CMS-10199 CMS-10199.stent data entry

Record #	Date of procedure mm/dd/yyyy	Patient SSN	Last nsme	First name	Medicare ID	Date of Birth mm/dd/yyyy	Gender 1=male 2=female	Patient is symptomatic 1=yes 2=no	Patient has angina 1=yes 2=no	Patient has contralateral occlusion 1=yes 2=no	Patient meets high surgical risk criteria 1=yes 2=no {see Appendix)	CHF class (use Arabic digits)	Modified Rankin scale score if patient had stroke	Lesion location left=1 right=2 both=3	Location of stent left=1 right=2 both=3	Location of lesion within carotid ICA=1 CCA=2 both=3	% stenosis by angiography	% stenosis of 2nd lesion by angiography (if applicable)	Device manufacturer Guidant=1 Cordis=2 Abbott=3 Other=4	Embolic protection used 1=yes 2=no	Any complications 1=yes 2=no
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