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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]].


== Introduction to CCI Procedure Coding ==
== Collection instructions ==
*CCI stands for ''Canadian Classification of Interventions''.  It is the standard schema used in all of Canada to code all types of medical procedures.
===Start Date: Jan 1, 2019 ===
*We decided to code procedures as a subset of [[CCI]].  By ''subset" we are referring to the fact that there are over 18,000 procedures in all of CCI; we will only be keeping track of a fairly small fraction of these.
**See [[Reasoning around moving to CCI and our subset of it]] for reasons.
*We will collect procedure in two separate "bins": '''admit''' and '''acquired'''; see [[Px Type]] form more info.
**Acquired procedures are those done AFTER admission to the ICU/ward.
**Admit procedures are those done '''BEFORE''' admission and are relation to admission.
**For example, with admission after a surgery, the surgery is an admit procedure.
**NOTE:  If a person is admitted and the plan is to take them to the unit first, and soon thereafter do the procedure, you should code this as '''acquired''', not '''admit'''.
*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 Procedures]]
**2. [[#Non-imaging Diagnostic Procedures]]
**3. [[#Diagnostic Imaging Procedures]]
**5. [[#Obstetrical Procedures]] -- these comprise a small picklist of therapeutic and diagnostic procedures directly related to the pregnant mother.  Other procedures done on a woman who happens to be pregnant (i.e. are not directly related to pregnancy and childbirth) would go under one of the other CCI categories listed on this page.
**8. [[#Miscellaneous]] - Immunotherapy procedures -- the only item on this list is intravenous administration of immunoglobulin (ivIg)
*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'''.  For example, for a diagnostic cardiac catheterization where at the same sitting a stent is placed, only code the stent placement.
*The approach/rules for coding procedures are different for the different categories/chapters


== Collection Instructions for Therapeutic Procedures ==
=== Selecting and entering [[CCI]] procedure in [[CCMDB]] ===
=== Which therapeutic procedures to collect/include ===
*Here are the rules for what we will code and what we won't code:
*1. Include ''all codable therapeutic procedures'' done '''outside the patient’s unit'''.
*2. Include ''all codable therapeutic procedures'' done '''using an endoscope''' (in or out of the patient's unit) - whether inserted through an orifice, incision or wound.
**'''Important note regarding the meaning of "ALL CODABLE therapeutic procedures" as used above.  As we're not including all 18,000 CCI procedures, there are many procedures we are not seeking to capture.  The way this limitation shows itself is that the 2nd level of coding of therapeutic procedures (2nd level identifies "what was done" to the body part chosen in the 1st level) does not include all available options -- some that are not included in our CCI subset are dressings, oxygenation, and many others.'''
*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:
**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
**tracheostomy placement (i.e. done bedside)
 
 
 
*{{discussAllan|that code includes lists I can't find pages/links for, so what codes would we enter? }}
**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.
*{{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.
* {{Discussion}} I suggest that VAC dressing changes be put in this category because they are usually done in the OR and done numerous times in a patient's stay. --[[User:LKolesar|LKolesar]] 14:02, 2018 March 15 (CDT)
**AG reply:  Two things here.  First, VAC dressings are just a special type of dressing.  So we're not particularly interested in it.  But you might then notice that would give us a problem with rule#1, to code all procedures done outside of the patient's unit.  In this regard, see the "Important note" above that's in '''ALL BOLD'''.
 
=== Collecting a procedure ===
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 [[L_CCI_Picklist subform]], the top of the tab, and enter the procedure there, else enter it in the [[L_CCI_Component subform]] at the bottom of the tab
## 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.
# in whichever form you used,  
## 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.
## enter the [[Px Type]] - "admit" or "acquired"  
##* pick the left column, [[CCI component 1 codes - what organ was something done to]].
## enter the [[Px_Date]] - Date of procedure
##** 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]].
## enter the [[Px_Count]] - the number of '''separate''' times it was done''' '''''on a given day
##* 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,  
### enter a [[Px_Type]] - "admit" ([[Admit Procedure]]) or "acquired" ([[Acquired 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


==== Picklist Entries ====
==== productivity features ====
Just pick the [[CCI Picklist]] entry.
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


==== Component Entries ====
== Collection modes ==
To enter a [[CCI Component]]:
<!--As discussed [[Task_Team_Meeting_-_Rolling_Agenda_and_Minutes#ICU_Database_Task_Group_Meeting_.E2.80.93_October_31.2C_2018]] -->
# pick the left column, the body system: [[CCI Component#Component 1|Component 1]].
*We code CCI procedures in 5 different [[CCI Collection Mode]]s''':
#* 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]].
{{:CCI collect each}}
# code what was done: [[CCI Component#Component 2|Component 2]].
{{:CCI collect count each}}
{{:CCI collect count days}}
{{:CCI collect count units}}
{{:CCI collect first}}


