ICD 13 Baptist Memphis TN cathPCI education 14 Doylestown Hospital by eoz25885

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									ICD                   13   Baptist Memphis


                                                     TN

cathPCI & education   14   Doylestown Hospital
                                                     PA
Education             15




cathPCI               16   Suburban Hospital




Education             17   Indiana Heart Institute




                                                     IN



NCDR                  18
Education                19




cathPCI                  20   Memorial Hospital


                                                    IN




Cath PCI & ACTION-GWTG   21   Mainland Med Center




                                                    TX
Cath PCI & ACTION-GWTG   22   MSHA (I work mostly from home)




                                                                  TN
Education                23


cathPCI                  24   Martha Jefferson Hospital
                                                                  VA




NCDR                     25   Fairview Southdale Hospital-Edina




                                                                  MN
Education   26




Education   26




cathPCI     27   Metro West Medical Ctr.



                                           MA




cathPCI     28   RN. QMCV Coordinator




                                           FL
Education   29   Baxter Regional Medical Center




                                                  AR




cathPCI     30   Genesis Health System




                                                  IA


Education   31   Oak Hill Hospital

                                                  FL
cathPCI   32   St. Luke's Hospital


                                         MO



cathPCI   33   St. Jude Medical Center


                                         CA
cathPCI   34   Gundersen Lutheran
                                         WI
cathPCI   35




cathPCI   36
cathPCI   37   Hartford Hospital




                                              CT




cathPCI   38   Cheyenne Regional Med Center




                                              WY
cathPCI and education   39   IHVI


                                                        VA
cathPCIand education    40   Marion General Hospital
                                                        OH




cathPCI                 41   Westchester Medical Ctr.




                                                        NY




cathPCI                 42   Clarian Health Partners




                                                        IN
cath PCI    43




cathPCI     44




cathPCI     45   Marin General Hospital
                                          CA




education   45   Marin General Hospital



                                          CA
ICD                     45   Marin General Hospital

                                                              CA




cathPCI and education   46   Florida Medical Ft. Lauderdale




                                                              FL

NCDR                    46   Florida Medical Ft. Lauderdale
                                                              FL




cathPCI                 47   Delnor Community Hospital



                                                              IL




NCDR                    48   WPAHS




                                                              PA
Education               49




ACTION-GWTG             50   Mary Washington Hospital



                                                         VA




cathPCI & ACTION-GWTG   51   CMMC (St. Cloud Hospital)



                                                         MN




Education               52
NCDR   53   Johns Hopkins Hospital




                                     MD




CARE   54   PCMH



                                     NC
Please clarify in FAQ Prior HxCHF Hospitalization. Elem #3095. Is the intent to capture actual admit for CHF primarily -or- admit
with episode of treated CHF -or- any admission where CHF is noted as co-morbidity? Also, will you provide a section for all
FAQ's? Not just some. Elem #3180 - do you want us to capture yes>70% for pts c Hx MI? (It never occurred to me to do this!)
Elem #3110 - A pt who is shocked by ICD appropriately...would you capture this pt as yes tachy arrest? (Never thought of it until it
was mentioned by the speaker during mtg.) Elem #3540 - is there no a 3 mos timeline for LV Lead implant? Am I responsible for
making changes no matter how far out?
I am charged with educating Cath Lab Staff (RN/RCIS) to Point of Care for 4.3 I will be able to apply for & offer them CEU's from
State of PA. ?*Is it possible to get a copy of Powerpoint presentation to use?* The Powerpoint I'm referring to was for Cath PCI
Reg. 4.0
With the next conference, could you please indicate the changes with a new version with color coding? Highlighted yellow for
changes; no color for no changes.




Post-op complication: Myocardial infarction In case study: elevated tropnin level was the criteria to code "yes". In data dictionary -
it's the post CKMB (or CK) level that decides??




Since participants may attend registry workshops other than those they may actually participate in - it is helpful to have data
dictionaries & forms to review. Since some may not want to carry those home along with workshop notes create a second book
that has definition/forms. If participants don't want to carry home they don't have to but could still take workshop syllabus/notes.




FAQ should be available to all without having login/password
Very nice accomodations. Catering staff very pleasant. Think about North Texas for future conferences!




Regarding post PCI biomarkers. We regularly draw these post PCI. Those whose biomarkers elevate then fall into complication
of Post PCI MI. I have noticed if that patient is readmitted say 6-12 months later…it is not documented as the patient having had
an MI in the past. Should I be coding previous MI because I know they had elevated biomarkers in the past? Thank you, Darlene




Can you buddy up the ACTION registry to the CathPCI in order to save dual entry? We use CathPCI and the more thorough
ACTION information /graphs would be nice and useful.
Part 1 - Multiple depts collecting similar data w/ different vendors. I work for CVP services - have been abstracting AMI data
through GWTG/Outcome for Q.I. but Quality Dept submits to CMS/JCHHO through Premier and my partner submits CathPCI data
using Goodroe Cathsource. What would help us to consolidate if costs are a concern? Part 2 - Cath/PCI - Will Goodroe be a
certified software vendor for version 4.3? Part 3 - 1. If height and/or weight are stated values rather than actual values, do we
enter that data? (Assuming patient does not have an actual height/weight done at all) 2. Please clarify: is the device activation
time the insertion time or the 1st balloon predilation time?




Dr. Kutcher, was any of the data in your analysis subject to a data validation program? Also what steps are in place to assure
patient selection does not occur? Concern - Data integrity and clinical decisions being made on observational data.
We currently use the Cerner product to download the Cath/PCI data to the NCDR for version 3.0. Will we be able to continue to
use this product for v 4.3?
Just a general comment - This is my first NCDR conference and just started assisting another employee w/the CathPCI registry 4
months ago. My primary duty is being a specialized Interventional Radiology/Cardiology coder. I also have a 4 year degree in
Health Info. Mgt. After attending, I see even more greatly than before the great link between IR Coding & participating in the
CathPCI registry. I am coding the same cases that may end up in the registry. I wonder if the NCDR recognizes the value that IR
coders can bring to the registries. It was very easy for me to get involved and understand the data definitions. Not only that but I
found it exciting and interesting to dive just a little deeper into the details of each case to grab elements for the registry. If you
haven't already, I think the NCDR should further target getting IR coders involved in the NCDR (specifically CathPCI). I am excited
to bring back ideas to my organization of integratng the work I do on the registry right into my coding workflow. I see this as a
great way to get closer to the goals discussed here of more timely data collection/entry (rather than 1 month later as we have been
doing, I could get a majority of the abstraction done w/a few days of discharge) and I see a real cost savings. Thanks! I had a
Re Quality Strategies WS #16- Wanted to be sure you provide webinar how (to) utilize excel download of reports for building
graphs to present specific Q data over time.




 Part 2 - Nobody discussed certification for us data managers. In my institution it would help validate my expertise outside the CV
realm. Peers can be very critical, despite my presenting what NCDR is all about! oops Kathleen briefly brought up look forward to
more info.




Please clarify SEQ #5025 If the pt has been on one of these meds for longer than 2 weeks with no change in dose - is this coded
as YES? Or - is it only if med was started or changed in the prior 2 weeks do we code yes? Thanks.




My hospital gives detailed cardiac d/c and teaching instructions. The d/c instructions include instruction to discuss
appropriateness of cardiac rehab with their cardiologist. Does this qualify for yes on Cardiac Rehab? Thank you.
Could you email me all of the attendees from AR names, facility, email, phone #? I would be interested in starting a group in AR to
have study meetings to discuss NCDR registry, scenarios, etc. Thank you!




Part 1 - In current version, if a lesion was withing 5mm of previous treated lesion we were instructed to code new lesion as
actuallly having been previously treated with at least a balloon -assumption being if that near, at least the stent deployment bal.
from prev lesion would have touched area now treating - will this continue to be the expectation for coding in version 4.3? Thank
you! Part 2 - I remain confused on cardiac rehab referral @ discharge - does there need to be specific documentation of out pt
referral in order to code yes or is it really enough just to know rehab saw pt while in hospital? In past we were told we had to have
specific documentation of the referral @ this discharge - also told if have MI but doc was that rehab deferred til after staged pci we
had to say no to rehab for this initial stay - still same? Thank you! Part 3 - If is staged pci or cath done elsewhere & we do not do
Lv gram or left heart pressure & are doing coronary angiograms only, are we to answer yes to diag cor angios only & would
answer left heart cath as no? Want to be sure doing it correctly for version 4.3 - Thank you!




Comment! Why not put all informatin on thumb drives to limit book printing and just give brief handouts?
1. Lesion Length: If length is unknown, such as unsuccessful attempt at CTO do we leave blank? 2. Will DQR accommodate this,
as it did with V3? 3. CK-MB in V3 was entered as a "rounded" number. For V4 is this changed (so a number with a decimel can
be entered)?




If pt has "oozing" documented in nursing notes & Hgb drops >3 gm. Is this a 'bleeding event' 8050 & 8055 bleed @ access site?
Some MD's say Hgb drop may be due to dehydration or it is a minor or track oozing? Please clarify assume oozing within 72
hours. Thank You!



If you use a subsequent ECG as documented time for STEMI, does this become the new arrival time? (Relative to door to ballon)
Part 1 - 1. 4050 Standard in MA seems to be cardiac rehab referral done @ 2wk f/u. If MD notes will decide @ f/u - can we code
"yes"? 2. 5020 STEMI = CCS IV ?? 3. 4005 Does MD have to document HTN or can we assume HTN = 2 elevated BP's
documented? 4. 6100 - Shoud have a not documented choice - do not leave anything blank!! Part 2 - Are ss# and HIC #'s
mandated?? or optional since data being sent via internet? Part 3 - 1. If pt refuses to give ss# - do you check n/a? 2. If MI occurs
after date of arrival, what date for arrival date? 3. #5315 - Is temporary wire "other"? 4. 7020 - Need better clarification - salvage -
do you need shock & CPR or just 1? 5. #7040 -? hospital EKG or EMS EKG?




