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.

Collection instructions

Determining if the procedure you found is one we collect

• There are THREE subsets of procedures we 'will code
  • Procedures done outside the unit
  • Procedures done on the unit including an endoscope
  • A select group of other procedures done on the unit.

(A) Procedures done outside the unit

Include all codable procedures that meet the definition of one of the Px Types that are done outside the patient’s unit.

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

• This includes both diagnostic and therapeutic procedures done with an endoscope -- and that scope may be inserted through an oriface, incision or wound.
• Includes all of the following codable procedures done on the unit:

(C) Other on-unit procedures

• (b) all codable Diagnostic Pxs
• (c) all codable Imaging Pxs
• (d) all codable Obstetric Pxs
• (d) all codable Misc Pxs

CCI Procedures coded once per ward admission

Some procedures are only coded the first time they happen. See CCI Procedures coded once per ward admission.

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 of chest tubes, pacer wires, and vein harvest, but do NOT code those procedures separately, since they are "included" in the CABG code.

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

Aborted Procedure

• See Aborted Procedure for how to code

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.
   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

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 intervention are both diagnostic/imaging and therapeutic. For those situations, only code the therapeutic part.

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

Examples:

• for a Angiogram, coronary (diagnostic cardiac catheterization) where Angioplasty, coronary (with stenting) happens in the same sitting, only code the Angioplasty, coronary (with stenting).
• if a tissue Biopsy (non-endoscopic)/Biopsy (endoscopic) is done as part of an invasive Inspection, Exploration (non-endoscopic)/Inspection, Exploration (endoscopic) code only the Biopsy (non-endoscopic)/Biopsy (endoscopic).
• If a CT is done on the abdomen, chest and pelvis, enter 3 entries in the component area?

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 List of CCI procedures we don't code for more info.

How do we put the procedure: thrombectomy of the femoral artery for a blocked vascular graft (axillo-femoral graft). Please advise. --LKolesar 13:14, 2018 December 11 AG REPLY --- in general it appears that procedures performed on vascular grafts (either synthetic grafts or vessels harvested from elsewhere for use) are coded just as you would if the same thing was done to the native vessel. So this would be 1.KG.57 = therapeutic EXTACTION procedure [which includes thrombectomy] on arteries of the leg NOS [which includes the femoral arteries] Related item from AG: We should put this general rule about CCI someplace --- I'm not sure where, Tina??

• SMW

• Cargo

• Categories

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.

Procedures not coded

See List of CCI procedures we don't code

Proposed tweak

As discussed Task_Team_Meeting_-_Rolling_Agenda_and_Minutes#ICU_Database_Task_Group_Meeting_.E2.80.93_October_31.2C_2018:

• After discussion we recognized that we will need to create machinery to code 3 different categories of such procedures:
  • (i) Those coded every time they occur -- recorded with dates. Example is EGD
  • (ii) Those for which we mainly want total counts -- record the first date in which done, plus the total count over the entire admission. Example is CXR, ABG. For this one there is needed software/data entry “machinery” that Tina/Trish/etc will talk about offline.
  • (iii) Those for which we would ‘’prefer’’ the # of days on which it was done. Examples are noninvasive mechanical ventilation, dialysis, ECMO. However, after discussion we decided that in order to reduce the workload on the data collectors, we will only collect the date of the first use. We could reconsider adding # of days for these at a later point in time.

Thoughts?

• SMW

• Cargo

• Categories

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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 how they are collected

