Admit Procedure: Difference between revisions

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== Collection Instructions ==

*~~Code~~ a procedure ~~as [[Px_Type]]~~ '''~~admit~~'~~'' if it was:~~

*An admit procedure is a procedure related to the ''start of the database record'' in question

**(a~~) Performed '''within 48 hrs''' BEFORE~~ the [[~~Arrive DtTm~~]]

**As of October 2020, a single record may span direct transfers between different locations and even between different services. Accordingly, an admit procedure only relates to the very start of that database record. Procedures that do not qualify as an admit procedure will be acquired procedures.

**(b) '''~~AND~~''' ~~Was performed in a unit or location that we DO NOT COLLECT, see below [[#Moved patients]]~~

{{Ex |

**(c) '''AND'''

Admitted to MICU for sepsis --> 2 days later develops an acute abdomen and goes to OR where gets a bowel resection --> goes to PACU --> goes to SICU service and SICU as location. Since the ADMISSION of this continuous episode of ICU care (i.e. MICU-->SICU) was to MICU, and we do not begin a new record with the switch to SICU, this bowel resection is an acquired procedure, not an admit procedure}}

::* ~~Was~~ '''directly, causally''' related to the admission (this is a judgement call, see below [[#Causally related]])

*CODE A PROCEDURE AS [[Px_Type]] '''admit''' IF AT LEAST 1 OF 'A' ''AND'' 1 OF 'B':

~~:::~~*OR

*(A) -------------------------------------------------------------------------------------------------------------------------

::* ~~was~~ directly related to an '''[[Admit Diagnosis]]''' (see below [[#Directly related to the Admit Diagnosis]])

**(i) '''directly, causally''' related to the admission (this is a judgement call, see below [[#Causally related]]) ''OR''

**(ii) directly related to an '''[[Admit Diagnosis]]''' (see below [[#Directly related to the Admit Diagnosis]]) ''OR''

**(iii) an organ transplant during the current "hospital episode" (i.e. including this and other hospitals) and was '''directly, causally''' related to the current ward/unit admission

*'''AND'''

*(B) -------------------------------------------------------------------------------------------------------------------------

**(i) Performed '''no more than 48 hrs'''(''[[#Why within 48 hrs?]]'') BEFORE the start of this record, i.e. the [[Admit DtTm]] for the start of the record ''OR''

**(ii) Irrespective of whether it's within 48 hours (this could be outside of current hospitalization), if the association of that procedure with the admission is abundantly obvious (as per data collector discretion)

=== Recurring procedures ===

* If an admit procedure that qualifies is done more than once on two different calendar days, enter it once and set the count to the appropriate number

=== Moved patients ===

*There are important issues/rules for admit procedure coding when a patient is being transferred from one unit/ward to another unit/ward -- and this is even more complicated if in between leaving one unit/ward and arriving on another unit/ward, the patient stops in a procedure area and gets one or more procedures.

See [[CCI Collection#Moved patients]]

*Here are the guidelines for these situations:

**(i) Transfer from collecting location A to collecting location B without any stop in between where procedures might occur -- all procedures done before leaving location A will be collected by location A only.

**(ii) Transfer from collecting location A to collecting location B WITH a stop in between where procedures occur -- all procedures done before leaving location A will be collected by location A only, while procedures done at the stop in between will be coded by location B only.

**(iii) Transfer from noncollecting location A (which includes ED) to collecting location B without any stop in between where procedures might occur -- any qualifying admit procedures done before leaving location A will be collected by location B

**(iv) Transfer from noncollecting location A (which included ED) to collecting location B WITH a stop in between where procedures occur -- all procedures done before leaving location A or during the stop in between will be coded by location B only.

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**e.g. a chest imaging study done in ED that demonstrated a bad pneumonia for which the patient got admitted is not causally related to the admission, and since it was done prior to the admission, it should not be coded as an admit procedure

**e.g. person came to ED with suspected stroke, and head CT done while in ED showed that they did have a stroke -- this does NOT qualify as an admit procedure

*While causally-related admit procedures will USUALLY be invasive procedures, they do not NEED to be -- e.g. if a person is admitted for expressly '''[[Isolation, infectious]]''', this could be in this ~~bin~~.

*While causally-related admit procedures will USUALLY be invasive procedures, they do not NEED to be -- e.g. if a person is admitted for expressly '''[[Isolation, infectious]]''', this could be in this [[Dx Type]].

*The only way that a diagnostic procedure can be causative is if it caused a complication that was part of the admission diagnoses (does not necessarily have to be the MAIN admit dx)

**e.g. contrast-enhanced X-ray where the contrast caused anaphylaxis that was the main cause of the admission

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=== Directly related to the [[Admit Diagnosis]] ===

*These are procedures that didn't CAUSE the admission but are DIRECTLY related to one of the admit diagnoses

*The basic guidance for this is to include therapeutic procedures related to the admission diagnosis.