Dominance not documented leave blank? Help explain why UA vs stable. not spelled out Canadian class.
Seq 9050 Cardiac Rehab Referral our facility adopted a discharge checklist which outlines the importance of cardiac rehab & a
phone # to contact cardiac rehab which can be checked by the nursing staff if applicable - can this constitute a cardiac rehab
referral?




Re: 7325 & 7330: Is there evidence based article to support routine drawing of post procedure cardiac biomarkers - If so, please
let me know where I can find that. My docs never order these unless a pt has post procedure chest pain or for some reason a
post procedure ECG done & it showed changes.
When changing the form as extensively you are for Cath/PCI - more time and better presentation on the new form with better tools
should have been done. Rather than doing entire form the focus should have been only on changes. I think more webinars - or
some kind of computer learning needs to be posted. I need to do extensive orientation to other extractors and this has left me
confused. Kathy Ware's had the better presentation but not enough time. Dr. Ho and Susan "Frite" (sic) answered questions most
clearly.

I would recommend having an advanced Cath/PCI group & a beginner Cath/PCI group. Too many of us understand the definitions
& would like to review tough/hard cases that aren't clear-cut.




1. What other facilities are presently able to share how they collect concurrent PCI informatin and who puts the information in? 2.
As our facility uses Lumedx for data submission @ present, we are currently trying to implement the Phillips Hem System (ACC
Info) and have some information scrape over to Lumedx; How can this be perfected to cut down the amount of time actual data
abstraction is presently taking and are there models out there who presently use Phillips Hem system for PCI procedures that go
into Lumedx automatically & who is putting in the PCI info? Thank You!




Are the quality measures changing in any way with version 4?
Would you only code a hematoma as a bleeding complication if an intervention was necessary or if the hematoma resulted in a
prolonged hospital stay - Example - a 8cm hematoma which resolves with manual pressure - would this not be listed as a
complication?




Cath/PCI - day 1 - other major 5x was described as examples AAA - valve -/replacement - on - day 2 - other major 5x- was said to
be a upper GI Eval or anything that prolongs the hospital stay? Confusing




Part 1 - Cath/PCI - If v 4.3 is locked it would have been nice to have that form - Even as a blank form. sep. handout I would have
liked a blank form to think about how I would enter vs looking at (what) someone else has completed.




Part 3 - ALL - Thanks for all the hard work putting this together...interesting speakers, topics. Food was agreat, liked sit down
lunch also liked the way lunch tables were assigned. Thank you also for videotaping sessions. Due to finances my coworker was
unable to attend - and now she will be able (to) see and hear the newest and latest NCDR updates.
 Part 2 - ICD - I am new to the ICD registry as of 1/1/09. I want to compliment your customer service department. They have
been so helpful - sometimes answering the question more than once! They are the best. Thank you.




Part 1 - I was in a.m. PCI Case study - was looking forward to it and got nothing out of it…too many questions/comments - should
be held to 2 per issue… we covered very little. I found this very frustrating and not getting what we came here for. Maybe have
sessions for 1st timers separate from experienced. I wanted to learn changes - not spend 15 min on RACE!




Part 2 - Please make Heart Failure registry a priority.




Our facility often does myoview stress tests. Which stress test do I code this as? Standard/s/spect MPI/CMR?




I submit directly on line (NCDR site for both Cath/PCI and ICD). Will you eventually be able to queary prior to submission to look at
key indicators, e.g., D2B or vasc comps. etc.? (I would like to double check prior to submission.) Thanks!
You need to hire an education consultant to help plan this "education". Very Chaotic!




1. Please send universal definitions for MI to me and to (another participant). Thank you. 2. Please also send Tracy Wang
piece/abstact.




Please send the article on "What is an MI" - Thank You.




Shorter breaks, shorter lunch, a mix of day and evening sessions so that families can be better accomodated.
Will there be a merge with Cath/PCI & ACTION? Seems as though there is A LOT of double documentation. We do not have an
automated system so this creates a lot of work.




What percentage of CARE accounts are also collecting CEA surgical data along with the CAS data? Will there be a future
requirement that CEA data be submitted/mandated along with the CAS data? If so when?
       TOPIC   CARD #                      ORGANIZATION   STATE




ACTION-GWTG      50     Mary Washington Hospital           VA




ACTION-GWTG      57     Overlake Hospital Med Ctr.         WA




ACTION-GWTG      63     Kansas University Hospital         KS




ACTION-GWTG      64     SACMC                              TX




ACTION-GWTG      65     Forsyth Medical Center             NC
ACTION-GWTG              67    Parkview                                            IN



ACTION-GWTG              86    NHC                                                 KY



ACTION-GWTG              97    Baylor Jack & Jane Hamilton Heart & Vascular Hosp   TX




ACTION-GWTG              98    St. Francis Hosp & Medical Center                   CT




ACTION-GWTG              111   University Hosp.                                    GA




Cath PCI & ACTION-GWTG   21    Mainland Med Center                                 TX
Cath PCI & ACTION-GWTG   22    MSHA (I work mostly from home)   TN




cathPCI & ACTION-GWTG    51    CMMC (St. Cloud Hospital)        MN




cathPCI & ACTION-GWTG    60


cathPCI & ACTION-GWTG    113   North Kansas City Hospital       MO
QUESTION


1. Please send universal definitions for MI to above email. Thank you. 2. and to Kelly.eppeldauer@medicorp.org
 3. Please also send Tracy Wang piece/abstact.




 Part 6 - How may I obtain pocket guides for our physicians of the -UA/STEMI guidelines? -STEMI guidelines?




If there is documentation of a 1st EKG but its not in the chart so you don't have a time how do you answer 1st
EKG time?




Part 1 - If EMS goes to someone's house & documents ST elevation from cardiac monitoring but does not have
a 12 lead ECG until hospital arrival, which is documented as 1st noted ST elevation? What are the criteria for
diagnosing heart failure? Part 2 - Thank you for such a wonderful experience! If you have a need for an
international respresentative in the future I'd love to discuss opportunities.




1. Will there be an alignment between ACTION & CMS as to medication? ACTION - if get ="y" CMS - even if get,
if there is CI - coded CI 2. Did Joe say that ACE/ARB NR if EF >40x ? 3. Did Joe say that only native vessel
coded - RCA = 70% RCA graft = 100% Answer = 70%
Sympton Onset Time Estimated. Please make this estimated time same a PCI 0700 morning 1200 lunchtime
1500 afternoon 1800 dinnertime 2200 evening 0300 awakened from sleep


Is participation in the ACTION-GWTG registry required for participation in Mission Lifeline?


Please email me regarding continued GWTG CAD. Until 1/09 we participated for recognition in GWTG. We
understood that for continued recognition we only had to participate in ACC ACTION beginning 1/1/09. What do
we need to do to continue GWTG recognition for 2009?



Inclusion CRITERIA - Please explain - why 72 hours for STEMI on Tx pts? Most of our STEMI's are within hours
Tx. Have not seen Tx >24 hr for STEMI. We do see many NSTEMI's >48 degree transferred whom are not
included. Please clarify meaning behind this Inclusion CRITERIA.




Please send me the article on the definition of an MI. Also Abstract by Tracy Wang on Post Bio Marker. Thanks.




Can you buddy up the ACTION registry to the CathPCI in order to save dual entry? We use CathPCI and the
more thorough ACTION information /graphs would be nice and useful.
Part 1 - Multiple depts collecting similar data w/ different vendors. I work for CVP services - have been
abstracting AMI data through GWTG/Outcome for Q.I. but Quality Dept submits to CMS/JCHHO through Premier
and my partner submits CathPCI data using Goodroe Cathsource. What would help us to consolidate if costs
are a concern? Part 2 - Cath/PCI - Will Goodroe be a certified software vendor for version 4.3? Part 3 - 1. If
height and/or weight are stated values rather than actual values, do we enter that data? (Assuming patient does
not have an actual height/weight done at all) 2. Please clarify: is the device activation time the insertion time or
the 1st balloon predilation time?




Please send the article on "What is an MI" - Thank You.




Est time for AMI awakened from sleep is 4:00 am but 3am for Cath/PCE which is it?




Am I correct that peak enz in Cath/PCI & ACTION may not always align? In that Cath/PCI only looks at certain
time & ACTION just states peak.
NOTE
Universal Definition of MI-
http://circ.ahajournals.org/cgi/reprint/1
16/22/2634.pdf Biomarkers-
http://www.chestnet.org/education/onl
ine/pccu/vol21/lessons05_06/index.p
hp#
The pocket guides for clinical
practice guidelines can be requested
through the ACC Guidelines. These
may be dowloaded from
http://www.acc.org/qualityandscience/
clinical/pocket_guidelines.htm or
ordered in hardcopy.
http://www.acc.org/qualityandscience/
clinical/pdfs/Pocket_Guide_Order_Fo
rm.pdf


The time that prehospital therpy was
administered, such as Aspirin
administration, is an acceptable
proxy for the pre-hospital ECG time.

