CCMDB Wiki

CCI Collection: Difference between revisions

← Older edit
TOstryzniuk (talk | contribs)
CCMDB_legit, approved, Bureaucrats, Administrators
27,522 edits
m Text replacement - "[[Category: " to "[[Category:"
 
(255 intermediate revisions by 12 users not shown)
Line 1: Line 1:
This article provides general information about collecting and coding a [[CCI Procedure]].  
This article provides general information about collecting and coding a [[CCI Procedure]].
  In Progress.......
They are entered in [[CCMDB.mdb]] in the [[Patient viewer tab CCI]] on the [[Patient viewer tab CCI]].


There are some [[ICD10 Diagnoses and CCI Codes that need to be coded together]]. For background information, see [[CCI]] and [[Reasoning around moving to CCI and our subset of it]].
They are entered in [[CCMDB.accdb]] in the [[Patient Viewer Tab CCI_Pick]] and [[Patient Viewer Tab CCI_Comp]] on the [[Patient Viewer]].


== Collecting a procedure ==
For background information, see [[CCI]] and [[Reasoning around moving to CCI and our subset of it]].
 
== Collection instructions ==
===Start Date: Jan 1, 2019 ===
 
=== Selecting and entering [[CCI]] procedure in [[CCMDB]] ===
Follow these steps, in this order:  
Follow these steps, in this order:  
# if no procedures were performed, see [[#No Procedures Performed]]
# for every procedure:  
# for every procedure:  
## check if the procedure is listed in the [[CCI Picklist]] in the [[L_CCI_Picklist subform]] at the top of the CCI tab/screen, and enter there if available
## check if the procedure is listed in the [[CCI Picklist]] in the [[L_CCI_Picklist subform]] which is the top half of the CCI screen. Select from drop down list.
## if '''not''' available in picklist, enter it in the [[CCI Component]] in the [[L_CCI_Component subform]] at the bottom of the CCI tab/screen
## if '''not''' available in CCI picklist, enter it in the [[CCI Component]] in the [[L_CCI_Component subform]] which is the bottom half of the CCI screen.
##* pick the left column, [[CCI component 1 codes - what organ was something done to]].
##* pick the left column, [[CCI component 1 codes - what organ was something done to]].
##** if there are too many and you only want to see e.g. the therapeutic ones and not the imaging ones, use the [[L_CCI_Component_subform#CCI_Chooser (the "?" button)]]. In the form it opens you can filter by the [[CCI Category]].
##** if there are too many and you only want to see e.g. the therapeutic ones and not the imaging ones, use the [[L_CCI_Component_subform#CCI_Chooser (the "?" button)]]. In the form it opens you can filter by the [[CCI Category]].
##* in the column on the right, pick the [[CCI component 2 codes - what was done]].
##* in the column on the right, pick the [[CCI component 2 codes - what was done]]; the component on the right has to be of the same ''diagnostic / therapeutic / imaging'' kind as the component 1 - if you try to mix types you will get an error.  
## whether picklist or component,  
## whether CCI picklist or CCI component,  
### enter the [[Px Type]] - "admit" or "acquired"  
### enter a [[Px_Type]] - "admit" ([[Admit Procedure]]) or "acquired" ([[Acquired Procedure]])
### enter the [[Px_Date]] - Date of procedure
### enter a [[Px_Date]] - Date of procedure '''for acquired px only'''
### enter the [[Px_Count]] - the number of '''separate''' times it was done''' '''''on a given day
### enter a [[Px_Count]] - the number of '''separate''' times it was done''' '''''on a given day
 
