CCI Collection

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.

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

• For all interventions we are keeping track of:
  • Px Type - whether the procedure was occurred before and associated with the with the patients's admission to the unit OR was done after admission.
  • Px_Date - Date of procedure
  • Px_Count - the number of separate times it was done on a given day

Steps in selecting and entering CCI procedure in CCMDB

Follow these steps, in this order:

1. if no procedures were performed, see #No Procedures Performed
2. 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.
   3. whether CCI picklist or CCI component,
      1. enter a Px_Type - " admit" or " acquired"
      2. enter a Px_Date - Date of procedure
      3. enter a Px_Count - the number of separate times it was done on a given day

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

Collection Instructions for Procedures

Which procedures to collect/include

Here are the rules for what we will code and what we won't code:

Procedures done outside the unit

Include all codable procedures done outside the patient’s unit.

Procedures done on the unit (endoscope or non-therapeutic)

Include all of the following codable procedures done on the unit:

• • (a) any procedure that uses an endoscope -- whether inserted through an orifice, incision or wound
  • (b) all codable Diagnostic Procedures
  • (c) all codable Imaging Procedures
  • (d) all codable Obstetric Procedures
  • (d) all codable Miscellaneous Procedures

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:
    • Hemodialysis (intermittent)
    • Peritoneal dialysis
    • Plasmapheresis
    • Mechanical ventilation, noninvasive - includes CPAP, BiPAP, and classic NIV (where a mask is connected to a regular ventilator)
    • Isolation, infectious
    • ECMO, VA
    • ECMO, VV
    • Template:DiscussAllan

• • Sublist of these procedures that are coded in the usual CCI manner, i.e. using components:
    • PEG -- for which you combine the 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 code for body part Therapeutic Intervention on Trachea with "what was done" as Bypass

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.

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.

Examples:

• for a Coronary angiogram (diagnostic cardiac catherization) where Coronary angioplasty with stenting happens in the same sitting, only code the Coronary angioplasty with stenting.
• if a tissue Biopsy is done as part of an invasive Inspection, Exploration code only the Biopsy.

We are not tracking all possible procedures

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.

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.

Procedures not coded

See CCI procedures we don't code

Questions?

additional codes?

• 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.
  • As opposed to coding it as Therapeutic Intervention on Thoracic Cavity, anything inside, NOS, Drainage, Evacuation? Ttenbergen 16:11, 2018 April 5 (CDT)

• 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. --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)

• 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.

Template: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--LKolesar 13:34, 2018 April 9 (CDT)?

• Template:DiscussionHow do we code an intubation, I used therapeutic intervention on the lung and is it an internal device or external? Lois

• Template:DiscussionI cannot find Albumin 5pct and Albumin 25pct on the picklist. Are we not still counting these? Lois

• Template: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.--LKolesar 13:32, 2018 May 2 (CDT)

• Template:Discussion: I notice that isolation, infectious is now added to the pick list in CCI. We don't have to code reverse isolation? --LKolesar 08:07, 2018 May 9 (CDT)

Ability to differentiate in reports

• 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??--LKolesar 12:26, 2018 March 20 (CDT)
  • Laura, does having ECMO, VA and ECMO, VV address this question? If so, please take it out. If not, please clarify. Ttenbergen 17:13, 2018 May 8 (CDT)
• I see you have put ECMO on the picklist. How do we put VAD's in the component method?

• 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. --LKolesar 14:11, 2018 May 1 (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. --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

• • 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.

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)

• SMW

• Cargo

• Categories

• Template:Discussion For upper GI scope, should it be coded diagnostic/therapeutic interventions on "stomach" or "small intestine"? (since duodenum is first part of small intestine). Also, if biopsy is done with inspection and exploration, but no interventions like clipping or to control bleeding, should that be coded as "biopsy" or "inspection, exploration"? --Malcudia 10:13, 2018 April 11 (CDT)
  • Re whether to code stomach or intestine, see #Related Imaging, Diagnostic and Therapeutic procedures performed at the same time above in this document. Re whether to code biopsy or exploration. I'll leave that open for now. Ttenbergen 10:57, 2018 April 11 (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. --LKolesar 13:32, 2018 March 15 (CDT)
• I see arterial blood gases are on the picklist. However, Dr Garland had said that arterial blood gases and venous blood gases will remain in our count list unlike all the other things we count. Should arterial blood gases be removed from the CCI pick list?--LKolesar 13:29, 2018 April 9 (CDT)

• 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:
• What about chest tubes inserted in the unit?; ECMO inserted in the unit?; CRRT done in the unit? Intubations and central lines in the unit? Cardioversions and Defibs in the unit?; Pacemakers in the unit? IABP in the unit?etc. --LKolesar 13:59, 2018 April 20 (CDT)

counts, and moving labs to CCI

Lab counts

• SMW

• Cargo

• Categories

• 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? 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?

Template:DiscussAllan

• 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.--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?

ABG/VBG counts tests in CCI & concerns

• 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

Template:DiscussAllan

• For example:

one patient that was in ICMS for 3 weeks

• on ECMO had 86 ABG's done in their admission.
• It took me 15 minutes to just enter the ABG's in CCI.
• It only takes one minute to enter this item in the old count method off of EPR labs.
• If I spent the time to enter all the blood products, tests and labs, etc. It would have taken much longer. No one has that much extra time in their day to spend it putting in these CCI entries for every lab. It may work for short stay patients with minimal labs and procedures but not for more complex patients. We need to discuss this. --LKolesar 14:13, 2018 April 20 (CDT)

• • Laura,' we discussed your testing at task. A question came up in regards to what method did you use to enter these 86 ABG's?
    • Were you counting number of ABG PER day and then enter that count into CCI and assigning a date? or
    • Did you go from EPR to paper then into CCMDB CCI?
    • Did you use the + button? Trish Ostryzniuk
      • I did the CCI entries exactly as directed using the + button for new entries and putting the # for each day in the column for that. I did it as efficiently as I could, I never use paper. You can likely see it in the profile if you would like to look at it. I think it was MICU profile #31216. I sent it in after April 17th. --LKolesar 07:10, 2018 April 26 (CDT)
        • I had a look and there is nothing for CCI for profile indicated above. Only 19 row of label ACQUIRED, but no data. I will talk to Tina.Trish Ostryzniuk 15:06, 2018 April 26 (CDT)
      • Entering these tests is very tedious and time consuming and it takes away from our time doing diagnostic coding. It took me 20 mins to enter just CXR's on a patient that was a long stay patient and I was only half done. --LKolesar 14:19, 2018 May 1 (CDT)

Date Integrity Checks

Template:CCMDB Data Integrity Checks - Must have at least one entry

Template: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

Template:CCMDB Data Integrity Checks - CCI Procedure vs Previous Location Cross Check

If from OR or PACU, must have at least 1 CCI

related literature

CIHI.ca coding standard CCI