Card Tech Minutes 2015.11.09

Patient History Section of TAVR

• Charles Thomas developed his own crosswalk of all data elements withing the TVT Registry. This may help clinicians understand the complexity of the data requirements for submitting to the registry.
• Diabetes is listed as a disorder, and the style of treatment, e.g. diet, insulin, etc., is a finding. This information may impact how a procedure is performed if a patient may go into renal failure due to IV contrast media.
• Permanent ICD is considered a situation, the removal of a device is a finding.
• Repair of implanted aortic paravalvular leak is a specific finding for TAVR that are unique to this registry.
• There is no SNOMED code for mitral valve replacement.

Discussion

• Q: Patients are unlikely to return for a 2nd valve replacement, and there is no code for these procedures. Should we exclude this from consideration?
• Q: There is no code for Hostile Chest. How should we proceed?
• Q: There is no perfect match for Porcelain Aorta, however, there is an Atherosclerosis of the aorta, as a disorder. Should we use this as a coding option? A: Harry Solomon provided this link [1] to give descriptions of the terms.
• Q: Is better to use a code that might not be as exact, to encourage the ACC to develop a code that provides the more accurate description? A: Yes, that should be decided on a case-by-case basis. This may have implications for clinicians as reporting, not just for Registry usage. The ACC has created blended codes in the past with other registries. The risk is that the end product is a code that's 70+ characters long with no context. Complexity may be a problem, e.g. carotid stenosis requires three different concepts to articulate.
• Charles will develop a list of deficits that are best handled by the development of codes by the ACC. Paul will find the contact at the ACC for this conversation.
• The CP Voting is open for another nine days and closes on Dec 18th. Please submit your ballot if you are eligible to vote. As they say in Chicago, vote early, and vote often.
• The IHE HPS in development by the ACC is in the peer review stage. We will have their comments in hand after the first of the year.