The first documentation of ST
segment elevation as demonstrated
by 12 lead ECG is required as ST
segment elevation must be in two or
more contiguous leads. Alternate
methods (3 lead
electrocardiography) do not display
contiguous leads simultaneously.
Concerning HF, please read the
definition of heart failure, which
contains the critiera for coding, and
then code based on the physician's
documention. Part 2: Thank you for
your kind words and offer to assist
NCDR. It is very much appreciated
1. The medication instructions for
ACTION Registry-GWTG and the
joint commission AMI core measure
are aligned. 2. Document if
ACEO/ARB was administered.
ACE/ARB are not required if
EF>40% 3. When coding occlusions
in grafted vessel, code the lesion
according to native vessel and the
percent stenosis of the culprit lesion,
be it native or graft.
It is acceptable to use the same
times that are outlined in CathPCI
Participation in the ACTION Registry-
GWTG is requiredfor Mission:Lifeline
Certification and Recognition
For questions regarding your
facilities GWTG-CAD recognition
please contact your AHA affilliate
office or QII representative.
This modification was to evaluate the
outcomes of those patients that are
transferred in greater periods of
time. This is more often the case in
rural areas with long transport times
or a higher porportion of lytic
administration
Universal Definition of MI-
http://circ.ahajournals.org/cgi/reprint/1
16/22/2634.pdf Biomarkers-
http://www.chestnet.org/education/onl
ine/pccu/vol21/lessons05_06/index.p
hp#
In version 4.3 CathPCI and ACTION
version 2 we will have about 80 data
elements that will overlap. Some of
these data elements can be filled out
in one place(registry) and will carry
over to the next registry for the same
data element, so you do not have to
enter the data twice. You will have to
use the same vendor for the
registries for this to work.
Part 1:You can use NCDR online
data collection tools or some ceritfied
software vendors that are certified in
both CathPCI and ACTION. That will
get you approximately 80 data
elements that overlap. However we
are not a vendor for data submission
to CMS/JCAHO. Part 2:Goodroe will
be a v4.3 software vendor and their
certification process is pending at
this time. Part 3: Height and weight
can be coded for patients supplying
that information. We prefer the
actual, but if you only have stated
height and weight we will accept that.
For the reperfusion time, it is always
the first device activation time for any
first device.

You may find the universal definition
of MI at these locations:
http://circ.ahajournals.org/cgi/reprint/1
16/22/2634.pdf ;
http://content.onlinejacc.org/cgi/conte
nt/full/j.jacc.2007.09.011

It is acceptable to use the times
outlined in the Cath PCI instructions,
therefore 3 am.. Because you are
using the CathPCI registry, please
use the definitons for the CathPCI
Registry. These will be better
aligned as we move forward.
That is correct. They are two
different registries and as such
sometimes use different timing.
       TOPIC   CARD #          ORGANIZATION   STATE




CARE             54     PCMH                   NC
QUESTION




What percentage of CARE accounts are also collecting CEA surgical data along with the CAS data? Will there
be a future requirement that CEA data be submitted/mandated along with the CAS data? If so when?
NOTE

Currently, we have 166
sites, with 46 of those sites
submitting both CAS and
CEA procedures, which
totals 27%. There are
no plans to mandate CEA
procedures for this registry
           TOPIC         CARD #               ORGANIZATION   STATE




cath PCI                   43




Cath PCI & ACTION-GWTG     21     Mainland Med Center         TX
Cath PCI & ACTION-GWTG   22   MSHA (I work mostly from home)   TN




Cath PCI and Education   94   St. Anthony's Memorial           IL
cathPCI   16   Suburban Hospital




cathPCI   20   Memorial Hospital           IN


cathPCI   24   Martha Jefferson Hospital   VA




cathPCI   27   Metro West Medical Ctr.     MA




cathPCI   28   RN. QMCV Coordinator        FL




cathPCI   32   St. Luke's Hospital         MO
cathPCI   33   St. Jude Medical Center   CA

cathPCI   34   Gundersen Lutheran        WI




cathPCI   35   Please post in FAQ's




cathPCI   36
cathPCI   37   Hartford Hospital              CT




cathPCI   38   Cheyenne Regional Med Center   WY
cathPCI   41   Westchester Medical Ctr.    NY




cathPCI   42   Clarian Health Partners     IN


cathPCI   44



cathPCI   45   Marin General Hospital      CA




cathPCI   47   Delnor Community Hospital   IL
cathPCI   57   Overlake Hospital Med Ctr.   WA
cathPCI   62                    CA




cathPCI   69   SSM Healthcare   MO




cathPCI   70   SSM Healthcare   MO
cathPCI   71   United Hospital   MN
cathPCI   72   Methodist Debakey Heart & Vascular Ctr.   TX




cathPCI   78   Norwood Hospital                          MA
cathPCI   79   Va. Commonwealth University               VA




cathPCI   81   Quality Mgmt. St. Johns Mercy Med. Ctr.   MO




cathPCI   83   HMC                                       PA
cathPCI   85




cathPCI   92




cathPCI   106   Prairie Lakes Healthcare   SD




cathPCI   112   Danbury Hospital           CT
cathPCI                 30    Genesis Health System        IA




cathPCI & ACTION-GWTG   51    CMMC (St. Cloud Hospital)    MN




cathPCI & ACTION-GWTG   60



cathPCI & ACTION-GWTG   113   North Kansas City Hospital   MO


cathPCI & education     14    Doylestown Hospital          PA
cathPCI & ICD           77   Lawrence & Memorial              CT




cathPCI and educaiton   61   Ochsner                          LA




cathPCI and education   39   IHVI                             VA




cathPCI and education   46   Florida Medical Ft. Lauderdale   FL




cathPCI and education   90   Florida Hospital                 FL
cathPCI and education   110   Teksan Heart Hospital     TX

cathPCIand education    40    Marion General Hospital   OH
QUESTION




Would you only code a hematoma as a bleeding complication if an intervention was necessary or if the
hematoma resulted in a prolonged hospital stay - Example - a 8cm hematoma which resolves with manual
pressure - would this not be listed as a complication?




Can you buddy up the ACTION registry to the CathPCI in order to save dual entry? We use CathPCI and the
more thorough ACTION information /graphs would be nice and useful.
Part 1 - Multiple depts collecting similar data w/ different vendors. I work for CVP services - have been
abstracting AMI data through GWTG/Outcome for Q.I. but Quality Dept submits to CMS/JCHHO through Premier
and my partner submits CathPCI data using Goodroe Cathsource. What would help us to consolidate if costs
are a concern? Part 2 - Cath/PCI - Will Goodroe be a certified software vendor for version 4.3? Part 3 - 1. If
height and/or weight are stated values rather than actual values, do we enter that data? (Assuming patient does
not have an actual height/weight done at all) 2. Please clarify: is the device activation time the insertion time or
the 1st balloon predilation time?




*Needs RSM Training** Have never had a training session with NCDR - when questioned NCDR at start up 1 yr
ago was advised to go to FAQ's.
Post-op complication: Myocardial infarction In case study: elevated tropnin level was the criteria to code "yes".
In data dictionary - it's the post CKMB (or CK) level that decides??




Regarding post PCI biomarkers. We regularly draw these post PCI. Those whose biomarkers elevate then fall
into complication of Post PCI MI. I have noticed if that patient is readmitted say 6-12 months later…it is not
documented as the patient having had an MI in the past. Should I be coding previous MI because I know they
had elevated biomarkers in the past? Thank you, Darlene


We currently use the Cerner product to download the Cath/PCI data to the NCDR for version 3.0. Will we be
able to continue to use this product for v 4.3?




Please clarify SEQ #5025 If the pt has been on one of these meds for longer than 2 weeks with no change in
dose - is this coded as YES? Or - is it only if med was started or changed in the prior 2 weeks do we code yes?
Thanks.




My hospital gives detailed cardiac d/c and teaching instructions. The d/c instructions include instruction to
discuss appropriateness of cardiac rehab with their cardiologist. Does this qualify for yes on Cardiac Rehab?
Thank you.




1. Lesion Length: If length is unknown, such as unsuccessful attempt at CTO do we leave blank? 2. Will DQR
accommodate this, as it did with V3? 3. CK-MB in V3 was entered as a "rounded" number. For V4 is this
changed (so a number with a decimel can be entered)?
If pt has "oozing" documented in nursing notes & Hgb drops >3 gm. Is this a 'bleeding event' 8050 & 8055 bleed
@ access site? Some MD's say Hgb drop may be due to dehydration or it is a minor or track oozing? Please
clarify assume oozing within 72 hours. Thank You!


If you use a subsequent ECG as documented time for STEMI, does this become the new arrival time? (Relative
to door to ballon)




Part 1 - 1. 4050 Standard in MA seems to be cardiac rehab referral done @ 2wk f/u. If MD notes will decide @
f/u - can we code "yes"? 2. 5020 STEMI = CCS IV ?? 3. 4005 Does MD have to document HTN or can we
assume HTN = 2 elevated BP's documented? 4. 6100 - Shoud have a not documented choice - do not leave
anything blank!! Part 2 - Are ss# and HIC #'s mandated?? or optional since data being sent via internet? Part 3 -
 1. If pt refuses to give ss# - do you check n/a? 2. If MI occurs after date of arrival, what date for arrival date? 3.
#5315 - Is temporary wire "other"? 4. 7020 - Need better clarification - salvage - do you need shock & CPR or
just 1? 5. #7040 -? hospital EKG or EMS EKG?




Dominance not documented leave blank? Help explain why UA vs stable. not spelled out Canadian class.
Seq 9050 Cardiac Rehab Referral our facility adopted a discharge checklist which outlines the importance of
cardiac rehab & a phone # to contact cardiac rehab which can be checked by the nursing staff if applicable - can
this constitute a cardiac rehab referral?




