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CCI Collection: Difference between revisions

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This article provides general information about collecting and coding a [[CCI Procedure]].   
This article provides general information about collecting and coding a [[CCI Procedure]].   


They are entered in [[CCMDB.mdb]] in the [[Patient viewer tab CCI]] on the [[Patient viewer tab CCI]].
They are entered in [[CCMDB.accdb]] in the [[Patient Viewer Tab CCI_Pick]] and [[Patient Viewer Tab CCI_Comp]] on the [[Patient Viewer]].


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]].
For background information, see [[CCI]] and [[Reasoning around moving to CCI and our subset of it]].


== Collection instructions ==
== Collection instructions ==
===Start Date: Jan 1, 2019 ===


=== Determining if the procedure you found is one we collect ===
=== Selecting and entering [[CCI]] procedure in [[CCMDB]] ===
Here are the '''rules''' for what we will code and what we won't code:
==== Procedures done outside the unit ====
Include ''all '''[[CCI procedures we don't code|codable]]''' procedures'' done '''outside the patient’s unit'''.
 
==== Procedures done on the unit (endoscope or non-therapeutic) ====
Include '''all of the following '''[[CCI procedures we don't code|codable]]''' procedures''' done on the unit:
**(a) any procedure that '''uses an endoscope''' -- whether inserted through an orifice, incision or wound
**(b) all [[CCI procedures we don't code|codable]] '''[[Diagnostic Procedure]]s'''
**(c) all [[CCI procedures we don't code|codable]] '''[[Imaging Procedure]]s'''
**(d) all [[CCI procedures we don't code|codable]] '''[[Obstetric Procedure]]s'''
**(d) all [[CCI procedures we don't code|codable]] '''[[Miscellaneous Procedure]]s'''
 
==== Procedures only coded once pre ward stay ====
In addition to (1) and (2) code the following (and '''only''' the following) procedures done in the patient’s unit - but '''only the FIRST TIME (date) IT WAS DONE''' during the patient’s stay on that unit
* Sublist of these procedures that are chosen from the Picklist:
** [[Whole body cooling]]
** [[Whole body warming - incl extracorporeal warming of blood]]
** [[Electroconvulsive (Shock) Therapy to Brain]]
** [[Cardioversion -- excl defibrillation which we are not tracking separately]]
** [[Plasmapheresis]]
** [[Peritoneal dialysis]]
** [[Hemodialysis (intermittent)]]
** [[Continuous renal replacement therapy -- incl for volume removal via PRISMA device]]
** [[Total parenteral nutrition (TPN)]]
** [[ECMO, VV]]
** [[ECMO, VA]]
** [[Pacemaker insertion, permanent]]
** [[Pacemaker insertion, temporary]]
** [[Mechanical ventilation, noninvasive]] - includes CPAP, BiPAP, and classic NIV (where a mask is connected to a regular ventilator)
** [[Isolation, infectious]]
** [[Total parenteral nutrition (TPN)]]
 
* Sublist of these procedures that are coded in the usual CCI manner, i.e. using components:
** PEG -- combine body part [[Therapeutic Intervention on Stomach, Pylorus]] with "what was done" as [[Bypass]]
** Debridement -- for which you combine the body part, with the "what was done" CCI code [[Excision, Resection, partial]]
** Tracheostomy placement (i.e. done bedside) -- combine body part [[Therapeutic Intervention on Trachea]] with "what was done" as [[Bypass]]
** Endotracheal intubation -- combine body part [[Therapeutic Intervention on Trachea]] with "what was done" as [[Implantation of Internal Device]]
** Chest tube (tube thoracostomy)-- combine body part [[Therapeutic Intervention on Pleura]] with "what was done" as [[Implantation of Internal Device]]
** Intraaortic balloon  pump (IABP) -- combine body part [[Therapeutic Intervention on Aorta, NOS]] with "what was done" as [[Implantation of Internal Device]]
 