== Introduction to CCI Procedure Coding ==
*We collect procedures that are associated with a patients' '''[[Admit Diagnosis | admission]], ([[Px Type]])''', to a unit and also procedures that where done '''([[Acquired Diagnosis / Complication | acquired]]), ([[Px Type]])''', during  their stay in a unit. 
*For all interventions we are keeping track of:
**[[Px_Date]] - Date of procedure
**[[Px_Count]] - the number of '''separate''' times it was done on a '''given day'''
*When you have a procedure to code in CCI, the first thing that needs to be done is to decide the intervention category/CCI chapter: 
**1. [[Therapeutic Procedure]]
**2. [[Diagnostic Procedure]]
**3. [[Imaging Procedure]]
**5. [[Obstetric Procedure]]
**8. [[Miscellaneous Procedure]] - currently only [[Administration of intravenous immunoglobulin]]
*It's usually easy to figure out which category to use, but sometimes an intervention can be both therapeutic and diagnostic (e.g. thoracentesis).  '''A rule is that when you have a procedure that has both therapeutic and diagnostic aspects, ONLY code the therapeutic part'''. 
**Example: diagnostic cardiac catheterization at same sitting as stent is placed, only code [[Coronary angioplasty with stenting]], but don't code [[Coronary angiogram (diagnostic cardiac catherization)]].
*The approach/rules for coding procedures are different for the different categories/chapters
{{DiscussAllan | "The approach/rules for coding procedures are different for the different categories/chapters" How? }}
 
== Collection Instructions for Therapeutic Procedures ==
=== Which therapeutic procedures to collect/include ===
*Here are the rules for what we will code and what we won't code:
*1. Include ''all '''[[CCI procedures we don't code|codable]]''' therapeutic procedures'' done '''outside the patient’s unit'''.
*2. Include ''all '''[[CCI procedures we don't code|codable]]''' therapeutic procedures'' done '''using an endoscope''' (in or out of the patient's unit) - whether inserted through an orifice, incision or wound.
*3. In addition to (1) and (2) code the following (and '''only''' the following) therapeutic procedures done in the patient’s unit - but '''only the FIRST DAY it was done''' during the patient’s stay on that unit {{discussion}} Tina will need to add a hint to CCMDB to list these... is the list complete at this point? [[User:TOstryzniuk|Trish Ostryzniuk]] 18:15, 2018 April 5 (CDT) :
**arterial catheter placement
**PEG
**[[Hemodialysis (intermittent)]]
**[[Peritoneal dialysis]]
**[[Plasmapheresis]]
**non-invasive mechanical ventilation - includes CPAP, BiPAP, and classic NIV (where a mask is connected to a regular ventilator)
**debridement (which in [[CCI component 2 codes - what was done]]?)
**tracheostomy placement (i.e. done bedside) (ie [[Therapeutic Intervention on Trachea]] and then what, [[Installation of External Appliance]]?)
*{{discussAllan|How would I code the items above that are not linked? Could not find procedures for these... Ttenbergen 15:10, 2018 April 5 (CDT)}}
**AG REPLY:  I'm confused about what is meant here.  These procedures would be coded as usual for CCI chapter 1.  If we want, we could make a picklist for them instead.
*** don't know if we need a picklist, just could not figure out how to code that. I want to make sure that searching for the term brings up the wiki page. Ttenbergen 15:10, 2018 April 5 (CDT)
 
*{{discussion}}what are the rules for CPAP Bipap do we code the pt own machines or just new starts?
** we will need to discuss that in the related article, for now we have no code for this at all. Ttenbergen 14:01, 2018 March 20 (CDT)
**AG REPLY --- of course this can be coded in Chap 1 of CCI.  Again could include in a picklist.  And it'd be coded the 1st time it's used in the patient's unit regardless of who owns the machine.
*** ''How'' can it be coded? It would need to be a combination of a [[CCI component 1 codes - what organ was something done to]] and a [[CCI component 2 codes - what was done]].  Ttenbergen 15:10, 2018 April 5 (CDT)
 
 
=== Repeated procedures ===
If a procedure is done repeatedly on the same day, only enter it once but count it in [[Px_Count]].
Procedures done on a different day should be entered again with a different date. This should be really quick by using the "duplicate" button.
 
{{DiscussTask | repeated CXRs - if we do collect them it will be a nuisance; if we don't they won't compare to the labs count [[CXR]] we are doing now, that this is supposed to replace. How should we proceed? }}
*Do we have to enter a CXR for each day it is done or can we enter CXR once and then keep using the times feature?
*For longer stay patients this could be 50 entries.
*Why do we need to know what day a CXR was done on? What is wrong with using the lab count feature we now use? The same for blood gases and scans.--[[User:LBilesky|LBilesky]] 14:05, 2018 January 19 (CST)
** That is what is planned for now, but this might be worth talking about again to confirm it is worth it.
*** Does the pt travel out of the unit for this?
{{DiscussTask | repeated  ABG/VBG counts - to many rows of data in CCI & lots of rows to scroll down to check what has been entered.}}
*I have tested a few pts and included ABG/VBG counts.  What is this being used for?  Is the counting necessary? This is a time Counting is a time consuming task, besides counting now also entering dates. 
*Example:  I had 2 pts that had 50-100 ABG/VBG's to count and enter dates for. I found there was too many rows of data in addition to the CCI being collected, so lots to scroll through to check what I had entered.  [[p:Joanna Velasco]]
 
