June 2005 ACC-NCDR Questions The following questions were sent to ACC-NCDR for clarification
of 3.04 version variables
Question: We have a patient
who received lytics at another hospital, was transferred 2 days
later to our hospital and then went for a cath /PCI the following
day. Per FAQ ID#191 we are to code meds administered at a transferring
facility, but what if the lytic therapy was not therapeutic at the
time of admission to our facility, such as in this case? What if
administration is 5 days prior to admit? Would an MI then be coded
as previous MI? If similar to FAQ ID#550 on coumadin administration,
it appears that it should be coded yes even if the med is not therapeutic. ACC Reply: If it has been 5 or more days, I think
it should be a no. If < 5 days, code yes. It is important to
know if they got it. But 5 days ago would be a long time.
Question: We have a supply of
Liberte Stents (Boston Scientific) but only the Taxus Liberte is
listed in the device lists. Is there going to be an update to include
bare metal Liberte stents? ACC Reply: Yes, I added it to our inventory and
will have it uploaded to the web.
Question: If a patient has had
a cardiac transplant should we document any cardiac history relating
to the patient's biological heart (such as a prior MI)? ACC Reply: No, code based on the transplanted heart.
Question: I was involved in a
case yesterday where we were planning on delivering a Cypher into
a D1 but the stent fell off the balloon in the LMCA and we had to
deploy it in the LMCA. I am not sure how to treat this. I have not
created a new lesion in the LMCA because there was no lesion. Any
suggestions? ACC Reply: That has happened before. Create a new
segment and code that a stent was utilized. It won't affect the
calculation of success, but the fact that a stent has been deployed
will be accounted for.
Question: We had a patient come
in via life flight with a STEMI, but it was decided later that the
EKG had been misinterpreted. He had clean coronaries and enzymes
were negative. How do we code the admission symptoms? ACC Reply: Code as atypical chest pain.
Question: For data element #658,
we are using MRI's increasingly for assessment of LV function including
EF, how should we be reporting this in terms of method by which
it is obtained? ACC Reply: Code estimate. I don't see another category
that would fit correctly.
Question: A patient came
in with an evolving MI. He had a diagnostic and intervention. While
recovering, he had tamponade and shock due to free wall rupture
as a complication of his infarct. All of the procedures were technically
successful and the tamponade was related to the heart attack. The
patient died. Do I mark the tamponade and shock as complications
of the first procedure or not? ACC Reply: Yes, they need to be coded even though
the pt died. They need to be coded regardless of cause or timing
(unless the patient is in the hospital >30 days and it occurs
after that).