picklist

Has CCI Collection Mode AXR (abdominal plain X-ray) CCI collect count each Amniocentesis (non-imaging diagnostic) CCI collect first Angiogram, aortic (any part of aorta) CCI collect each Angiogram, artery NOS (except specifically coded) CCI collect each Angiogram, cerebral (including vertebral arteries) CCI collect each Angiogram, coronary (diagnostic cardiac catheterization) CCI collect each Angiogram, pulmonary artery (pulmonary arteriogram) CCI collect each Angiogram, vein CCI collect each Angioplasty, coronary (with stenting) CCI collect each Angioplasty, coronary (without stenting) CCI collect each Arterial catheterization, any location CCI collect first Arthrocentesis, diagnostic CCI collect first BMT (Bone marrow transplant or transfusion) CCI collect first BiPAP, CPAP, NIV, own ventilator (Mechanical ventilation, noninvasive) CCI collect first Blank procedure entry CCI collect each Blood gas, arterial CCI collect count each Blood gas, venous CCI collect count each CAM positive (TISS Item) CCI collect each day CAR-T (Chimeric Antigen Receptor T-cell Immunotherapy) CCI collect each CCI PickList Procedure CCI collect each CPR within past 24 hrs (TISS Item) CCI collect each day CPR, cardiac resuscitation CCI collect first CRRT (TISS Item) CCI collect each day CRRT (incl volume removal via PRISMA device) CCI collect first CT of chest with PE protocol (CT angiogram of pulmonary vessels) CCI collect each CVC placement, any location CCI collect first CXR (plain film) CCI collect count each Capsule Endoscopy CCI collect each Cardiac CT or Cardiac CT angiogram (with or without coronary arteries) CCI collect each Cardiac MRI CCI collect each Cardiac electrophysiology study CCI collect first Cardiac nuclear scan (e.g. MUGA) CCI collect each Cardiac stress test (any kind) CCI collect each Cardioversion (EXCLUDE defibrillation-we are not tracking) CCI collect first Central venous catheter (TISS Item) CCI collect each day Cesarean section delivery (therapeutic) CCI collect first Chest tube, left in place CCI collect first Defibrillator, insertion CCI collect first ECHO (echocardiogram of heart) CCI collect each ECMO, VA CCI collect count days ECMO, VV CCI collect count days ECT (Electroconvulsive shock therapy to brain) CCI collect first EEG (electroencephalography) CCI collect first ERCP (endoscopic retrograde cholangiopancreatography) CCI collect each ETT Present (TISS Item) CCI collect each day HD (Hemodialysis) CCI collect first IABP CCI collect first ICP monitor (Placement of implanted, invasive intracranial pressure monitoring device) CCI collect first IV hyperalimentation (TISS Item) CCI collect each day IVIG (IV administration of immunoglobulin) CCI collect first Induction of labor (therapeutic) CCI collect first Insertion of ETT (TISS Item) CCI collect each day Intermittent hemodialysis (TISS Item) CCI collect each day Intracranial pressure monitoring (TISS Item) CCI collect each day Invasive Mechanical Ventilation (TISS Item) CCI collect each day Isolation, infectious CCI collect first LP (lumbar puncture, diagnostic) CCI collect first Nephrostomy placement CCI collect first No TISS Item (TISS Item) CCI collect each day No codable procedure done in OR CCI collect first No procedure entered CCI collect first No procedure performed CCI collect first Non-invasive CPAP or BIPAP (TISS Item) CCI collect each day PD (Peritoneal dialysis) CCI collect first PFT (pulmonary function test) CCI collect first Pacemaker insertion, permanent CCI collect first Pacemaker insertion, temporary CCI collect first Paracentesis (diagnostic) CCI collect first Patient is on isolation (TISS Item) CCI collect each day Peripheral arterial line (TISS Item) CCI collect each day Peritoneal dialysis (TISS Item) CCI collect each day Planned extubation (TISS Item) CCI collect each day Plasmapheresis CCI collect first Postpartum surgical repair (therapeutic) -- incl episiotomy CCI collect first Prone positioning CCI collect each day Pulmonary arterial line (TISS Item) CCI collect each day Right heart catheterization, in cardiac cath lab CCI collect each SVD (Spontaneous vaginal delivery) CCI collect first Sleep Study (Polysomnogram, done in Miseracordia Sleep lab) CCI collect first Supp O2 through any device, delivered via nose, mouth, ETT or trach (TISS Item) CCI collect each day Suppression of labor (therapeutic) - incl via pharmacologic tocolytics CCI collect first Surgical removal of extrauterine pregnancy (therapeutic) CCI collect first Suturing of cervical os (therapeutic) CCI collect first Swan-Ganz (Pulmonary Artery Flotation) Catheter placement CCI collect first TIPS (transjugular intrahepatic portosystemic shunt) CCI collect each TPN (Total parenteral nutrition) CCI collect first Targeted Temperature Management (TTM) CCI collect first Termination of pregnancy pharmacologic (therapeutic) CCI collect first Termination of pregnancy surgical (therapeutic) CCI collect first Thoracentesis (diagnostic) CCI collect first Trach Tube Present (TISS Item) CCI collect each day Tracheostomy creation CCI collect first Transfusion of PRBC CCI collect count units Transfusion of albumin CCI collect first Transfusion of plasma products CCI collect count units Transfusion of platelets CCI collect count units Unplanned extubation (TISS Item) CCI collect each day Urodynamics study (cystometrogram, done by urology lab) CCI collect first Vasoactive drug IV continuous-multiple simultaneous (TISS Item) CCI collect each day Vasoactive drug IV continuous-single (TISS Item) CCI collect each day