Re: 7325 & 7330: Is there evidence based article to support routine drawing of post procedure cardiac
biomarkers - If so, please let me know where I can find that. My docs never order these unless a pt has post
procedure chest pain or for some reason a post procedure ECG done & it showed changes.
1. What other facilities are presently able to share how they collect concurrent PCI informatin and who puts the
information in? 2. As our facility uses Lumedx for data submission @ present, we are currently trying to
implement the Phillips Hem System (ACC Info) and have some information scrape over to Lumedx; How can this
be perfected to cut down the amount of time actual data abstraction is presently taking and are there models out
there who presently use Phillips Hem system for PCI procedures that go into Lumedx automatically & who is
putting in the PCI info? Thank You!




Are the quality measures changing in any way with version 4?




Cath/PCI - day 1 - other major 5x was described as examples AAA - valve -/replacement - on - day 2 - other
major 5x- was said to be a upper GI Eval or anything that prolongs the hospital stay? Confusing

Part 1 - Cath/PCI - If v 4.3 is locked it would have been nice to have that form - Even as a blank form. sep.
handout I would have liked a blank form to think about how I would enter vs looking at (what) someone else has
completed.




Our facility often does myoview stress tests. Which stress test do I code this as? Standard/s/spect MPI/CMR?
Part 2 - PCI - 1. When will regional outcomes be a part of our Institutional Outcomes Report? 2. What will
Reigional reports look like: -at Executive Summary level; -at Detail level? Part 3 - Regarding pre-PCI Troponin
for STEMI: the v. 4.0 form does not offer an option for baseline Troponin for transfer patients nor a check box for
if bedside Troponin (POC) was obtained for non-transfer pts. Will this be added in future? Our facility is using
more POC Troponins. Part 4 - UA?NSTEMI Guidelines recommend early intervention for high risk UA and
NSTEMI: 1. What is the definition of "early"? I have been told everything: from "<90 min D2B" to "2-3 days" from
the ACC. 2. Is there a published recommendation from ACC/AHA for time frame for early intervention? Part 5 -
For PCI sites without an electronic medical record (80+% manual abstraction) and 1500 annual procedure
volume: 1. What is the average time per case involved in data abstraction (including data entry)? 2. What total
time is involved in data "clean -up" (Validation) before submitting to ACC?
Are you going to go c the times accepted in PCI Eg 0700 morning? Need to include automatic change of height
>cm I keep seeing pts being put on amiodarone then (either max or mag) BB. It is not listed as a
contraindication.




If pre PCI LVEF (#7025) absolute? i.e., If V-gram is done immediately post pci - that will not count as pre? Is this
correct?




IN Case study #2, seg 5061 cardiogenic shock within 24 hours: NO. Pt was asystole, vfib, vtach precath. He
had a BP > 80 with this. Is it a problem with length of time? Why is it a post complication and not a precondition?
Part 1 - PAD > does this include subclavian arteries? Chronic lung disease: does this include asbestosis? Anti
Anginal meds > How do we know what the intent was at the time the meds were prescribed? What if they are on
B-blockers for migraines or Hi BP or ectopy (PAT)? Part 2 - Cardiogenic shock> what if pt's baseline BP is 90
or less? PCI Procedure> Our hospital only reports PCI. Do we use the "Perc" time as start of procedure if a
diagnostic cath is done at same setting, or do we use "Intervention begins" documentation? Part 3 - EF> If the
EF is done as part of the diagnostic cath immediately before the PCI begins, do we use it? First Device> What if
the guidewire opens the artery & TIMI 3 flow is restored? What time do we use?
Part 1 - 1. How to code family history of CAD but do not know age when relative had it. 2. If pt has a RCA PCI
on 3/26 and I fill out the form completely. Then if this pt had a LAD PCI on 3/38 (same admission) do I have to fill
out this entire form again? Part 2 - If our institution only submits PCI do I check (310) diagnostic Cath also if a
diagnostic Cath was done?




Prior PCI Seq #4035 "placement of angioplasty guide wire" I thought wire was not device & didn't count.
Part 1 - Does your data show a trend change in volume of cath & PCI nationally? Do other institutions use a pre
cath risk scoring system to make an impact on risk-adjusted mortality? (using appropriatness criteria)? Part 2 -
In case #2 PCI you did not count shock since it occurred before admission & pt not in shock in ER. In past we
were told to include this since it greatly affects risk adjusted mortality. This is a truly indicative factor for how sick
this pt is.




Ref: Risk adjusted mortality % on DQR Quarterly Update - We do many of cases that no one else will take,
therefore our Risk Adjusted Mortality Rate is barely inside the whisper box low end. I don't see any way of ever
seeing this improve unless my hospital won't take these patients but that will never happen. We take everyone.
That is in our mission statement etc. Is there a way to set aside this particular Risk Group to subset them in a
different subset group but also include all other in a separate group (a subset)? Perhaps after listening to the
previous lecture from Dr. Rumsfeld maybe at point of service for RISK stratification at the door to direct to their
specific subgroup-




STS uses Hbg A1C for defining Diabetes why doesn't PCI?
CCS Class coding - For ease of keying during data entry why not use: 1=No; 2=1; 3=2; 4=3; 5=4. 0=No; 1=1;
2=2; 3=3; 4=4 (less mistakes)




1. PTCA & stenting of dissection usually has nothing to do c disease but rather tacking down flaps, so % of
stenosis is really not important. 2. I think if an EF is not done pre-PCI, previous EF's should not be recorded for
risk adjustment unless the EF is known to be abnormal (i.e. 20%).




1. Does anyone have their Hemo systems connect to your EMR? What Hemosystem do you have & what EMR
are you running? 2. Will you be adding a future question regarding Cardiac Scoring?




Re Element 7085 Cath/PCI: During Cath/PCI definitions 3/26 the new PCI reason for delay I believe it was said
that if you did PCI with 90 mins you do not address the delay. But on 3/27 Case #2 D2B was 67 mins from
arrival@hosp #1 to device at hosp #2. Why was the delay captured? Just because MD charted it?
Part 1 - In current version, if a lesion was withing 5mm of previous treated lesion we were instructed to code new
lesion as actuallly having been previously treated with at least a balloon -assumption being if that near, at least
the stent deployment bal. from prev lesion would have touched area now treating - will this continue to be the
expectation for coding in version 4.3? Thank you! Part 2 - I remain confused on cardiac rehab referral @
discharge - does there need to be specific documentation of out pt referral in order to code yes or is it really
enough just to know rehab saw pt while in hospital? In past we were told we had to have specific documentation
of the referral @ this discharge - also told if have MI but doc was that rehab deferred til after staged pci we had
to say no to rehab for this initial stay - still same? Thank you! Part 3 - If is staged pci or cath done elsewhere &
we do not do Lv gram or left heart pressure & are doing coronary angiograms only, are we to answer yes to diag
cor angios only & would answer left heart cath as no? Want to be sure doing it correctly for version 4.3 - Thank
you!




Please send the article on "What is an MI" - Thank You.




Est time for AMI awakened from sleep is 4:00 am but 3am for Cath/PCE which is it?




Am I correct that peak enz in Cath/PCI & ACTION may not always align? In that Cath/PCI only looks at certain
time & ACTION just states peak.

I am charged with educating Cath Lab Staff (RN/RCIS) to Point of Care for 4.3 I will be able to apply for & offer
them CEU's from State of PA. ?*Is it possible to get a copy of Powerpoint presentation to use?* The Powerpoint
I'm referring to was for Cath PCI Reg. 4.0
Is there one software vendor that is more user friendly than another? Which do you prefer?




Can a form - containing only the changes be developed and distributed?




When changing the form as extensively you are for Cath/PCI - more time and better presentation on the new
form with better tools should have been done. Rather than doing entire form the focus should have been only on
changes. I think more webinars - or some kind of computer learning needs to be posted. I need to do extensive
orientation to other extractors and this has left me confused. Kathy Ware's had the better presentation but not
enough time. Dr. Ho and Susan "Frite" (sic) answered questions most clearly.




Part 1 - I was in a.m. PCI Case study - was looking forward to it and got nothing out of it…too many
questions/comments - should be held to 2 per issue… we covered very little. I found this very frustrating and not
getting what we came here for. Maybe have sessions for 1st timers separate from experienced. I wanted to
learn changes - not spend 15 min on RACE!




 Re 1:30-3:00: Several speakers on the panel did not speak clearly. But, were quick to speak clearly when
needing to comment on questions being asked.
Do you have any resource or training on reading the report - what it means - how to read the report, the
importance of the report?




I would recommend having an advanced Cath/PCI group & a beginner Cath/PCI group. Too many of us
understand the definitions & would like to review tough/hard cases that aren't clear-cut.
NOTE
First of all the hematoma
definition requires this to
occur within 72 hours. To
clarify we are assuming
that you did not have a
drop in Hct or Hgb or you
did not require a
transfusion. A prolonged
hospital stay is not part of
the requirement for this
definition in v4. Also part of
the note states that
prolonged pressure does
not qualify as an
intervention. So in the case
that you have stated here,
we would not code this as
an adverse event. Again
note, that is with the
information that you have
provided.


In version 4.3 CathPCI and
ACTION version 2 we will
have about 80 data
elements that will overlap.
Some of these data
elements can be filled out
in one place(registry) and
will carry over to the next
registry for the same data
element, so you do not
have to enter the data
twice. You will have to use
the same vendor for the
registries for this to work.
Part 1:You can use NCDR
online data collection tools
or some ceritfied software
vendors that are certified in
both CathPCI and
ACTION. That will get you
approximately 80 data
elements that overlap.
However we are not a
vendor for data submission
to CMS/JCAHO. Part
2:Goodroe will be a v4.3
software vendor and their
certification process is
pending at this time. Part
3: Height and weight can
be coded for patients
supplying that information.
We prefer the actual, but if
you only have stated height
and weight we will accept
that. For the reperfusion
time, it is always the first
device activation time for
any first device.