=== Repeated procedures ===
=== List of CCI Elements and their collection modes ===
If a procedure is done repeatedly on the same day, only enter it once but count it in [[Px_Count]].
{{Collapsable
Procedures done on a different day should be entered again with a different date. This should be really quick by using the "duplicate" button.
| always= picklist
 
| full=
{{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 x-ray]] we are doing now, that this is supposed to replace. How should we proceed? }}
{{#ask: [[Has CCI Picklist Code::+]][[Has StopDate::>{{CURRENTDAY}} {{CURRENTMONTHNAME}} {{CURRENTYEAR}}]]
*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)
|?Has CCI Collection Mode
** That is what is planned for now, but this might be worth talking about again to confirm it is worth it.
|format=broadtable
*** Does the pt travel out of the unit for this?
|link=all
 
|limit=1000
=== Related Imaging, Diagnostic and Therapeutic procedures performed at the same time ===
|class=sortable wikitable smwtable
Some interventions consists of imaging and/or diagnostic and/or therapeutic procedures.
}} }}
 
{{Collapsable
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. 
| always= component 2 list
 
| full=
Examples:  
{{#ask: [[Has CCI 2 Code::+]][[Has StopDate::>{{CURRENTDAY}} {{CURRENTMONTHNAME}} {{CURRENTYEAR}}]]
* for a [[Coronary angiogram (diagnostic cardiac catherization)]] where [[Coronary angioplasty with stenting]] happens in the same sitting, only code the [[Coronary angioplasty with stenting]].
|?Has CCI Collection Mode
* if a tissue [[Biopsy]] is done as part of an invasive [[Inspection, Exploration]] code only the [[Biopsy]].
|format=broadtable
 
|link=all
=== We are not tracking all possible procedures ===
|limit=1000
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]] for more info.
|class=sortable wikitable smwtable
 
}} }}
{{DiscussTask | how to code things not on the list... should we keep [[Therapeutic Intervention, NOS]]? What would be the coding instructions so it is not used for the small and common ones we don't want to collect? }}
Ttenbergen 14:12, 2018 March 5 (CST)


== 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 [[L CCI Picklist subform]], 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 ===
=== General CCI questions ===
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.  
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.  
***{{Discussion}}why is there no xray under CCI component entries I want to enter acquired/ foot xray/ so I put in acquired/then DI of lower limb then I want to enter xray but there is none so then do I enter Inspection?exploration?


== Procedures not coded ==
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]].
We don't code all procedures. Generally, if it is not on the list, we don't code it. Here are some examples of procedures we have specifically considered, and decided not to code.  


{{discussion}} This is just a placeholder for now. The questions keep coming up and we need a place to put the answers. More will be added as we go.
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.


* EKG
=== 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]]).


== Questions? ==
=== Related Imaging, Diagnostic and Therapeutic procedures performed at the same time ===
{{discussAllan | various CCI questions, at least some can likely be answered on the spot, others might need to go to task }}
*When at the same sitting both diagnostic and therapeutic procedures are done, then CODE THEM BOTH
=== additional codes? ===
{{ex|*  a cardiac cath is done and then a stent is placed -- code the diagnostic cath and the therapeutic stenting.
* central lines included?
* 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 your pick list but not a therapeutic one.  This should be on the picklist as it is very common. 
=== [[Aborted Procedure]] ===
*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 ==
* 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)
{{Collapsable
*{{discussion}}How do we code an intubation, I used therapeutic intervention on the lung and is it an internal device or external? Lois
| always= List of cross-checks
*{{discussion}}I cannot find albumin both 5% and 25% on the picklist. Are we not still counting these? Lois
| full= {{#ask: [[DICSummary::+]] [[Category:CCI Px check]]
 
|?DICSummary = summary
=== Ability to differentiate in reports ===
|?DICStatus = implementation status
* 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)
|sort=DICStatus, DICSummary
* 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)
|default=No corresponding old article found
 
|format=broadtable
=== admit vs acquired dxs and the rule to only code if off unit ===
|limit=100
*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)
|link=all
** Ah! Yes, will our restrictions for procedures with [[Px Type]] "admit" be the same as for on unit?
|headers=show}} }}
 
=== 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)
 
=== Obstetrical codes on picklist ===
* ... I hope this is not the picklist because I do not see the codes we need or frequently use. Why are there so many obstetrical codes on it? These are not frequently used.
** We did not include the obstetric codes in CCI Component and instead only included those specific few we wanted in Picklist.
 
=== 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
***Do we code EKG in CCI=I don't think we need it.  A lot are done on some patients, and in truth it's a relatively minor diagnostic test which --- if it finds something --- will be then listed in the list of diagnoses.AG Thank you Tina and Dr Garland for your information.


== Related Articles ==
{{Related Articles}}


== related literature ==
[https://secure.cihi.ca/free_products/CodingStandards_v2018_EN.pdf CIHI.ca coding standard CCI]


==={{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| *]]
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