Frequently Asked Questions - 1st DRAFT

 

The Society of Thoracic Surgeons

 

Frequently Asked Questions: Adult Cardiac Surgery Database

 

Version 2.52.1

 

 August, 2006

 

 

How to use the “interactive” FAQ Document:

 

1.  To review all clinical questions in an individual section, click on the section title below.

 

Section A:  seq# 40-80

Section F:  seq# 750-870

Section K:  seq# 1630-1880

Section P:  seq# 2710-3010

Section B:  seq# 100-210

Section G:  seq# 890-1040

Section L:  seq# 1920-2350

Section Q:  seq# 3020-3080

Section C:  seq# 220-340

Section H:  seq# 1050-1200

Section M:  seq# 2360-2560

Section R:  seq# 3090-3210

Section D:  seq# 350-550

Section I:  seq# 1210-1500

Section N:  seq# 2570-2600

Section S:  seq# 3220-3240

Section E:  seq# 560-670

Section J:  seq# 1520-1620

Section O:  seq# 2610-2700

 

 

2.      To review an individual Seq# clinical question, click on the Seq# title below.

 

310 ICUInHrs                                   2470 OCarAFib

340 TotHrICU                                  2560 OCarOthr

440 RenFail                                     2710 Complics                                                            

490 InfEndo                                     2750 COpReOth                                                         

850 ArrhyTyp                                   2780 CISternDeep

1050 NumDisV                                2830 CNStrokP

1260 EmergRsn                              2950 COtCoag

1280 OpCAB                                    3090-3180 Section R.

1310 OpOCard                                3220 Readm30

1380 PerfusTm                                3240 ReadmPro

1410 XClampTm

1640 OpMitral

1650 OpTricus

 

3.  CC/TM:  Corrections/Clarifications to Training Manual

 

NEW

Date

SeqNo

FieldName

Definition

 

 

2360

Other Card-LVA

Indicate whether the patient had a Left Ventricular Aneurysm Repair either in conjunction with or as the primary surgical procedure.

 

 

2370

Other Card-VSD

Indicate whether the patient had a Ventricular Septal Defect Repair either in conjunction with or as the primary surgical procedure.

 

 

2380

Other Card-ASD

Indicate whether the patient had an Atrial Septal Defect Repair either in conjunction with or as the primary surgical procedure.

 

 

2390

Other Card-Batista

Indicate whether the patient had a Left Ventricular Reduction Myoplasty either in conjunction with or as the primary surgical procedure. Left Ventricular Reduction Myoplasty is a procedure whereby left ventricular myocardium is excised to reduce left ventricular volume in patients with a dilated cardiomyopathy, with or without mitral valve replacement or repair. If a concomitant valve procedure is performed, please check that category also.

 

 

2400

Other Card-Surgical Ventricular Restoration

Indicate whether the patient had a Surgical Ventricular Restoration either in conjunction with or as the primary surgical procedure.  Surgical Ventricular Restoration are procedures that restore the geometry of the heart after an anterior MI.  They include the Dor procedure or the SAVER procedure.  This SVR procedure is distinct from an anterior left ventricular aneurysmectomy (LVA) and from a Batista procedure (left ventricular volume reduction procedure).

 

 

2410

Other Card-Congenital

Indicate whether the patient had a congenital defect repair either in conjunction with or as the primary surgical procedure.

From version 2.41

8/03

Would repair of a foramen ovale fall under Other Cardiac Procedures – Other?

No, code a foramen ovale repair under Other Cardiac Procedures – Congenital Defect Repair.

 

 

2420

Other Card-Transmyocardial

Indicate whether the patient underwent the creation of multiple channels in left

ventricular myocardium with a laser fiber either in conjunction with or as the primary surgical procedure.

 

 

2430

Other Card-Cardiac Trauma

Indicate whether the patient had a surgical procedure for an injury due to Cardiac Trauma either in conjunction with or as the primary surgical procedure.

 

9/04

Patient admitted as a MVA trauma with a transection of the descending aorta.  Should the procedure to correct the transaction be coded under aortic aneurysm, seq# 2510, or cardiac trauma, seq# 2430? 

The procedure needs to be coded as a cardiac trauma.  The trauma caused the transaction.  If the transaction was caused by pathological reasons, you would code under aortic aneurysm. 

 

 

 

 

2440

Other Card-Card Tx

Indicate whether the patient had a Heterotropic or Orthotropic heart transplantation either in conjunction with or as the primary surgical procedure.

 

 

2450

Other Card-Arrhythmia Correction Surgery

Indicate if one of the following arrhythmia correction devices was surgically placed either in conjunction with or as the primary surgical procedure:

 

-None

-Permanent Pacemaker: an internal electronic generator that controls the heart rate.

-Permanent Pacemaker with Cardiac Resynchronization Therapy (CRT): an internal permanent pacemaker that uses biventricular electrical stimulation to synchronize ventricular contraction.  

-Automatic Implanted Cardioverter Defibrillator (AICD): an internal device that

defibrillates the heart.

-AICD with CRT: an internal AICD that uses biventricular electrical stimulation to synchronize ventricular contraction.

 

01/06

The surgeon placed epicardial leads for an ICD and CRT but no device during surgery. The device was placed later in the cath lab. How do I code this?

Because no device was implanted, it would be coded as a Other Cardiac Other

 

 

2460

Other Card-Arrhythmia Correction Surgery-Lead Placement

Indicate which lead placement was used for the permanent pacemaker with CRT or AICD with CRT:

                       

Epicardial: the outer most layer of the heart.             