We have multiple training
sessions per year via
webcasts. Please check
the Announcement and
Latest News pages on the
website for the dates and
times. We also post many
resources on our website,
including several case
studies with answers. In
addition, please do not
hesitate to email or call us
with a question. We are
here to assist you.
In version 4.3, we use the
Universal Definition of MI.
And in section 2a of the
definition for Myocardial
Infarction indicates a rise
and fall in cardiac
biomarkers, preferably
Troponins. In v3.04 we had
indicated the use of CK
only; in v4.3 we can use
either CK or Troponins.
Yes, you should code this
as a previous MI if you
know this data. We
understand that it might not
be part of the discharge
summary or the procedure
summary.
Yes Cerner, is scheduled
to be certified the end of
May or early June.
You code yes if the patient
has taken the medication
(any of them) in the past
two weeks. It does not
matter if the dose has or
has not been changed or
however long they have
been on the medication.
No. The referral must be
communicated to the
patient prior to discharge
or at the time of discharge
for Cardiac Rehabilitation
Referral to be coded as
Yes. If the referral is to be
decided during an
outpatient follow up
appointment, then code
No, they did not get a
rehab referral.
If lesion length is unknown,
the lesion length should be
coded as left blank. In v4.3
we will allow for double
decimal places for the
coding of biomarkers.
It doesn't matter if there is
an ooze or not. If it meets
the definition, then it needs
to be coded. If there is a
3Gm drop in Hgb, within
the 72 hours as noted,
then code it.
Yes you would code this
time as the door time.
Part 1: The referral must
be communicated to the
patient prior to discharge
or at the time of discharge
for Cardiac Rehabilitation
Referral to be coded as
Yes. If the referral is to be
decided during an
outpatient follow up
appointment, then code
No, they did not get rehab.
# 2. Not necessarily,
STEMI patients could be
categorized with CCS III.
#3. Yes the physician
needs to document HTN.
#4: If Dominance is
unknown, it will be
necessary to leave it blank.
The data thresholds will
allow this to occur a small
percentage of the time.
Part 2: There will be
information posted on the
website regarding SS and
HIC numbers. Data
submitted via the web are
secured beyond the
requirments dictated. The
data zip files are encrypted
and the website is
password protected. # 2
The question doesn't relate
If dominance is not
documented, you will have
to leave the field blank.
Unstable vs. stable angina
is listed in CAD
Presentation (SEQ 5000).
It is not listed in CCS class.
Angina should be should
be at least a CCS Class III.
The referral must be
communicated to the
patient prior to discharge
or at the time of discharge
for Cardiac Rehabilitation
Referral to be coded as
Yes. If the referral is to be
decided during an
outpatient follow up
appointment, then code
No, they did not get rehab.


The 2005 ACC/AHA/SCAI
Guideline on Percutaneous
Coronary Intervention
recommends that serum
CK-MB and Troponin I or T
should be measured in all
patients with symptoms
suggestive of an MI during
or after PCI and in all
patients with complicated
procedures . The
guidelines consider it
reasonable to routinely
measure CK-MB and/or
troponin I or T in all
patients 8 to 12 hours after
PCI. This approach was
not changed in the 2007
ACC/AHA focused update
of the PCI guidelines. But
we do have a presentation
by Tracy Wang, MD that
shows that while the
prevalence of peri-
procedural MI is greater,
the patients also got better
quality of care at those
centers.
1. We are not able to share
this information with you.
However since you are a
part of the HCA network
you could ask your fellow
data managers in the HCA
network this question. 2.
You will have to work with
your software vendor to
make sure that you can
scrape the data over and
that it meets the data
definitions for the CathPCI
registry. Once completed
you are correct that this
should cut down on the
time it takes to enter data.
We do not work with
hemodynamic vendors and
your software vendor will
have to do that.


Yes, there will be new
metrics coming out. There
will be some metrics that
will stay the same. But
since it is a new version
there will be several new
metrics. We are still in the
process of working on the
new metrics.

Unable to understand
question. No answer given.
Both a pdf and Word
document are posted on
the website under the
v4.xx documents.
In v4.3 this would be coded
in SPECT/MPI as it is a
nuclear scan type of test.
We plan to update the
imaging tests in a year to
be able to code this more
accurately.
Part 2:We are working on
the development of v4.3
outcome reports. We hope
to have an interactive type
of report that the end user
can define. This would
include a regional type
report. We are not sure
what they will look like
since they are still in
development. Part 3: If the
patient is a transfer or only
has POC testing done,
they should code Not
Drawn. We do not plan on
having data elements in
the future that will capture
these Pre PCI labs. Part 4:
The definition of early in
the guidelines for
NSTEMI/UA are general
and it is left up to the
physicain's discretion of
treatment time. However
most of the timelines in the
guidelines state 6 to 8
hours for enzymes, after
the onset of symptoms,
and according to our
definition of acute
treatment, we are looking
at treatment within 24
hours from the onset of
 The CathPCI Registry
asks that the physician, NP
or PA document why a
medication is
contraindicated. We can
not have full access to the
medical chart and thus can
not determine what the
physician was thinking.
The providers are
liscensed to use clinical
judgement to prescribe
medications to their
patients. There will never
be a set of guidelines
agreed upon by all nor
followed by all. Thus it is
not possible for the
CathPCI Registry to create
such coding instructions.
Yes, that is correct. An
LVEF done anytime after
the PCI is to be coded in
data element # 9030,
LVEF in the discharge
section.
Answered at Meeting:
Stated BP would not have
been decreased. In fact,
they said pts BP was
150/90 so they said NO to
precardiogenic shock
within 24 hour timeframe.
Part 1. Yes, PAD includes
subclavian arteries. In
regard to the Chronic Lung
disease, the answer is
clinically active asbestosis
(as opposed to just the
presence of pleural
plaques, but disease that
alters lung function) or
black lung or parasitic lung
disease counts. The intent
of the prescription is not
what is being asked. We
are asking you to code
whether or not the patient
has been on these
medications during the two
weeks prior to admission,
not necessarily why they
were on these
medications. Part 2. If the
patient is experiencing
signs and symptoms
suggestive of cardiogenic
shock then code Yes. If the
patient is maintaining that
baseline without
symptoms, nor requiring
inotropes or ventricular
support, then code No to
Cardiogenic Shock. Start
time of the procedure will
be coded as "perc time"
#1. If you do not know the
age of the relative, code
NO to family history. #2.
Subsequent cath lab visits
during the same admission
do not require the entire
form to be completed.
There is a Add Cathlab
visit function which can be
used if you are using the
NCDR data collection tool.
In the heading of each
section within the data
collection form there is a
comment that indicates
what needs to be
completed for each cath
lab visit or PCI. Part 2.
Sites that submit as PCI
Only are asked to submit
the diagnostic cath that
indicates the PCI should
be submitted as well.
This is a change from
Version 3. The definition of
Prior PCI now includes "the
placement of an
angioplasty guidewire".
Part 1. The number of sites
participating and
successfully submitting
data fluctuates in a way
that does not allow us to
report trends in volume.
We also do not have
capture of all cathlabs in
the country, so we do not
report "national" numbers.
There are too many
dependent variables
involved to be able to
report upon trends. We are
not aware of any facilities
using a pre cath risk
scoring system at this time.
Part 2. If the patient is not
in cardiogenic shock upon
admission or in the
hospital, Code NO for
Cardiogenic Shock. This
has not changed from
Version 3. If the patient
has recovered from CS
prior to the admission, then
code No.

The essence of adjusting
for the risk of PCI is to
allow for an equal
comparison. If the data
elements are coded
correctly then the odds
associated with mortality
for the more severely ill
patient will increase when
compared to those patients
without any risk factors.

Hbg A1C is not
recommended to be a
diagnostic lab. The lab is
recommended to be used
only for patient monitoring.
Thank you for your
comment which we will
consider at the next
registry update. However,
because this would require
a change to the specs and
the software vendors
would need to reprogram
their software, we will not
be changing it at this
moment.
We appreciate your
comments. We base our
defintions on the guidelines
and reaching consensus
on the expert opinions of
our physicians on the
CathPCI working group.

The NCDR online data
collection tool does not
allow for an interface with
any cathlab equipment.
Please network with other
participants for questions
and answers regarding
Hemosystems. We do not
know what systems the
participating hospitals are
using. Question #2 can not
be understood.

You can code any reason
for a delay. It does not
need to be coded only for
patients that are greater
than 90 minutes for DTB. It
can be coded for all
patients even those less
than 90 minutes for a DTB
time. And yes, part of the
reason why we coded it in
the test case was because
the physician documented
it.
1) That will not be an
assumption in v4.3. For the
treated area we cannot
assume that any area
beyond the stent or
previous treated lesion
length has been treated.
Therefore, we would keep
the treated are limited to
the lesion length/stent
length only. 2) In v4.3 we
need to have the actual
referral in the chart. We do
have the option to code
ineligible. 3) In v4.3 you
code 5310 as "Yes" and
then code 6020 as Yes
since it is only coronary
angiography. You would
code No to 6025 as this is
not a left heart cath.

