CCI Collection

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

They are entered in CCMDB.accdb in the Patient Viewer Tab CCI_Pick and Patient Viewer Tab CCI_Comp on the Patient Viewer.

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

Collection instructions

Selecting and entering CCI procedure in CCMDB

Follow these steps, in this order:

1. for every procedure:
   1. 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.
   2. 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.
        • 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; 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.
   3. whether CCI picklist or CCI component,
      1. enter a Px_Type - "admit" (Admit Procedure) or "acquired" (Acquired Procedure)
      2. enter a Px_Date - Date of procedure for acquired px only
      3. enter a Px_Count - the number of separate times it was done on a given day

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

Collection modes

• We code CCI procedures in 5 different CCI Collection Modes:

Collecting "CCI collect each" items

• "CCI collect each" items are entered each time they happen
• Px Date
  • if an Acquired Procedure, enter the Px Date for each day that they happen
  • if an Admit Procedure leave the date blank
• Px Count
  • if they happen more than once on a day, enter the number of times for that day, otherwise enter a Px Count of 1

Collecting "CCI collect count each" items

Blood gas, arterial, and Blood gas, venous are only collected manually at the Grace, at HSC or STB they are automatically uploaded from DSM Lab Extract.

• "CCI collect count each" items are entered as counts of how often they occurred
• Px Date
  • if an Acquired Procedure, enter the Px Date of the first time they happen
  • if an Admit Procedure leave the date blank
• enter the total number of times the procedure was done as Px Count. If it happened as an Admit Procedure and as an Acquired Procedure, enter separately.

Collecting "CCI collect count days" items

• "CCI collect count days" items are entered as counts of how often they occurred
• Px Date
  • if an Acquired Procedure, enter the Px Date of the first time they happen
  • if an Admit Procedure leave the date blank
• enter the total number of days on which the procedure was done, even just for part of the day, Admit Procedure and each Acquired Procedure of this type as Px Count
• this data is cross-checked by query check_CCI_vs_LOS_count_days_component and query check_CCI_vs_LOS_count_days_picklist

Collecting "CCI collect count units" items

• "CCI collect count units" items are entered as counts of how often they occurred
• Px Date
  • if an Acquired Procedure, enter the Px Date of the first time they happen
  • if an Admit Procedure leave the date blank
• enter the total number of units that were administered for each Admit Procedure and each Acquired Procedure of this type as Px Count

Collecting "CCI collect first" items

• "CCI collect first" items are entered the first time they happen
• Px Date
  • if an Acquired Procedure, enter them with the Px Date of the first time they happen
  • if an Admit Procedure leave the date blank and just enter the procedure
• Px Count is always 1 for this collection mode

List of CCI Elements and their collection modes

picklist

Has CCI Collection Mode CCI PickList Procedure CCI collect each Intracranial pressure monitoring (TISS Item) Invasive Mechanical Ventilation (TISS Item) Isolation, infectious LP (lumbar puncture, diagnostic) Nephrostomy placement No TISS Item (TISS Item) No codable procedure done in OR No procedure entered No procedure performed Non-invasive CPAP or BIPAP (TISS Item) PD (Peritoneal dialysis) PFT (pulmonary function test) Pacemaker insertion, permanent Pacemaker insertion, temporary Paracentesis (diagnostic) Patient is on isolation (TISS Item) Peripheral arterial line (TISS Item) Peritoneal dialysis (TISS Item) Planned extubation (TISS Item) Plasmapheresis Postpartum surgical repair (therapeutic) -- incl episiotomy Prone positioning Pulmonary arterial line (TISS Item) Right heart catheterization, in cardiac cath lab SVD (Spontaneous vaginal delivery) Sleep Study (Polysomnogram, done in Miseracordia Sleep lab) Supp O2 through any device, delivered via nose, mouth, ETT or trach (TISS Item) Suppression of labor (therapeutic) - incl via pharmacologic tocolytics Surgical removal of extrauterine pregnancy (therapeutic) Suturing of cervical os (therapeutic) Swan-Ganz (Pulmonary Artery Flotation) Catheter placement TIPS (transjugular intrahepatic portosystemic shunt) TPN (Total parenteral nutrition) Targeted Temperature Management (TTM) Termination of pregnancy pharmacologic (therapeutic) Termination of pregnancy surgical (therapeutic) Thoracentesis (diagnostic) Trach Tube Present (TISS Item) Tracheostomy creation Transfusion of PRBC Transfusion of albumin Transfusion of plasma products Transfusion of platelets Unplanned extubation (TISS Item) Urodynamics study (cystometrogram, done by urology lab) Vasoactive drug IV continuous-multiple simultaneous (TISS Item) Vasoactive drug IV continuous-single (TISS Item)

component 2 list

Has CCI Collection Mode MRI Nuclear Imaging Occlusion Pharmacotherapy, thrombolytic agent Procure, Harvest, Obtain for Further Use Radiation Therapy Reattachment Release, Decompression Removal of Foreign Body Repair Transplant Ultrasound

Special Cases

No Procedures Performed

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.

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 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).

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

Example:

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

Example:

if a CT of chest, abdomen and pelvis is done, code them all

• For endoscopic inspection/explorations, code only the "furthest/deepest" area assessed.

Aborted Procedure

• See Aborted Procedure for how to code

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.

Data Integrity Checks

List of cross-checks

summary implementation status Query check CCI TISS CAM positive vs Dx Query NDC Dialysis TISS CCI Query check CCI TISS time means must be two Query check TISS each day Query check CCI component 1 and 2 compatible Query check CCI vs LOS count days picklist Query check CCI vs LOS count days component Query check CCI TISS if no then none Query check CCI if no then none Query check CCI from OR no CCI Query check CCI TISS matching BoardingLoc time Query check ICD10 trach has trach but no TISS Query check ICD10 trach create but no TISS Query check CCI Component duplicates Query check CCI Picklist duplicates Sub Dx Checker Query check CCI TISS NrDays GT LOS Query check CCI TISS NrDays LT LOS Query check CCI must have entry Query check CCI Component no admin entries Query check CCI Picklist if no admin entries Query check ICD10 trach dxs consistent Query check CCI Component unfilled Query check CCI Picklist unfilled Query check CCI Date Query check eliminated CCI Comp Query check eliminated ICD10 Query check eliminated CCI Pick Query check CCI each count vs LOS Query check CCI CRRT vs Tmp Query NDC TISS CCI endoscopic Query NDC cardioversion dx vs TISS Query NDC zCRRT CCI Px but no TISS Query NDC zCRRT TISS but no CCI Px Query NDC Trach Dx TISS

related literature

CIHI.ca coding standard CCI