Endocardial: the inner most layer of the heart.

 

6/04

We just attended an inservice on the biventricular pacemakers and AICDs. We were informed that biventricular lead placement for AICD or Permanent Pacemaker with CRT (cardiac resynchronization therapy) could be epicardial in one ventricle, and endocardial in the other ventricle.  In this case we would need to code an answer that allows us to choose both 1-epicardial and 2-endocardial.  Per the data specifications, it does not look like we are allowed to choose both.   Please clarify.

 

Most CRT BiV devices are implanted endocardially, with one lead in the endocardial RV and the second lead endocardially in the coronary sinus ("LV lead").  Some patients receive an epicardial LV lead via a thoracoscope or mini-thoracotomy approach.

 

If the LV lead is placed in the coronary sinus, then both leads are endocardial.  If the LV lead is placed on the epicardium via this thoracoscopic/thoracotomy approach, then it should be coded as an epicardial lead.  In both cases, the RV lead is endocardial.

 

If in a particular case, both epicardial and endocardial leads are placed, please code seq# 2460 as “epicardial”.  The option of choosing “both” will be considered in the next specification upgrade.

 

 

2470

Other Card-Atrial Fibrillation Correction Surgery

Indicate if one of the following atrial fibrillation correction surgeries was performed either in conjunction with or as the primary surgical procedure.  The intent of both surgeries is to preclude the atria from fibrillating by disrupting the abnormal reentry pathways of electronic signals that lead to atrial fibrillation. 

                       

Standard Surgical Maze Procedure:  Surgical procedure in which full thickness

incisions are made in the atria of the heart.  Sutures are then used to reapproximate the incised tissue.   The resulting lesion disrupts the abnormal reentry pathways of electronic signals that lead to atrial fibrillation. 

                       

Other Surgical Ablative Procedure:  Surgical procedure in which lesions are created in the atria of the heart by an energy source.  The lesion disrupts the abnormal reentry pathways of electronic signals that lead to atrial fibrillation.

                       

Combination of Standard Surgical Maze Procedure and Other Surgical Ablative Procedure.

 

1/06

I am needing some verification.  When a patient has a CAB procedure along with a MAZE procedure we are documenting this as a CAB + other.  Is this correct?

Yes. A CAB+MAZE would be coded as: Seq# 1280 OpCAB = Yes; Seq# 1310 OpOCard = Yes; Seq# 2470 OcarAFib = Appropriate Choice; Seq# 2480 OCarAFES = Appropriate Choice

NEW!

08/06

Other Card - Other
  Message: Pt had a CABG and a Maze procedure; in addition the pt had an amputation of the Left atrial appendage.  Do I code this procedure?

Amputation of the left atrial appendage is not an additional procedure. This would be an Isolated CABG

 

 

2480

Other Card-Atrial Fibrillation Correction Surgery-Energy Source

Indicate which energy source was used to create the lesions in the atria of the heart.

 

 

2510

Other Card-Ao Aneur

Indicate whether the patient underwent an Aortic Aneurysm repair either in conjunction with or as the primary surgical procedure.  This includes dissections, non-dissections and ruptures of the Aorta.

CC/TM

1/05

The Data Field Intent/Clarification section of the Training Manual, for seq# 2510, Other Card-Ao Aneur, should read:  “Aneurysm may refer to the pathologic or traumatic dissection, non-dissection and ruptures of the aorta.

 

 

2520

Other Card-Asc

Indicate if the patient underwent repair of ascending aortic aneurysm either in conjunction with or as the primary surgical procedure.  Aneurysm refers to pathologic dilatation of the aorta. The ascending aorta begins at the aortic annulus and ends at the origin of the innominate artery where the aorta continues as the transverse arch.

 

 

2530

Other Card-Arch

Indicate if the patient underwent repair of aneurysm in the arch of the aorta either in conjunction with or as the primary surgical procedure.  The arch begins at the origin of the innominate artery and ends beneath the left subclavian artery. It is the portion of the aorta at the top of the heart that gives off three important blood vessels; the innominate artery, the left carotid artery and the left subclavian artery.

 

 

2540

Other Card-Desc

Indicate if the patient underwent repair of a descending aortic aneurysm either in conjunction with or as the primary surgical procedure. The descending aorta is the portion of the aorta between the arch and the abdomen.

 

 

2550

Other Card-Thoracoabdominal

Aneurysm

Indicate if the patient underwent repair of a thoracoabdominal aneurysm either in conjunction with or as the primary surgical procedure. Thoracoabdominal aneurysms can involve the entire thoracoabdominal aorta from the origin of the left subclavian artery to the aortic bifurcation or can involve only one or more segments of the abdominal aorta.

 

 

2560

Other Card-Other

Indicate whether the patient had another cardiac procedure performed either in conjunction with or as the primary surgical procedure that is not included within this section.

 

9/04

Following is a guideline for assessing which procedures to capture under seq# 2560, Other Card-Other:

 

Those procedures that have a high likelihood of negatively impacting a patient's outcome (survival, quality of life, ability to recover) and/or prolong the patient's length of stay. 

 

12/04

Due to the impossibility of publishing a complete list of procedures to include and not to include in this field, the STS continues to encourages sites to submit the procedure in question as a clinical question.  Whether to include or not to include a procedure will be dealt with on a procedure by procedure basis. 

NEW!

08/06

Cardiac other
  Message: In addition to CABG, the patient had "ligation of fistula between LAD and PA". Should this be listed as "Cardiac Other" or ignored and just an antecdotal note to myself. Thanks.

Isolated CAB