You may find the universal
definition of MI at these
locations:
http://circ.ahajournals.org/c
gi/reprint/116/22/2634.pdf ;
http://content.onlinejacc.org
/cgi/content/full/j.jacc.2007.
09.011
It is acceptable to use the
times outlined in the Cath
PCI instructions, therefore
3 am.. Because you are
using the CathPCI registry,
please use the definitons
for the CathPCI Registry.
These will be better
aligned as we move
forward.
That is correct. They are
two different registries and
as such sometimes use
different timing.
All presentations will be
made available online
We do not use the
software that the vendors
supply. We also cannot
recommend one over the
other. We suggest that you
contact local hospitals or at
one of our meetings,
discuss this with them to
see how they feel.


This is an excellent
suggestion. We have
made the data collection
form available on our
website in the Documents
(V4.0x) section The form
shows elements with no
change as white
background, elements with
minimal change to name or
definition as yellow
background, and totally
new elements are in green.


Thank you for your
excellent feedback. We
will use this as we continue
to prepare for other
educational sessions to
improve the presentations..

Thank you for your
feedback, which will be
given to the speakers. We
are sorry that you found
the experience not as
beneficial as you had
hoped. For the next
meeting, we will be asking
the room faciliator to assist
in moderating the Q & As
during the presentation.

Thank you for your
feedback. We appreciate
receiving critiques like this.
This information will be
given to the speakers and
used to improve our
presentations.
We do have an
interpretation guide that will
assist you with the
questions that you have
asked. It is located on the
website once you log in at
https://www.ncdr.com/Web
NCDR/RESOURCES/V3D
OCUMENTS.ASPX#15
Thank you for this
suggestion.
        TOPIC     CARD #                 ORGANIZATION   STATE




Education & ICD     4      Boca Raton Comm Hospital      FL




cathPCI & ICD       77     Lawrence & Memorial           CT

Education & ICD     9      Mercy Medical Center          OH




ICD                 1      Washington Hospital Center    DC




ICD                 2      United Hospital               MN


ICD                 8      Largo Medical Center          FL



ICD                 11     St. Joseph's Hospital         GA
ICD   12    North Colorado Medical Center   CO




ICD   13    Baptist Memphis                 TN




ICD   45    Marin General Hospital          CA
ICD   55    Memorial Medical Center         NM




ICD   56    Florida Hospital -Orlando       FL




ICD   108   Forsyth Medical Center/Novant   NC
ICD/Care   89   EMH   OH
QUESTION


1. May I get a copy of the slides Dr. Kremors explained befoe the case studies (in which he reviewed some CMS
requirements)? 2. Does medicare pull every registry entry to verify billing for reimbursement or only ones that fall
out or are yellow-lighted?




Is there one software vendor that is more user friendly than another? Which do you prefer?




I would like the slides that the Dr. who presented case #4-#6 had shown. Particularly the slide that had shown
primary prevention and secondary def & criteria.


If a pt with a EF of 30% has an ICD implanted then returns later for a generator replacement and now has an EF
of 55%...which EF do we submit?




Many sites have the ICD implanting physicians filling out the ICD form. The data they put on the forms is not
always available in the patient medical record. How will those charts be audited?




How do you code for a pt that went AMA?


Could you put an area next to implant date that states discharge date…it keeps you from flipping the data
collection sheet. I amended the sheet I use & made copies. It is easier when using the online data collection
tool.
Pt Hx: No hx CHF (EF 50%), No hx ischemic heart disease but hx of Hypertrophic CM w/ re-entrant outflow track
tachycardia. Since this is different from non-ischemic dilated CM, do I say No to both Ischemic and non-
ischemic cardiomyopathy currently?




Please clarify in FAQ Prior HxCHF Hospitalization. Elem #3095. Is the intent to capture actual admit for CHF
primarily -or- admit with episode of treated CHF -or- any admission where CHF is noted as co-morbidity? Also,
will you provide a section for all FAQ's? Not just some. Elem #3180 - do you want us to capture yes>70% for pts
c Hx MI? (It never occurred to me to do this!) Elem #3110 - A pt who is shocked by ICD appropriately...would
you capture this pt as yes tachy arrest? (Never thought of it until it was mentioned by the speaker during mtg.)
Elem #3540 - is there no a 3 mos timeline for LV Lead implant? Am I responsible for making changes no matter

Part 2 - ICD - I am new to the ICD registry as of 1/1/09. I want to compliment your customer service
department. They have been so helpful - sometimes answering the question more than once! They are the best.
 Thank you.

Will version 2.0 include procedure indication criteria and reporting if it is met?




In version 2, if a patient requires multiple therapies (generator implant, lead replacement for broken lead) but
done at different times, can this be abstracted on one form or multiple due to different intervention date and
times? Thank You.




Can lead dislodgements for ICD Registry be separated for new implants & generator changes? The % of lead
dislodgements should be higher for new implants. Do some sites only do generator changes? Part 2: Can
NCDR create individual physician scorecards with quarterly reports?
Part 1 - Will version 2 include complication after discharge date? Example - Infection on Hematoma evacuation.
Part 2 - Can you make the online tools alike for both ICD & Care - Data collection? Example - make yes or no
the first drop down on both.
NOTE
1. All presentations will be
made available online. 2.
Every Medicare Primary
Prevention ICD inserted is
subject to an audit by
Medicare
We do not use the
software that the vendors
supply. We also cannot
recommend one over the
other. We suggest that you
contact local hospitals or at
one of our meetings,
discuss this with them to
see how they feel.
All presentations will be
made available online
For the purpose of the ICD
Registry, please code the
most recent lowest EF
available. In this case
scenario, please code 55%.

Please encourage your
physicians to provide
documentation of patient’s
clinical indications in the
medical record. If in the
event of an audit by CMS,
documentation will need to
be provided in the patient
medical record.
For V1.08 please code
contraindicated if patient
leaves AMA
Thank you for your
feedback. We will take this
into consideration as we
finalize V2.0.
V1.08 is not equipped to
code congenital or
structural abnormalities.
We will be addressing
these issues in V2.0, but
for the purposes of V1.08,
please code according to
the information provided.
To clarify your question in
the scenario you provided,
please code (No) to
Ischemic and (Yes) to Non
Ischemic cardiomyopathy.


To clarify your question in
the scenario you give:
Please code (No) to
Ischemic and (Yes) to Non
Ischemic cardiomyopathy.

Thank you for your kind
comments. We are here to
help you which helps all
the cardiovascular patients.
Yes
A new form will need to be
completed for each visit
however, not all DCT
sections will need to be
completed depending on
the procedure. There will
be coding instructions
available to guide you
through different scenarios
of which sections to
complete
Part 2 We will have the
technical ability in the near
future to do physician
reports but have not
created a plan to do this.
Part 1. The ICD Registry
collects inpatient data only.

Part 2. We are continually
looking to build our tools in
a consistent manner and
the Modernization program
described during the
Annual Meeting will help in
this regard. This will be
done as Registries move
to new versions and/or are
developed
        TOPIC            CARD #                 ORGANIZATION   STATE




Cath PCI and Education     94     St. Anthony's Memorial        IL




Education & ICD            4      Boca Raton Comm Hospital      FL


cathPCI & education        14     Doylestown Hospital           PA




cathPCI and educaiton      61     Ochsner                       LA




cathPCI and education      39     IHVI                          VA
cathPCI and education   46    Florida Medical Ft. Lauderdale   FL




cathPCI and education   90    Florida Hospital                 FL




cathPCI and education   110   Teksan Heart Hospital            TX

cathPCI and education   40    Marion General Hospital          OH




Comment                 88    VBMC




Comment                 95
Education   29   Baxter Regional Medical Center   AR


Education   5    Fairview Southdale Hospital      MN




Education   6    Community _________M.C.          OH

Education   15




Education   17   Indiana Heart Institute          IN
Education   19

Education   23



Education   26




Education   26




Education   31   Oak Hill Hospital        FL




education   45   Marin General Hospital   CA
Education   49




Education   52




Education   57   Overlake Hospital Med Ctr.                  WA




Education   58   Lancaster General Hospital                  PA

Education   73   Sacred Heart Hospital                       FL




Education   75

Education   80   Central MN Heart Ctr @ St. Cloud Hospital   MN
Education         82    Morton Plant Mease Healthcare       FL




Education         105   St. John's Mercy Medical Ctr.       MO




Education         114   Botsford Hosp                       MI

Education & ICD    9    Mercy Medical Center                OH




NCDR              104   Boca Raton Comm Hospital            FL


NCDR               3    Clarian Health                      IN



NCDR               7    Mary Greeley                        LA




NCDR              18




NCDR              25    Fairview Southdale Hospital-Edina   MN
NCDR   46   Florida Medical Ft. Lauderdale       FL




NCDR   48   WPAHS                                PA




NCDR   53   Johns Hopkins Hospital               MD


NCDR   57   Overlake Hospital Med Ctr.           WA




NCDR   59   Stony Brook University Medical Ctr   NY


NCDR   68   Main Line Health                     PA




NCDR   76   Baylor Heart & Vascular Hospital     TX
NCDR   76   Baylor Heart & Vascular Hospital   TX



NCDR   84




NCDR   87   Holy Redeemer Hospital             PA




NCDR   91


NCDR   99
NCDR   100   Henry Ford Nacomb Hospital      MI




NCDR   101




NCDR   102   Holy Cross Hospital             FL




NCDR   103   Monongalia Gen. Hosp.           WV




NCDR   105   St. John's Mercy Medical Ctr.   MO




NCDR   107   Mary Washington Hospital        VA
NCDR               109   Heart of FL. Hwy 27     FL




NCDR & Education   10    St. Joseph's Hospital   GA




Question           66    WFUBMC
Question   68   Main Line Health   PA




Question   93
Question   96   Morristown Mem Hosp   NJ
QUESTION




*Needs RSM Training** Have never had a training session with NCDR - when questioned NCDR at start up 1 yr
ago was advised to go to FAQ's.




