Failed Attempt at Thrombectomy (v2020B1)

Specifications Manual for Joint Commission National Quality Measures (v2020B1)

Posted: 3/30/2020

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Release Notes:
Data Element
Version 2020B1

Name:

Failed Attempt at Thrombectomy

Collected For:

CSTK-08, CSTK-11, CSTK-12

Definition:

Documentation demonstrates that a mechanical thrombectomy procedure was attempted to remove a large vessel cerebral occlusion (LVO) but was unsuccessful and/or aborted.

Question:

Was a mechanical thrombectomy procedure attempted but unsuccessful or aborted before removal of the LVO?

Format:

Length:	1
Type:	Alphanumeric
Occurs:	1

Allowable Values:

Y (YES) There is documentation that a mechanical thrombectomy procedure was attempted but unsuccessful or aborted before removal of the LVO.

N (No) There is no documentation that a mechanical thrombectomy procedure was attempted but unsuccessful or aborted before removal of the LVO, OR unable to determine from medical record documentation.

Notes for Abstraction:

If medical record documentation does not include an ICD-10-PCS Principal or Other Procedure Code on Table 8.1b Mechanical Endovascular Reperfusion Procedures, continue to review the record for documentation that an extirpation procedure failed. When documentation clearly indicates that a mechanical thrombectomy procedure was attempted but unsuccessful or aborted before removal of the LVO, select “Yes.”
Examples:
- 67 Y/O male presents with acute right MCA stroke and occlusion. Neuroendovascular interventionalist documents in a procedure note, e.g., "Despite multiple passes with the wire, distal access with the microcatheter could not be obtained. Given the tortuosity, distal nature of clot, and chronicity/organization of the clot, the procedure was concluded."
- Operative note states, e.g., "Attempted mechanical thrombectomy of M1 occlusion, S/P unsuccessful mechanical thrombectomy. Procedure terminated after multiple attempts at clot. The M1 segment remained occluded with no recanalization."
If a mechanical thrombectomy procedure was attempted and down coded to the root ICD-10-PCS Principal or Other Procedure Code due to extirpation procedure failure, select “Yes.” A procedure code on Table 8.1c is not necessary to select "Yes" for this data element, but may assist abstraction.
Examples:
- Operative note includes documentation that left groin was punctured but thrombectomy intervention could not be completed due to inability to access the target parent vessel. Pre-procedure TICI 0; post-procedure TICI 0. No root procedure code assigned. ICD-10-PCS B3121ZZ fluoroscopy is the only procedure code. Select "Yes".
- ICD-10-PCS procedure code 037J3ZZ Dilation of Left Common Carotid Artery, Percutaneous Approach assigned. ICD-10-PCS 037J3ZZ is on Table 8.1c. Medical record documentation indicates that mechanical thrombectomy attempted but unsuccessful. Select "Yes".
If medical record documentation includes an ICD-10-PCS Principal or Other Procedure Code on Table 8.1b Mechanical Endovascular Reperfusion Procedures, select "No."
- ICD-10-PCS procedure codes 037J3ZZ Dilation of Left Common Carotid Artery, Percutaneous Approach and 03CL3ZZ Extirpation of Matter from Left Internal Carotid Artery, Percutaneous Approach assigned. TICI score 2A post-procedure, select "No".
If medical record documentation includes only an ICD-10-PCS Principal or Other Procedure Code on Table 8.1c Thrombectomy Root Procedures and no documentation of extirpation procedure failure, select "No."
- ICD-10-PCS procedure code 037J3ZZ Dilation of Left Common Carotid Artery, Percutaneous Approach assigned. Medical record documentation indicates that carotid artery stenting was performed. Select "No".
If medical record documentation mentions that a mechanical thrombectomy procedure was planned but not initiated, select "No".
- Patient taken to the interventional suite for possible MER procedure. No arterial/groin puncture. Patient returned to ICU bed for monitoring, select "No".
- Patient taken to angio for MER procedure. Groin punctured. Clot dissolved with IV t-PA. TICI 3. Mechanical thrombectomy not initiated, select "No".
If unable to be determined from medical record documentation that the procedure attempted was a mechanical thrombectomy for removal of a LVO, select “No”/UTD.

Suggested Data Sources:

Consultation notes
Diagnostic test reports
Operative notes
Procedure notes

Additional Notes:

Guidelines for Abstraction:

Inclusion	Exclusion
Patients with ICD-10-PCS procedure codes on Table 8.1c Thrombectomy Root Procedures, if medical record documentation states that the mechanical thrombectomy procedure was attempted but unsuccessful or aborted before removal of the LVO. Refer to Appendix A, Table 8.1c Thrombectomy Root Procedures for examples of acceptable ICD-10-PCS procedure codes.	Patients with ICD-10-PCS procedure codes on Table 8.1c Thrombectomy Root Procedures, if medical record documentation does not indicate that the procedure attempted was a mechanical thrombectomy for removal of a LVO. Refer to Appendix A, Table 8.1c Thrombectomy Root Procedures for examples of acceptable ICD-10-PCS procedure codes.

Specifications Manual for Joint Commission National Quality Measures (v2020B1)
Discharges 07-01-20 (3Q20) through 12-31-20 (4Q20)

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