuppressive therapy (i.e. systemic steroid therapy) within
30 days preceding the operative procedure. Does not include topical
applications and inhalers or one time systemic therapy. There is
no "chronic" language in the definition. I think that
it is safe to say that intra spinal use of steroid is not topical
in nature or an inhaler and that it is systemic. So if the patient
received more than a one time dose and it was within 30 days of
the operative procedure, I would code as "yes."
Question: If a patient is seen
in the office for a follow up visit at 27 days post surgery and
is given a clean bill of health, do we have to contact the patient
to confirm “alive /dead “status? Mass-DAC Reply: Yes. 30 day mortality is 30 days
post surgery.
Question: Seq# 560, version 2.52:
How would you count each of the following surgeries in the incidence?
Patient 1: Scenario: CABG plus VAD. n days later (same hospitalization)
VAD removal. Incidence = 1 or 2?
Patient 2:Scenario: CABG. n days later (same hospitalization) VAD
insert. n days later (same hospitalization) the VAD is removed.
Response: Incidence = 1, 2 or 3?
Patient 3:Scenario: VAD placement in cath lab. n days later (same
hospitalization) VAD removed in OR with CABG. Incidence = 1 or 2
Patient 4:Scenario: CABG. n days later (same hospitalization) re-explored
for bleeding. Something surgical fixed (e.g.: repair graft suturing/cannulation
site etc). Incidence 1 or 2? STS Reply: PREVIOUS CV INTERVENTIONS definition:
Indicate if this is the patient's:
* first cardiovascular surgery
* first re-op cardiovascular surgery
* second re-op cardiovascular surgery
* third re-op cardiovascular surgery
* fourth or more re-op cardiovascular surgery.
The intent of this field is to capture the incidence of the procedure
that the patient is about to go through during the current hospitalization
as compared to those procedures prior to this hospitalization. In
all of your examples you need to determine if the patient had any
cardiovascular procedures done prior to the procedure the patient
is about to go through during the current hospitalization, not as
compared to procedures that were done after the procedure that the
patient was initially admitted for. In your examples, the procedures
that occur after the procedure that the patient was initially admitted
for need to be captured in the complication section. According to
the training manual, the intent is to capture procedures done on
the heart and/or great vessels-surgical procedures identified as
CABG, Valve or intrapericardial or great vessels. Question: These examples are all prior admissions.
So for example patient in now for VALVE (DOS = 8/11/2004) but has
history of CABG (1/1/2004) and VAD (1/5/2004).
The VAD in this case was placed as a complication of the CABG. So
my question is when coding the incidence for the valve am I counting
both the CABG and the VAD as 2 separate procedures? STS Reply: Yes.
Question: Seq# 2980, version
2.52 What do we do if the patient has renal failure that requires
dialysis postoperatively that improves before discharge or if a
patient is trached for failure to wean postoperatively but ultimately
gets extubated or the patient who gets liver failure as a result
of hypoperfusion that gets better? Are these organ failures? STS Reply: Multisystem organ failure means there
is no revival of the organ and its function. Mechanical and/or pharmacological
mechanism do not revive the organ's function. Endstage means end
stage. Therefore, a patient that continues to be sustained by dialysis
does not have endstage renal disease as they continue to live with
mechanical assistance. A patient with prolonged ventilation time
resulting in the patients inability to be weaned resulting in ventilator
dependency is not endstage respiratory, as they continue to live
with mechanical assistance. Organ failure is end stage, irreversible
organ failure.