=== Before You Decide to NOT Code a Procedure ===
*We're not looking to code procedures that not either: (a) on the picklist, or (b) able to be constructed from it's components [e.g. a body part, and what was done to that body part].
*The main issue here is that among the lists "what was done", we haven't included EVERY possibility.
**For example, in the Imaging Procedures, besides some plain X-rays contained in that picklist, the "what type of imaging study was done" does NOT include plain x-rays.  Thus we're not enabling creation of a plain X-ray of other body part other than those contained in the picklist.
**Similarly, for the Therapeutic Procedures, there is a list of approximately 30 items of "what was done" to the chosen body part. So some items of "what was done" are not available and you won't be able to code such procedures. 
***'''BUT, before you decide this is the case, you will need to become very familiar with the descriptions of EACH of the "what was done" items that ARE available'''.  For example the item '''[[Bypass]]''' includes creating a ostomy (which includes a colostomy and even a tracheostomy).
****See '''[[CCI component 2 codes - what was done]]'''
 
== Selecting and entering [[CCI]] procedure in [[CCMDB]] ==
Follow these steps, in this order:  
Follow these steps, in this order:  
# for every procedure:  
# for every procedure:  
Line 63: Line 15:
##* 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 CCI picklist or CCI component,  
## whether CCI picklist or CCI component,  
### enter a [[Px_Type]] - "[[Admit Diagnosis | admit]]" or "[[Acquired Diagnosis / Complication | acquired]]"
### enter a [[Px_Type]] - "admit" ([[Admit Procedure]]) or "acquired" ([[Acquired Procedure]])
### enter a [[Px_Date]] - Date of procedure
### enter a [[Px_Date]] - Date of procedure '''for acquired px only'''
### enter a [[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


=== Repeated procedures ===
==== productivity features ====
If a procedure is done repeatedly '''on the same day''', only enter it once but count it in [[Px_Count]].
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


Procedures done on a '''different''' day should be entered again with a different date. This should be really quick by using the "duplicate" button.
== Collection modes ==
 
<!--As discussed [[Task_Team_Meeting_-_Rolling_Agenda_and_Minutes#ICU_Database_Task_Group_Meeting_.E2.80.93_October_31.2C_2018]] -->
=== Related Imaging, Diagnostic and Therapeutic procedures performed at the same time ===
*We code CCI procedures in 5 different [[CCI Collection Mode]]s''':
Some interventions consists of imaging and/or diagnostic and/or therapeutic procedures.  
{{:CCI collect each}}
 
{{:CCI collect count each}}
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. 
{{:CCI collect count days}}
{{:CCI collect count units}}
{{:CCI collect first}}


Examples:
=== List of CCI Elements and their 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]].
{{Collapsable
* if a tissue [[Biopsy]] is done as part of an invasive [[Inspection, Exploration]] code only the [[Biopsy]].
| always= picklist
 
| full=
=== We are not tracking all possible procedures ===
{{#ask: [[Has CCI Picklist Code::+]][[Has StopDate::>{{CURRENTDAY}} {{CURRENTMONTHNAME}} {{CURRENTYEAR}}]]
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.
|?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.


=== Procedures not coded ===
=== Moved patients ===
See [[CCI procedures we don't code]]
*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.


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]].


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.


=== Don't code sub-procedures that are part of a larger procedure ===
*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]]).


end of instructions, the questions below will eventually be cleared out.
=== Related Imaging, Diagnostic and Therapeutic procedures performed at the same time ===
----
*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.


== Questions? ==
=== [[Aborted Procedure]] ===
{{discussAllan |
*See [[Aborted Procedure]] for how to code
* various CCI questions, at least some can likely be answered on the spot, others might need to go to task}}


=== admit vs acquired dxs and the rule to only code if off unit ===
=== Repeated procedures ===
*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)
If a procedure is done repeatedly '''on the same day''', only enter it once but count it in [[Px_Count]].
** Ah! Yes, will our restrictions for procedures with [[Px Type]] "admit" be the same as for on unit?


