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.

Template:Discussion*For interfacility transfers from units that collect data are the "before" associated procedures with patient admission considered captured by the sending facility or do these previous procedures need to be coded again by the receiving facility? Would all acquired procedures performed at the sending facility be coded by the receiving facility or limited to acquired procedures that have direct association with patient admission to the receiving facility? Pamela Piche 08:58, 2018 April 9 (CDT)

• • No, I this would be too much unnecessary double coding however, I will ask Allan Garland to weigh in on this. Trish Ostryzniuk 11:19, 2018 April 9 (CDT)

• • Px_Date - Date of procedure
  • Px_Count - the number of separate times it was done on a given day
• The categories (corresponding to CCI chapter numbers chapters) are:
  • 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
  • Rule: 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 placemen -- here 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

Template:DiscussAllan AG REPLY --- a number of ways. Chapters 5 and 8 have no "levels" while Chapters 1,2, and 3 do. The names/meaning of the 1st levels are similar for Chaps 1,2,3, but are different for the 2nd levels. In short, I think it will be very important for training if we teach them the different chapters DIFFERENTLY, which includes NOT trying to pretend they all have the same rules.

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

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 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.
• 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 Template:Discussion Tina will need to add a hint to CCMDB to list these... is the list complete at this point? 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?)
• Template:DiscussAllan
  • 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)

• Template:Discussionwhat 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.

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?

• SMW

• Cargo

• Categories

• 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?

repeated ABG/VBG counts - to many rows of data in CCI & lots of rows to scroll down to check what has been entered.

• SMW

• Cargo

• Categories

• 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.

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.

---

General CCI questions

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 CCI procedures we don't code

Questions?

additional codes?

• central lines included?

• 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 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)

• How do we code tracheostomy? Therapeutic intervention on trachea and then is it installation of internal or external device (which one?)--LKolesar 12:57, 2018 March 28 (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

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)

• 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. if they are done in the unit?? I am pretty sure that Julie needs this data. --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. --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. ... --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.

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

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)

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

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