This should include an appropriate description of the key features of the clinical presentation, along with documentation of noninvasive stress testing and functional assessments (if clinically indicated and performed) and the severity of angiographic stenosis for the treated lesion. PCIs are performed to improve symptoms or sur- vival. Documentation of these elements allows for an evaluation of the patient s indication for the procedure and also provides prognostic utility. This ultimately permits an appropriate risk/ benefit ratio to be inferred for the procedure. In addition, fulfill- ment of this measure will enable assessment of other important quality indicators derived from the ACC/AHA/SCAI guideline and the appropriate use criteria for coronary revascular- The documentation for many PCIs per- formed in the United States lacks essential data to determine the procedure's appropriateness, making this a measure with a pos- sibly important gap in care.19 A potential concern is that several of the features pertaining to the indication for PCI are attribut- able to both the physician referring the patient for PCI and the Nallamothu et al ACC/AHA/SCAI/AMA-PCPI/NCQA 2013 PCI Performance Measure 935 physician performing the procedure, which leads to challenges with attribution. Nonetheless, the writing committee s opinion is that compiling all the required elements at the level of the thera- peutic intervention is a process of care that is linked to desirable outcomes for patients undergoing PCI. It is therefore the ulti- mate responsibility of the physician performing the PCI and of the physician s institution to accurately document key features. 5.2. 