**e.g. Patient came to ED with bleeding esophageal varices and in ED got EGD with banding. Here the procedure did not cause the admission, but it was certainly related to the admission diagnosis

**e.g. Patient got an elective CABG for chronic ischemic heart disease/CAD -- the CABG is directly related to the CAD and so should be included as an admit procedure

**a more complicated example: Patient with cirrhosis with ascites is admitted with hepatorenal syndrome. While in ED the staff couldn't insert a Foley due to a urethral stricture, so urology came down to ED and did a cystoscopy to dilate the urethra and pass the Foley. Here admit diagnoses include: [[Hepatorenal syndrome]] and the [[Urethra, urethral stricture]], and in this case the cystoscopic dilation (coded by components with [[(T) Ureter, Bladder or Urethra]] and [[Dilation]]) is directly related to the stricture, in much the same way that the CABG is directly related to the CAD in the above example.

**a more complicated example: Patient with cirrhosis with ascites is admitted with hepatorenal syndrome. While in ED the staff couldn't insert a [[Foley]] due to a urethral stricture, so urology came down to ED and did a cystoscopy to dilate the urethra and pass the [[Foley]]. Here admit diagnoses include: [[Hepatorenal syndrome]] and the [[Urethra, urethral stricture]], and in this case the therapeutic cystoscopic dilation (coded by components with [[(T) Ureter, Bladder or Urethra]] and [[Dilation]]) is directly related to the stricture, in much the same way that the CABG is directly related to the CAD in the above example.

*Just as above ~~for~~ in the section on causally-related procedures, purely diagnostic procedures done prior to admission -- including procedures that merely demonstrated the presence of an admit diagnosis -- should not be coded as an admit procedure.

*Just as above in the section on causally-related procedures, purely diagnostic procedures done prior to admission -- including procedures that merely demonstrated the presence of an admit diagnosis -- should not be coded as an admit procedure.

**Indeed, the only diagnostic-only procedures that would be included as admit procedures are those that caused a complication that then required treatment --- e.g. a central line placement that led to a perforation -- and even here, this would then really come under the item above of "Was directly, causally related to the admission".

*A few additional notes on this:

**'''Do NOT COUNT or INCLUDE BEFORE admission as a procedure unless they caused a complication''':

***'''transfusions''' (a complication of transfusion would be, for example; transfusion reaction, CHF)

***'''central lines (even vascaths)''', (a complication of line insertion would be, for example; vessel performation)

== Why within 48 hrs? ==

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[[Category: CCI]]

[[Category:CCI]]