1. May I get a copy of the slides Dr. Kremors explained befoe the case studies (in which he reviewed some CMS
requirements)? 2. Does medicare pull every registry entry to verify billing for reimbursement or only ones that fall
out or are yellow-lighted?


I am charged with educating Cath Lab Staff (RN/RCIS) to Point of Care for 4.3 I will be able to apply for & offer
them CEU's from State of PA. ?*Is it possible to get a copy of Powerpoint presentation to use?* The Powerpoint
I'm referring to was for Cath PCI Reg. 4.0




Can a form - containing only the changes be developed and distributed?




When changing the form as extensively you are for Cath/PCI - more time and better presentation on the new
form with better tools should have been done. Rather than doing entire form the focus should have been only on
changes. I think more webinars - or some kind of computer learning needs to be posted. I need to do extensive
orientation to other extractors and this has left me confused. Kathy Ware's had the better presentation but not
enough time. Dr. Ho and Susan "Frite" (sic) answered questions most clearly.
Part 1 - I was in a.m. PCI Case study - was looking forward to it and got nothing out of it…too many
questions/comments - should be held to 2 per issue… we covered very little. I found this very frustrating and not
getting what we came here for. Maybe have sessions for 1st timers separate from experienced. I wanted to
learn changes - not spend 15 min on RACE!




 Re 1:30-3:00: Several speakers on the panel did not speak clearly. But, were quick to speak clearly when
needing to comment on questions being asked.




Do you have any resource or training on reading the report - what it means - how to read the report, the
importance of the report?




I would recommend having an advanced Cath/PCI group & a beginner Cath/PCI group. Too many of us
understand the definitions & would like to review tough/hard cases that aren't clear-cut.



CK-MB Hospitals that no longer collect (routinely) CKMB - only troponins are drawn.




He is very difficult to understand. Please slow down.
Could you email me all of the attendees from AR names, facility, email, phone #? I would be interested in starting
a group in AR to have study meetings to discuss NCDR registry, scenarios, etc. Thank you!




Next year to support green efforts- check into how many people would bring their own laptops and you provide
electrical outlets and also make the handouts available on disk or download at site.




Part 1 - Please post all FAQ's that come in. We are all on a learning curve and need all the help we can get.
Part 2 - Dr. Rumsfeld Need copy of his presentation -EXCELLENT!!! Maybe it can justify our roles and need to
attend NCDR.




With the next conference, could you please indicate the changes with a new version with color coding?
Highlighted yellow for changes; no color for no changes.




Since participants may attend registry workshops other than those they may actually participate in - it is helpful to
have data dictionaries & forms to review. Since some may not want to carry those home along with workshop
notes create a second book that has definition/forms. If participants don't want to carry home they don't have to
but could still take workshop syllabus/notes.
Very nice accomodations. Catering staff very pleasant. Think about North Texas for future conferences!




Dr. Kutcher, was any of the data in your analysis subject to a data validation program? Also what steps are in
place to assure patient selection does not occur? Concern - Data integrity and clinical decisions being made on

Re Quality Strategies WS #16- Wanted to be sure you provide webinar how (to) utilize excel download of
reports for building graphs to present specific Q data over time.




Part 2 - Nobody discussed certification for us data managers. In my institution it would help validate my
expertise outside the CV realm. Peers can be very critical, despite my presenting what NCDR is all about! oops
Kathleen briefly brought up look forward to more info.




Comment! Why not put all informatin on thumb drives to limit book printing and just give brief handouts?




Part 3 - ALL - Thanks for all the hard work putting this together...interesting speakers, topics. Food was agreat,
liked sit down lunch also liked the way lunch tables were assigned. Thank you also for videotaping sessions.
Due to finances my coworker was unable to attend - and now she will be able (to) see and hear the newest and
latest NCDR updates.
You need to hire an education consultant to help plan this "education". Very Chaotic!




Shorter breaks, shorter lunch, a mix of day and evening sessions so that families can be better accomodated.




Part 1 - It would be great if Cardiac Care Associate membership in ACC would be extended to Technologists;
Data Abstractors or other Quality professionals associated with the ACC-NCDR Registries as
contributors/participants.



It would be so good if members have questions, they should email it to NCDR, instead of lengthening the
sessions. It would be good to have three days vs. 2 days, it is very exhausting from 6:30 -6:00 pm for those who
have illnesses.


Will we have access to the slide presentation by Dr. Rumsfeld? It was excellent.



I basically abstract all charts and submit all data. However, I am not the site manager. Can I still obtain the
participant certification for RSM? Thanks



Will Dr. Rumsfeld's slides be available on the ACC website? (Not in book)
1. Are Dr. Rumfeld's slides available online? A- 2. Is the Bleeding Risk Score Tool now available? 3. What are
the credentials CPHQ? A-




Part 2 Can you create a slide of "Trends" over the last 10 years of ACC-NCDR attendance. Thanks.




Is it possible to get the slide presentation from John Rumsfeld?



I would like the slides that the Dr. who presented case #4-#6 had shown. Particularly the slide that had shown
primary prevention and secondary def & criteria.



Re Physician Engagement: What was the low-hanging fruit you left with the med staff?



When do you expect to have an implementation timeline for the PAD registry and HF registry? My facility would
like to be considered as a pilot site. We currently have a heart base tool for the PV population. Thanks.

We have had trouble collecting Bun,Crea, & Na. Is there a time limit for the age of those lab values? My
physicians have also stated that Medicare will not pay for these labs. Why are we asking for labs that Medicare
won't acknowledge & are we working on that?




FAQ should be available to all without having login/password



Just a general comment - This is my first NCDR conference and just started assisting another employee w/the
CathPCI registry 4 months ago. My primary duty is being a specialized Interventional Radiology/Cardiology
coder. I also have a 4 year degree in Health Info. Mgt. After attending, I see even more greatly than before the
great link between IR Coding & participating in the CathPCI registry. I am coding the same cases that may end
up in the registry. I wonder if the NCDR recognizes the value that IR coders can bring to the registries. It was
very easy for me to get involved and understand the data definitions. Not only that but I found it exciting and
interesting to dive just a little deeper into the details of each case to grab elements for the registry. If you haven't
already, I think the NCDR should further target getting IR coders involved in the NCDR (specifically CathPCI). I
am excited to bring back ideas to my organization of integratng the work I do on the registry right into my coding
workflow. I see this as a great way to get closer to the goals discussed here of more timely data collection/entry
Part 2 - Please make Heart Failure registry a priority.




I submit directly on line (NCDR site for both Cath/PCI and ICD). Will you eventually be able to queary prior to
submission to look at key indicators, e.g., D2B or vasc comps. etc.? (I would like to double check prior to
submission.) Thanks!




Will there be a merge with Cath/PCI & ACTION? Seems as though there is A LOT of double documentation.
We do not have an automated system so this creates a lot of work.




3. Will Regional or other reporting become transparent @ org. level

Any updates on when an auditing program will begin for ICD and CARE? We have trouble getting our physicians
to take the benchmarks seriously since they argue that our chart abstractors might be interpreting the
specifications for adverse events more stringently than other hospitals, and interpreting risk factors less strigently
(i.e., we're too quick to judge something an adverse event & too slow to judge something a risk factor. An
auditing program would help convince physicians that our own data are comparable to everyone else's.

Part 1 - Will you be doing a peripheral database registry?




Re Dr. Rumsfeld's Presentation: Part 1 - Great presentation. Inspiring and motivating. Exciting info re:
documenting bleeding risks being excluded for RAC. However RAC organizations do not have a standardized
criteria yet and ____CMI. ________ criteria does not cover risk as determining factor in patient's acuity.
Re Dr. Rumsfeld's Presentation: Part 2 - Any future plan on validation process to check if facilities are entering
"truthful" data and not making up answers to get great outcomes report?




HiC # are given to medicare eligible pts. so why don't you include a parent/child relationship to insurance payor?




Given the fact that there is no validation process for data accuracy how do you believe CMS & other payors will
have accurate information?




I noticed the panel has an obvious more in depth definition than what we have. Can this be made available to
us? It would reduce the FAQ's tha you get.



Does NCDR believe we have quality/accurate data?
What is the hierarchy of the Source of Truth?




Re- Letters of Info regarding NCDR - statement of purpose - and utilization of data collected. Comment on point
of sending letters to hospital Administrators - May I suggest you also include copies to Directors of Diagnostic
Services, Assistant VP f Nursing, VP of critical care services, Director of Cardiovascular Services - etc....




I would love to have NCDR BROCHURES! We need the HF Registry - ASAP! Thank You! Great Job!




Is there a place for site comparison data on the NCDR re: data collection /abstractors? My hospital has one
person doing paper abstractions for approx 300 + Cath/PCI's per month. How do other organizations/facilities
with similar volumes manage to do so? Is it the number of abstractors? Thank you!




Re Risk Adjusted Mortality: What affects this % & what is the weighted value of each entity affecting this?
Thanks- Lucy.




How do I find out more about the physicians getting recertification points by being a part of NCDR? I need help
with physician "buy in" to get help with data collection
I'm a X-Ray tech. Been in Cath lab for 32 years. I been doing data for a long time and working Cath lab
hopefully you will recognize us also to the certification and ACC associate. Thank you.




Regarding outcomes it would be most valuable to provide extensive data query capability at MD & pt level to
support hospital quality & ER physician data for feedback & PI initiative. Education opportunities are key.
Webinars & user group meetings in regional environments that are care-effective would be beneficial. Additional
resources for understanding outcomes data would be helpful also. With 90% of participants using on-line tool,
will vendors continue to certify thier products with future versions? Looking forward at our CATHICP data
systems I wonder if we should consider their EP registry module.