=== Related Imaging, Diagnostic and Therapeutic procedures performed at the same time ===
Some interventions consists of imaging and/or diagnostic and/or therapeutic procedures.


For these, '''only code the most invasive part''' that implies the other/s. Do '''not''' code the implied codes. For endoscopic inspection/explorations, code only the '''"furthest/deepest"''' area assessed. 
==== productivity features ====
To reduce clicks to enter same Picklist entries for additional days, there are some extra buttons:
* "x2" will duplicate this line with the next date
** "+" and "-" will up or down the date by one day, to make the copy more useful
* [[Blue button in CCI Picklist]] will fill a range of dates


Examples:
== Collection modes ==
* for a [[Coronary angiogram (diagnostic cardiac catherization)]] where [[Coronary angioplasty with stenting]] happens in the same sitting, only code the [[Coronary angioplasty with stenting]].
<!--As discussed [[Task_Team_Meeting_-_Rolling_Agenda_and_Minutes#ICU_Database_Task_Group_Meeting_.E2.80.93_October_31.2C_2018]] -->
* if a tissue [[Biopsy]] is done as part of an invasive [[Inspection, Exploration]] code only the [[Biopsy]].
*We code CCI procedures in 5 different [[CCI Collection Mode]]s''':
{{:CCI collect each}}
{{:CCI collect count each}}
{{:CCI collect count days}}
{{:CCI collect count units}}
{{:CCI collect first}}


=== We are not tracking all possible procedures ===
=== List of CCI Elements and their collection modes ===
We are not tracking all possible procedures; see [[Reasoning around moving to CCI and our subset of it#Why do we not include the entire set of CCI codes]] and [[CCI procedures we don't code]] for more info.
{{Collapsable
| always= picklist
| full=  
{{#ask: [[Has CCI Picklist Code::+]][[Has StopDate::>{{CURRENTDAY}} {{CURRENTMONTHNAME}} {{CURRENTYEAR}}]]
|?Has CCI Collection Mode
|format=broadtable
|link=all
|limit=1000
|class=sortable wikitable smwtable
}} }}
{{Collapsable
| always= component 2 list
| full=
{{#ask: [[Has CCI 2 Code::+]][[Has StopDate::>{{CURRENTDAY}} {{CURRENTMONTHNAME}} {{CURRENTYEAR}}]]
|?Has CCI Collection Mode
|format=broadtable
|link=all
|limit=1000
|class=sortable wikitable smwtable
}} }}


== Special Cases ==
=== No Procedures Performed ===
=== No Procedures Performed ===
If no procedures were performed you still need to enter something so we can test that procedures were not just forgotten. Enter [[No Procedure Performed]] as an Admit procedure into the [[CCI Picklist]], the top of the tab.
If no procedures were performed '''enter [[No procedure performed]] as an [[Admit Procedure]] with a [[Px Count]] of 1 into the [[CCI Picklist]]''', the top of the tab. Do not enter any procedrues into the CCI Component section, ie leave it as "[[No procedure entered]]". Entering this will mean at least one CCI entry is present when [[Query check CCI must have entry]] checks that entering procedures was not just forgotten.


=== 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.
*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.


----
=== Procedures we don't code ===
We are not tracking all possible procedures. If a procedure can not be coded using the picklist or combined method, then we likely are not interested in coding it.


