Q&A: Standardizing queries for V-fib

Q: Is it appropriate to routinely query cardiothoracic surgeons for ventricular fibrillation experienced by patients immediately after cardiopulmonary bypass (CPB) for open heart procedures? Our centers performing this type of surgery are hoping to identify ventricular fibrillation (V-fib) requiring defibrillation one or multiple times during the reperfusion stage and perhaps requiring additional lidocaine infusions during the post-op period in the ICU/CTSU.

We are exploring the surgeon’s perspective on these occurrences as a tachyarrhythmia that is:

• “Integral” to the reperfusion period
• “Common” to the reperfusion period, or
• “A complication” of the reperfusion period

As we prepare to present our position on this matter to an interdisciplinary team, is it appropriate to query to capture this as an MCC and/or to link this occurrence with specific conditions that predispose specific patient populations to V-fib? 

A: Only the surgeon can identify the appropriateness of reporting these arrythmias and if they are thought to be expected or integral to the procedure or not.

Factors that would influence this decision include:

• Is the arrythmia and/or the treatment provided typical and expected to occur? Or,
• Is the arrythmia and/or the treatment provided out of the ordinary?

I do encourage facilities to work with their cardiovascular surgeons to develop criteria that identify what is expected and what deviates from the norm. These criteria could then be used by CDI and coding to staff to better understand when a query should be deployed.

Providers should also be encouraged to document with wording that clearly states if the arrythmia was expected (not reportable) or if the treatment deviated from the normal (likely would allow reporting- even if the arrythmia was expected).

Editor’s Note: Laurie Prescott, RN, MSN, CCDS, CCDS-O, CDIP, CRC, CDI education director at HCPro, answered this question. For information regarding CDI Boot Camps, click here.