=== Bronchoscopy ===
Procedures done on a '''different''' day should be entered again with a different date. This should be really quick by using the "duplicate" button.
* 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)
** 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)
 
=== Insert Pacemaker ===
{{discussTask | ICD insertion
* ICD insertion was supposed to be on the picklist because they look the same done in the component entry section. [[Pacemaker insertion, permanent]] and [[Pacemaker insertion, temporary]] are in picklist now. '''How about the ICD?''' Ttenbergen 18:34, 2018 May 16 (CDT)}}
 
===Closure of surgical incision that was left open ===
{{discussion}} how do we code closure of a surgical incision done later.  Many times if a patient bleeds excessively or if they expect a lot of edema or a requirement for further future surgery, they leave the surgical incision open. When the patient eventually goes back for closure, how do we code this in CCI--[[User:LKolesar|LKolesar]] 13:34, 2018 April 9 (CDT)? 
 
===Lumbar puncture===
*{{discussion}} for a lumbar puncture, I put interventions on the spinal cord or spinal canal. Do I use drainage, evacuation for this? They just take a sample of CSF but there is no sample option.--[[User:LKolesar|LKolesar]] 13:32, 2018 May 2 (CDT)
 
===VAD===
How do we put VAD's in the component method?
 
===Thrombolyic agents for PE, MI, stroke ===
*{{discussion}}: how do we differentiate thrombolytic agents given for PE, MI or stroke?  For component 1: I thought it should be "theuapeutic intervention on circulatory system" for all of these options and then "pharmacotherapy, thrombolytic agent" for component *If the patient has only one of the above diagnosis, one could assume that the treatment was related to that.  Does it matter what it is given for? --[[User:LKolesar|LKolesar]] 13:02, 2018 May 10 (CDT) 
 
===Blakemore vs UGI scope for banding ===
{{discussion}}
* How do we differentiate a Blakemore tube from an Upper GI scope with banding or hemostasis?  They both look the same in CCI:  Therapeutic Intervention on Stomach, pylorus... and Control of Bleeding. --[[User:LKolesar|LKolesar]] 14:11, 2018 May 1 (CDT)
 
== Common items done in a unit that are missing from Picklist ==
*also check out: [[CCI procedures we don't code]].
{{Discussion}}
{{DiscussAllan | Your instructions for therapeutic procedures done in the unit exclude several important procedures that are commonly done in the unit.  Just checking if this is correct... see list below:}}
*chest tubes inserted and left in place (ie. therapeutic thoracentesis, not just diagnostic)
*paracentesis (therapeutic, not just diagnostic)
*ECMO inserted in the unit
*CRRT - already added to pick list, but can we shorten it to CRRT, not the full name?
*intubation (is on TISS)
*tracheostomy insertion (is on TISS)
*PEG insertion
*central line insertions (do we need to differentiate between PICCs, Vasc.caths, regular CL's, etc. They all look the same in component CCI).
*cardioversion - already added to pick list.
**Defib not added as per task meeting May 9.18[[User:TOstryzniuk|Trish Ostryzniuk]] 14:50, 2018 May 14 (CDT)
*Temp Pacemakers in the unit (is on TISS)
*IABP in the unit --[[User:LKolesar|LKolesar]] 13:59, 2018 April 20 (CDT)
*foley - is this one that we want to leave of?
*FMS
*NG's/OG's
*Art lines
*Pulmonary Arterial Catheters (ie. Swan Ganz catheters)
 
 
----
And the content below here will need to stay as well
 
==Date Integrity Checks ==
==={{CCMDB Data Integrity Checks|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}} - CCI Procedure vs [[Previous Location]] Cross Check ===
==Data Integrity Checks ==
If from OR or PACU, must have at least 1 CCI
{{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}} }}


== Related Articles ==
== Related Articles ==
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== related literature ==
== related literature ==
[https://secure.cihi.ca/free_products/Coding%20standard_EN_web.pdf CIHI.ca coding standard CCI]
[https://secure.cihi.ca/free_products/CodingStandards_v2018_EN.pdf CIHI.ca coding standard CCI]






[[category: ICD10/CCI Conversion]]
[[category: ICD10/CCI Conversion]]
[[Category: CCI| *]]
[[Category:CCI| *]]
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