=== General CCI questions ===
See [[List of CCI procedures we don't code]] for procedures we explicitly don't collect. If you come across a procedure you were not able to code, but think we probably should be coding, please note it [[List of CCI procedures we don't code|there]].
Collectors, please put '''general''' CCI questions here, but specific ones to their respective articles, e.g.
* CCMDB.mdb user interface concerns:
** [[L_CCI_Picklist_subform#Any_questions_or_suggestions_about_this_form_in_CCMDB.mdb]]
** [[L_CCI_Component_subform]]
** [[CCI_Chooser_form]]
* for general concerns about why CCI, or why specific dxs were not included, comment in
** [[Reasoning_around_moving_to_CCI_and_our_subset_of_it]]
* for criteria or specific comments about a specific CCI code, please comment in the page for that article; see [[CCI Picklist]] and [[CCI Component]] for complete list.


== Procedures not coded ==
See [[Reasoning around moving to CCI and our subset of it#Why do we not include the entire set of CCI codes]] and [[List of CCI procedures we don't code]] for more info.
See [[CCI procedures we don't code]]


== Questions? ==
=== Don't code sub-procedures that are part of a larger procedure ===
{{discussAllan | various CCI questions, at least some can likely be answered on the spot, others might need to go to task }}
*Do not code a procedure that is part of a "Bigger" procedure already coded.
'''Example:''' In the course of many or most CABG surgeries, there is placement (or replacement) of chest tubes, pacer wires, arterial lines, central lines, and vein harvest, but do NOT code those procedures separately, since they are "included" in the CABG code.
*On the other hand, things done in OR that are NOT part of the standard procedure (e.g. for someone coming out from OR after CABG who now has ECMO, Swan-Ganz, IABP), you SHOULD code these as [[Admit Procedure]]).


=== additional codes? ===
=== Related Imaging, Diagnostic and Therapeutic procedures performed at the same time ===
* central lines included?
*When at the same sitting both diagnostic and therapeutic procedures are done, then CODE THEM BOTH
{{ex|*  a cardiac cath is done and then a stent is placed -- code the diagnostic cath and the therapeutic stenting.
* for an [[Angiogram, coronary (diagnostic cardiac catheterization)]] where [[Angioplasty, coronary (with stenting)]] happens in the same sitting, code both}}
* if a tissue [[Biopsy (non-endoscopic)]]/[[Biopsy (endoscopic)]] is done as part of an invasive [[Inspection, Exploration (non-endoscopic)]]/[[Inspection, Exploration (endoscopic)]] code both
*When multiple procedures are done at one sitting, code them all
{{Ex|if a CT of chest, abdomen and pelvis is done, code them all}}
*For endoscopic inspection/explorations, code only the '''"furthest/deepest"''' area assessed.


* There is a diagnostic thoracentesis on the [[CCI Picklist]] but not a therapeutic one.  This should be on the picklist as it is very common.
=== [[Aborted Procedure]] ===
** As opposed to coding it as [[Therapeutic Intervention on Thoracic Cavity, anything inside, NOS]], [[Drainage, Evacuation]]? Ttenbergen 16:11, 2018 April 5 (CDT)
*See [[Aborted Procedure]] for how to code


* I tried putting in a diagnostic bronchoscopy. I put in Diagnostic Intervention on the lung but there is no option in the second component to capture taking a sample of secretions for culture. --[[User:LKolesar|LKolesar]] 12:26, 2018 March 20 (CDT)
=== Repeated procedures ===
** For diagnostic the only options are [[Inspection, Exploration]] and [[Biopsy]], so you are correct. Are we OK with that? Ttenbergen 19:00, 2018 March 22 (CDT)
If a procedure is done repeatedly '''on the same day''', only enter it once but count it in [[Px_Count]].  


* Also, at the task group meeting, Dr Garland said that Pacemaker insertion and ICD insertion would be on the picklist because they look the same done in the component entry section.  I guess this item has not been added yet.  
Procedures done on a '''different''' day should be entered again with a different date. This should be really quick by using the "duplicate" button.