How do you know your peak if your initial was drawn at OSH with DIFF norm ranges?
Part 2 - Patient has S.O.B. no CP. Do I document no symptoms because it is not chest pain? How do I
document S.O.B.?




In the past we have coded an unknown cabg date as 01/01/01. What do we code in new version?
Pt has hx of LBBB. Admitted & dx c STEMI all over chart + cardiac markers. Do we code pt as STEMI or
NSTEMI?
NOTE
We have multiple training
sessions per year via
webcasts. Please check
the Announcement and
Latest News pages on the
website for the dates and
times. We also post many
resources on our website,
including several case
studies with answers. In
addition, please do not
hesitate to email or call us
with a question. We are
here to assist you.
1. All presentations will be
made available online. 2.
Every Medicare Primary
Prevention ICD inserted is
subject to an audit by
Medicare
All presentations will be
made available online


This is an excellent
suggestion. We have
made the data collection
form available on our
website in the Documents
(V4.0x) section The form
shows elements with no
change as white
background, elements with
minimal change to name or
definition as yellow
background, and totally
new elements are in green.


Thank you for your
excellent feedback. We
will use this as we prepare
for other educational
sessions to improve the
presentations.
Thank you for your
feedback, which will be
given to the speakers. We
are sorry that you found
the experience not as
beneficial as you had
hoped. For the next
meeting, we will be asking
the room faciliator to assist
in moderating the Q & As
during the presentation.

Thank you for your
feedback. We appreciate
receiving critiques like this.
This information will be
given to the speakers and
used to improve our
presentations.

We do have an
interpretation guide that will
assist you with the
questions that you have
asked. It is located on the
website once you log in at
https://www.ncdr.com/Web
NCDR/RESOURCES/V3D
OCUMENTS.ASPX#15
Thank you for this
suggestion.
Thank you for your
comment. However, I am
not I understand the
question. If you contact
us with the complete
question, we would be
happy to assist.
Thank you for this
comment about one of the
speakers. We do provide
individual feedback to each
of the presentors.
However, you didn't
include a name on the
card. We hope that you
did provide this information
when completing the online
evaluation of the NCDR
Annual Meeting.
We would have to have
permission in order to do
that. However, we
understand the reasons
that you would like this
information. Therefore, on
the registration form for the
next meeting, we will
request permission to
release attendees personal
information.
Thank you for this great
idea. We will explore the
feasibility of doing this..
Part 1: Great idea. You
should be able to find all
the questions that were
posed at the Annual
Meeting online. Part 2:
Thank you for your kind
words about his
presentation. All
presentations will be
posted online.
This is an excellent
suggestion.

 While this may be helpful
during the program, it
would significantly increase
the cost of the program.
During the case studies,
the faculty try to present as
much helpful information
as possible as well as
answer as many questions
as possible. This
information is also included
in the syllabus.
We are glad that you found
the hotel accomodations
and staff of good quality.
As for location of the
program, the program is
offered concurrently with
the ACC Annual Meeting.
Because of the size of the
ACC Annual Meeting, this
helps to lower the costs of
the program; however, it
also limits the locations
where it can be held.
Please note that the ACC
annually reviews potential
locations.



Thank you for this
suggestion. We will add
this to the list of potential
topics for next year.
We know that many of you
are very interested in
participanting in a
certification program. We
are continuing to work on
the development of this
program and hope to kick
off the first step at the next
NCDR Annual Meeting.

Thank you for this
suggestion. We will added
to the list of potential
changes for next year.

Thank you for your
comments. Its always nice
to hear that your hard work
is beneficial. We hope that
you heard from us that all
your hard work is beneficial
to all the cardiovascular
patients.
Thank you for your
comment. We are sorry
that you felt the program
was chaotic. We would be
glad to hear from you and
any specific suggestions
that you have for improving
the program.

Thank you for the
suggestions. They will be
added to the list of
potential changes for next
year. Please note that the
comment related to a
particular speaker was
edited out of the "question"
but will be included in the
feedback to the presenter.
We hope that you also
included the comment in
the speaker evaluation as
part of the online
evaluation of the program.

This is a great idea. Your
suggestion has been
forwarded to the
appropriate department
and is being reviewed for
implementation implications

Thank you for this
suggestion. We will added
to the list of potential
changes for next year.
All presentations will be
made available online
Yes, even if you are not the
RSM, you will be able to
obtain certfication, which
will be geared to people
who abstract and/or
manage the registry data.
All presentations will be
made available online
1. All presentations will be
made available online. 2.
3. Certified Professional in
Healthcare Quality

Part 2: This is a very
interesting suggestion. We
will look at the feasibility of
doing this for the next
NCDR Annual Meeting.

 All presentations will be
made available online. We
have had some significant
delays because of
technical difficulties.
Please stay tuned.
 All presentations will be
made available online
Our registries can be used
to achieve ABIM
MOC…they are an
example of being involved
in a quality improvement
program
We do not have current
plans to develop either of
these registries.
In order to answer this
question we need to know
which registry which it is
referencing.
FAQs are a service
provided to participant
facilities and their staff
only….we control this
through the need for users
to have logins and
passwords

We encourage all
specialties to be involved
in our efforts. In the future,
we are looking to provide a
certification program and
will keep your comment in
mind as we develop this
program
We do not have current
plans to develop this
registry.
We are building
completenes checks into
our online data collectiuon
tools moving forward...as
to calculations being done
prior to submission, we do
not have any plans, at this
time, to provide this
functionality.


We are working toward the
ability to share certain sets
of elements between these
two registries allowing
users to upload these data
elements between the two.
Vendors who provide both
CathPCI and ACTION are
required to demonstrate
interoperability between
the two for shared data
fields

We will not directly reveal
specific facility names at
any reporting level.
The first ICD audit was
completed this year (2009)
and CARE is being
planned.
We do not have current
plans to develop this
registry
Thank you for your kind
comments. The purpose
of the program and the
goal of each of the
presentors is to be
inspiring and motivating.
We could not clearly read
the rest of the statement,
but would be glad to
address it if you sending us
an email with your
complete question.
We currently have an audit
program in place for
CathPCI and ICD with
CARE and ACTION being
next. We are also
expanding the breadth of
methods we will employ to
provide audit services. We
would hope that each site
maintains and promotes
truthful data collection and
submission and we are
also in the process of
improving our contract
language so that if a site
does not conform to our
data standards the
contract could be
terminated immediatley.
Great question and will
take that into consideration
as we develop new
versions.
As far as NCDR
Registries, we have an
audit program in place and
that is continuing to go
through changes to
improve the process. We
also provide a wide range
of educational programs
and training to ensure that
the participants
comprehend the measures
utilized within our registry.
Additionally we are
changing out contract so
that there may be more
penalties for those sites
that do not submit truthful
data.

We aren't sure how to
answer this one because
we need to know to which
registry this question refers.
Yes we do as we believe in
and perform auditing of
data.
I do not believe this refers
to an NCDR
function…however, the
source of our truth is in the
data!!!!
That is a good idea and we
will add them to our
Communication and
Marketing plans. However
it is very difficult to get
each of the person's
address and keep the
contact information up to
date for each individual. It
is also very expensive to
send out maybe 4 to 5
times the mail that we
would currently do.

We can send you some
information, please contact
us at ncdr@acc.org…In
terms of a HF Registry, we
do not have current plans
to develop this.

There is not comparison
data and there are many
factors in the staff
distribution. If you are
interested in interacting
with other facilities to try to
get this information, please
contact us and we will see
how we can help you get to
the answer.
The RAM model is defined
on our website at
http://www.ncdr.com/WebN
CDR/ELEMENTS.ASPX.
You found find it at the
bottom of the page.

Please contact NCDR and
will be glad to send
documents about
recertfication using NCDR
that you will find helpful.
We are enthusiastic
supporters of x-ray techs in
this role. We will keep this
suggestion in mind as we
define a certification
process. We will forward
the suggestion regarding
the ACC Associate to the
appropriate people in the
ACC. Cardiovascular
Technologists are being
developed currently for
Associate inclusion. The
certification program that
we are developing will be
for the people who abstract
and manage the data and
is not dependent on a
particular profession.


We believe vendors will
continue to certify their
software as they seek to
provide value added
applications to their
customers. Your
suggestions are good asnd
we will keep them in mind
as we develop new
features and functionalities

We are sorry, but not
enough information,
espeically to which this
registry was the question
addressing, was included
in the question. Please do
note hesitate to contact us
to clarify the question.
We are sorry, but not
enough information,
espeically to which this
registry was the question
addressing, was included
in the question. If this is a
question about cath PCI
v4.3 you code this as Sx
Unlikely to be Ischemic or
NoSx/No Angina. We do
not document only SOB.
Please do note hesitate to
contact us to clarify the
question.


For ACTION and cathPCI,
the dates may entered
(e.g., as 01/01), but the
year has to be entered.
We prefer a specific date.
However, we understand
that there are times when it
is really pretty impossible
to find. So we have in our
specs that they can code
01/01 for mm/dd. However
for year, please find or
estimate the date. Using
01 for the year is no longer
in the new version specs.
For a reading of LBBB
block to be diagnostic of
STEMI, the LBBB must be
new or presumed new.
With that said, an ECG
reading is not necessarily
so straight forward, so you
must rely on the
Physicians documentation
at times. If the Physician is
documenting the patient's
AMI as STEMI, you would
accept that documentation.
If you have further
questions, you are always
welcome to review the
record with your Medical
Director for further
clarification.

								
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