1. STS Adult Cardiac Surgery v 2.61 FAQs 05/04/10

2. Sequence # 1280 Coronary Artery Bypass Procedure Patient went to the OR for a valve replacement for endocarditis. Due to the extent of the disease, the insertion of the valve required many additional sutures which caused narrowing on the RCA. While in the OR, the surgeon also performed coronary artery bypass grafting to the RCA. Is this coded as an isolated valve or a CABG/valve?

3. Sequence # 1280 Coronary Artery Bypass Procedure Code YES for Sequence # 1290 Operative Valve Procedure Code NO for Sequence # 1280 Operative CABG Procedure

4. Sequence # 1280 Coronary Artery Bypass Procedure “You have to consider the intent going into surgery and that the additional surgery might be the result of complications from the planned surgery.” You would not code the CABG as a post-op complication because the patient never left the OR, “what goes on in the OR, stays in the OR”

5. Sequence # 1310 Other Cardiac Procedure Patient had an transthoracic epicardial lead placed in the OR by one of our CT surgeons. Is this type of procedure captured in the Adult Cardiac Data Registry?

6. Sequence # 1310 Other Cardiac Procedure Code YES for Sequence # 1310 Other Cardiac Procedure Code YES for Sequence # 2450 Other Cardiac – Arrhythmia Correction Surgery only if there was also a Generator change Code YES for Sequence # 2560 Other Cardiac – Other for epicardial lead placements without a generator change

7. Sequence # 1310 Other Cardiac Procedure “When epicardial wires are implanted in conjunction with a CAB, Valve, or Other procedure and do NOT include the insertion of a generator, they are NOT included in the Adult Cardiac Data Registry. The issue of inclusion became complicated when surgeons started implanting these wires via a mini- thorocotomy as an isolated procedure with or without a generator change. If no generator was inserted, code this procedure as Cardiac Other.”

8. Sequence # 1640 Mitral Valve Procedure Patient had a Mitral Valve Replacement. The surgeon also documented “extensive debridement of the calcium deposit along the posterior annulus extending into the medial papillary muscles” performing a “transposition annuloplasty”. How is this coded?

9. Sequence # 1640 Mitral Valve Procedure Code YES for Sequence # 1640 Mitral Valve Replacement

10. Sequence # 1640 Mitral Valve Procedure “The main procedure was an Isolated Mitral Valve Replacement” (see handout from STS)

11. Sequence # 2560 Other Cardiac - Other Patient had an MVR with removal of both an atrial and a ventricular thrombus. Is this coded as YES for both Sequence # 1640 Mitral Valve Replacement and Sequence # 2560 Other Cardiac – Other ?

12. Sequence # 2560 Other Cardiac - Other Code YES for Sequence # 1640 Mitral Valve Replacement Code NO for Sequence # 2560 Other Cardiac – Other

13. Sequence # 2560 Other Cardiac - Other “The main procedure was an Isolated Mitral Valve Replacement” (see handout from STS)

14. Sequence # 2860 Comps – Prolonged Ventilation Patient was intubated in the OR at 0800 and arrived in the ICU immediately post op at 1330. Patient became agitated overnight and extubated himself at 0300. Due to poor oxygenation he was immediately reintubated. Patient was weaned off the ventilator and was extubated on POD#1 at 1245. Is this captured as a post-op reintubation or a complication for Prolonged Ventilation?

15. Sequence # 2860 Comps – Prolonged Ventilation Code NO for Sequence # 2680 Reintubated During Hospital Stay Code NO for Sequence # 2860 Complication – Prolonged Ventilation

16. Sequence # 2860 Comps – Prolonged Ventilation “Do not code unplanned extubation where the patient required reintubation.” “Prolonged Ventilation as a complication is defined as total intubation hours > 24 hours”

17. Sequence # 2990 Comps – Other – A Fib Patient was admitted in Atrial Flutter. In the post op period the patient developed new onset Atrial Fibrillation that was treated with Amiodarone and increased dose of Beta Blockers. Is this captured as a post-op complication for Other - A-Fib since it was a new onset?

18. Sequence # 2990 Comps – Other – A Fib Code YES for Sequence # 840 Arrhythmia Code YES for Sequence # 853 Arrhythmia Type – A Fib / A Flutter Code NO for Sequence # 2990 Comps – Other – A Fib

19. Sequence # 2990 Comps – Other – A Fib “Code Atrial Flutter in the same manner as you would Code Atrial Fibrillation”

20. Sequence # 3220 Readmission Patient was discharged to our stand-alone acute psychiatric hospital. Since transfers to another acute care hospital are to also be considered a readmission, is the patient in this scenario considered a readmission when being discharged to psych?

21. Sequence # 3220 Readmission Code NO for Sequence # 3220 Readmission Code Discharge to OTHER for Sequence # 3190 Discharge Location

22. Sequence # 3220 Readmission “Do not code this as a readmission. Many sites have psych units on their hospital campuses and the patient is discharged to Psych. Don’t code discharges to Rehab as a readmit either”

23. QUESTIONS / THOUGHTS