*{{discussion}} How should I code an ECMO?--I used Therapeutic Intervention of the heart and Installation of an External appliance, which does not sound right but nothing else fit. (from Lois)
==Data Integrity Checks ==
{{Collapsable
| always= List of cross-checks
| full= {{#ask: [[DICSummary::+]] [[Category:CCI Px check]]
|?DICSummary = summary
|?DICStatus = implementation status
|sort=DICStatus, DICSummary
|default=No corresponding old article found
|format=broadtable
|limit=100
|link=all
|headers=show}} }}


* How do we code tracheostomy?  Therapeutic intervention on trachea and then is it installation of internal or external device (which one?)--[[User:LKolesar|LKolesar]] 12:57, 2018 March 28 (CDT)
== Related Articles ==
 
{{Related Articles}}
*{{discussion}}How do we code an intubation, I used therapeutic intervention on the lung and is it an internal device or external? Lois
 
*{{discussion}}I cannot find [[Albumin 5pct]] and [[Albumin 25pct]] on the picklist. Are we not still counting these? Lois


=== Ability to differentiate in reports ===
== related literature ==
* I do not see how we are going to differentiate a VAD from AV ECMO as they are both installation of external device on the heart??--[[User:LKolesar|LKolesar]] 12:26, 2018 March 20 (CDT)
[https://secure.cihi.ca/free_products/CodingStandards_v2018_EN.pdf CIHI.ca coding standard CCI]
* the instructions seem to indicate that we should not even be coding many of the codes we previously have coded like VAD's ECMO's, etc. I am pretty sure that Julie needs this data. --[[User:LKolesar|LKolesar]] 12:40, 2018 March 20 (CDT)


=== admit vs acquired dxs and the rule to only code if off unit ===
*For the procedures listed specifically like arterial lines, PEG, hemodialysis, etc.  Do you want only if done during their stay or since arrival to the hospital,  or if they already had this done prior to arrival.  There are patients in the community with a PEG and on hemodialysis for example.  --[[User:LKolesar|LKolesar]] 08:07, 2018 March 7 (CST)
** Ah! Yes, will our restrictions for procedures with [[Px Type]] "admit" be the same as for on unit?


=== Coding GI Scopes ===
* ... It does not even include regular GI scopes which are very common and it is on your list of things you want.  ... --[[User:LKolesar|LKolesar]] 11:41, 2018 March 7 (CST)
** The GI Scopes are currently on the [[CCI Component]] list only and would be coded as [[Inspection, Exploration]]. The scope part would have been part 3 (how it was done) an we no longer code that.
{{DiscussTask | CCI codes GI scope as (body part), [[Inspection, Exploration]]. So, won't be able to identify those from laparoscopic surgery. Do we care? Ttenbergen 19:00, 2018 March 22 (CDT) }}
=== Which codes go on picklist ===
* What are the criteria for choosing the picklist items? I thought it was going to be procedures that are difficult to list by the component entry method and then more common procedures. 
* There are quite a few uncommon (rarely seen) procedures in the pick list, is there a reason for this?  Just wondering what the rationale is for these choices?  Maybe these can be left off the picklist and just left to the component entry method.  Just a suggestion.  --[[User:LKolesar|LKolesar]] 13:32, 2018 March 15 (CDT)
=== counts, and moving labs to CCI ===
* Also, I was not aware that we are moving all our count items to CCI and having to put a date for all blood products, CXR, echos, etc. This will definitely be more work than just counting the number of each.  Who is requesting dates for every single item?  Although I see almost all our count items here, I do not see Abdominal Ultrasounds which we currently count. Also there are additional diagnostic procedures on this list that we previously did not count.  At one time we did not add other diagnostic counts because the data was not requested.  Is all this additional data being requested now?  (ie:  EEG's, abdominal xrays, nuclear scans, urodynamic study, cardiac stress test, pulmonary function tests, etc).  We used to go the steering committee for requests for additional data collection items, has this now changed?
==Date Integrity Checks ==
==={{CCMDB Data Integrity Checks|ready to implement|ready to implement}} - Must have at least one entry ===
{{discussion}}
Will need to be implemented: to click complete:
* must have a other than [[No Procedure Performed]]
* code [[No Procedure Performed]] if there were no procedures
==={{CCMDB Data Integrity Checks|ready to implement|ready to implement}} - CCI Procedure vs [[Previous Location]] Cross Check ===
If from OR or PACU, must have at least 1 CCI
== Related Articles ==
{{Related Articles}}


[[category: ICD10/CCI Conversion]]
[[category: ICD10/CCI Conversion]]
[[Category: CCI| *]]
[[Category:CCI| *]]
Retrieved from "https://ccmdb.kuality.ca/index.php?title=CCI_Collection"