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 == Collection Instructions ==
-*Code a procedure as [[Px_Type]] '''admit''' if it was:
+*An admit procedure is a procedure related to the ''start of the database record'' in question
-**(a) Performed '''within 48 hrs''' BEFORE the [[Arrive DtTm]]
+**As of October 2020, a single record may span direct transfers between different locations and even between different services.  Accordingly, an admit procedure only relates to the very start of that database record.  Procedures that do not qualify as an admit procedure will be acquired procedures.
-**(b) '''AND''' Was performed in a unit or location that we DO NOT COLLECT, see below [[#Moved patients]]
+{{Ex |
-**(c) '''AND'''
+Admitted to MICU for sepsis --> 2 days later develops an acute abdomen and goes to OR where gets a bowel resection --> goes to PACU --> goes to SICU service and SICU as location. Since the ADMISSION of this continuous episode of ICU care (i.e. MICU-->SICU) was to MICU, and we do not begin a new record with the switch to SICU, this bowel resection is an acquired procedure, not an admit procedure}}
-::* Was '''directly, causally''' related to the admission (this is a judgement call, see below [[#Causally related]])
+*CODE A PROCEDURE AS [[Px_Type]] '''admit''' IF AT LEAST 1 OF 'A' ''AND'' 1 OF 'B':
-:::*OR
+*(A) -------------------------------------------------------------------------------------------------------------------------
-::* was directly related to an '''[[Admit Diagnosis]]''' (see below [[#Directly related to the Admit Diagnosis]])
+**(i) '''directly, causally''' related to the admission (this is a judgement call, see below [[#Causally related]]) ''OR''
+**(ii) directly related to an '''[[Admit Diagnosis]]''' (see below [[#Directly related to the Admit Diagnosis]]) ''OR''
+**(iii) an organ transplant during the current "hospital episode" (i.e. including this and other hospitals) and was '''directly, causally''' related to the current ward/unit admission
+*'''AND'''
+*(B) -------------------------------------------------------------------------------------------------------------------------
+**(i) Performed '''no more than 48 hrs'''(''[[#Why within 48 hrs?]]'') BEFORE the start of this record, i.e. the [[Admit DtTm]] for the start of the record ''OR''
+**(ii) Irrespective of whether it's within 48 hours (this could be outside of current hospitalization), if the association of that procedure with the admission is abundantly obvious (as per data collector discretion)
+=== Recurring procedures ===
 * If an admit procedure that qualifies is done more than once on two different calendar days, enter it once and set the count to the appropriate number
 === Moved patients ===
-*There are important issues/rules for admit procedure coding when a patient is being transferred from one unit/ward to another unit/ward -- and this is even more complicated if in between leaving one unit/ward and arriving on another unit/ward, the patient stops in a procedure area and gets one or more procedures.
+See [[CCI Collection#Moved patients]]
-*Here are the guidelines for these situations:
-**(i) Transfer from collecting location A to collecting location B without any stop in between where procedures might occur -- all procedures done before leaving location A will be collected by location A only.
-**(ii) Transfer from collecting location A to collecting location B WITH a stop in between where procedures occur -- all procedures done before leaving location A will be collected by location A only, while procedures done at the stop in between will be coded by location B only.
-**(iii) Transfer from noncollecting location A (which includes ED) to collecting location B without any stop in between where procedures might occur -- any qualifying admit procedures done before leaving location A will be collected by location B
-**(iv) Transfer from noncollecting location A (which included ED) to collecting location B WITH a stop in between where procedures occur -- all procedures done before leaving location A or during the stop in between will be coded by location B only.
 {{ICD10 Guideline follow up Care only}}
@@ Line 29: / Line 33: @@
 **e.g. a chest imaging study done in ED that demonstrated a bad pneumonia for which the patient got admitted is not causally related to the admission, and since it was done prior to the admission, it should not be coded as an admit procedure
 **e.g. person came to ED with suspected stroke, and head CT done while in ED showed that they did have a stroke -- this does NOT qualify as an admit procedure
-*While causally-related admit procedures will USUALLY be invasive procedures, they do not NEED to be -- e.g. if a person is admitted for expressly '''[[Isolation, infectious]]''', this could be in this bin.
+*While causally-related admit procedures will USUALLY be invasive procedures, they do not NEED to be -- e.g. if a person is admitted for expressly '''[[Isolation, infectious]]''', this could be in this [[Dx Type]].
 *The only way that a diagnostic procedure can be causative is if it caused a complication that was part of the admission diagnoses (does not necessarily have to be the MAIN admit dx)
 **e.g.  contrast-enhanced X-ray where the contrast caused anaphylaxis that was the main cause of the admission
@@ Line 45: / Line 49: @@
 === Directly related to the [[Admit Diagnosis]] ===
 *These are procedures that didn't CAUSE the admission but are DIRECTLY related to one of the admit diagnoses
+*The basic guidance for this is to include therapeutic procedures related to the admission diagnosis.
 **e.g. Patient came to ED with bleeding esophageal varices and in ED got EGD with banding. Here the procedure did not cause the admission, but it was certainly related to the admission diagnosis
 **e.g. Patient got an elective CABG for chronic ischemic heart disease/CAD -- the CABG is directly related to the CAD and so should be included as an admit procedure
-**a more complicated example:  Patient with cirrhosis with ascites is admitted with hepatorenal syndrome.  While in ED the staff couldn't insert a Foley due to a urethral stricture, so urology came down to ED and did a cystoscopy to dilate the urethra and pass the Foley.  Here admit diagnoses include:  [[Hepatorenal syndrome]] and the [[Urethra, urethral stricture]], and in this case the cystoscopic dilation (coded by components with [[(T) Ureter, Bladder or Urethra]] and [[Dilation]]) is directly related to the stricture, in much the same way that the CABG is directly related to the CAD in the above example.
+**a more complicated example:  Patient with cirrhosis with ascites is admitted with hepatorenal syndrome.  While in ED the staff couldn't insert a [[Foley]] due to a urethral stricture, so urology came down to ED and did a cystoscopy to dilate the urethra and pass the [[Foley]].  Here admit diagnoses include:  [[Hepatorenal syndrome]] and the [[Urethra, urethral stricture]], and in this case the therapeutic cystoscopic dilation (coded by components with [[(T) Ureter, Bladder or Urethra]] and [[Dilation]]) is directly related to the stricture, in much the same way that the CABG is directly related to the CAD in the above example.
-*Just as above for in the section on causally-related procedures, purely diagnostic procedures done prior to admission -- including procedures that merely demonstrated the presence of an admit diagnosis -- should not be coded as an admit procedure.
+*Just as above in the section on causally-related procedures, purely diagnostic procedures done prior to admission -- including procedures that merely demonstrated the presence of an admit diagnosis -- should not be coded as an admit procedure.
+**Indeed, the only diagnostic-only procedures that would be included as admit procedures are those that caused a complication that then required treatment --- e.g. a central line placement that led to a perforation -- and even here, this would then really come under the item above of "Was directly, causally related to the admission".
+*A few additional notes on this:
+**'''Do NOT COUNT or INCLUDE BEFORE admission as a procedure unless they caused a complication''':
+***'''transfusions''' (a complication of transfusion would be, for example; transfusion reaction, CHF)
+***'''central lines (even vascaths)''', (a complication of line insertion would be, for example; vessel performation)
 == Why within 48 hrs? ==
@@ Line 58: / Line 67: @@
-[[Category: CCI]]
+[[Category:CCI]]