component 2 list

Has CCI Collection Mode (T) NOS CCI collect each Amputation CCI collect each Biopsy (endoscopic) CCI collect each Biopsy (non-endoscopic) CCI collect each Bypass CCI collect each Closure of fistula CCI collect each Computerized Tomography (CT) CCI collect each Construction, Reconstruction CCI collect each Control of Bleeding CCI collect each Debridement CCI collect first Destruction CCI collect each Dilation CCI collect each Drainage, Evacuation CCI collect each Excision with Reconstruction, Replacement CCI collect each Excision, Resection CCI collect each Extraction CCI collect each Fixation CCI collect each Fusion CCI collect each Implantation of Internal Device CCI collect each Inspection, Exploration (endoscopic) CCI collect each Inspection, Exploration (non-endoscopic) CCI collect each MRI CCI collect each Nuclear Imaging CCI collect each Occlusion CCI collect each Pharmacotherapy, thrombolytic agent CCI collect each Procure, Harvest, Obtain for Further Use CCI collect each Radiation Therapy CCI collect first Reattachment CCI collect each Release, Decompression CCI collect each Removal of Foreign Body CCI collect each Repair CCI collect each Transplant CCI collect each Ultrasound CCI collect each

Data Integrity Checks

	summary	implementation status
Query check CCI TISS CAM positive vs Dx	Checks that each T9 - CAM positive (TISS Item) goes with an ICD10 code from Category:Delirium	declined
Query NDC Dialysis TISS CCI	Critical care patients who have CCI entries for a type of dialysis must have a TISS28 entry for the same type of dialysis as well, and vice versa.	declined
Check CRF vs ARF across multiple encounters	If a patient had a comorbid of CRF in any previous admission then ARF can not be an admit or complication in subsequent admissions.	declined
Query check CCI TISS time means must be two	If certain Px Dates have a time component, then there should also be a matching CCI Picklist without the time	declined
Query check TISS each day	There needs to be at least one TISS entry in CCI Picklist for each day for each ICU profile.	declined
Query check CCI component 1 and 2 compatible	Component CCIs must have compatible component 1 and component 2	implemented
Query check CCI vs LOS count days picklist	Confirm that CCI Collection Mode for CCI Picklist CCI collect count days items don't have a count > LOS.	implemented
Query check CCI vs LOS count days component	Confirm that CCI Collection Mode or CCI Component CCI collect count days items don't have a count > LOS.	implemented
Query check CCI TISS if no then none	If No TISS Item (TISS Item) in CCI Picklist there must be no other entry from TISS Item List in CCI Picklist, and vice versa	implemented
Query check CCI if no then none	If No procedure performed in CCI Picklist there must be no other entries in CCI Picklist or CCI Component	implemented
Query check CCI from OR no CCI	If from OR or PACU, must have at least 1 CCI Procedure other than No procedure performed	implemented
Query check CCI TISS matching BoardingLoc time	If the Px Date component of a CCI Picklist has a time, then there must be a corresponding Boarding Loc entry	implemented
Query check ICD10 trach has trach but no TISS	If there is a Tracheostomy, has one (Z93.0) ICD10, there should likely be a T23 - Trach Tube Present (TISS Item)	implemented
Query check ICD10 trach create but no TISS	If there is an acquired Tracheostomy creation there also has to be a Trach Tube Present (TISS Item)	implemented
Query check CCI Component duplicates	No duplication of CCI Component Px_Type, Px_Date	implemented
Query check CCI Picklist duplicates	No duplication of CCI Picklist Px_Type, Px_Date, Px_Count	implemented
Sub Dx Checker	Runs most Category:Old_dx_check, Category:ICD10 Dx check, Category:CCI Px check, and a few other checks for dxs	implemented
Query check CCI TISS NrDays GT LOS	There are more TISS Item Px_Dates than there are days between the first Service tmp entry and Dispo DtTm	implemented
Query check CCI TISS NrDays LT LOS	There are more TISS Item Px_Dates than there are days between the first Service tmp entry and Dispo DtTm	implemented
Query check CCI must have entry	There must be at least 1 CCI entry in L_CCI_Picklist table (which might be No procedure performed)	implemented
Query check CCI Component no admin entries	There must be no No procedure entered/Blank procedure entry in CCI Component.	implemented
Query check CCI Picklist if no admin entries	There must be no No procedure entered/Blank procedure entry in CCI Picklist.	implemented
Query check ICD10 trach dxs consistent	Tracheostomy related CCI and ICD10 codes must be consistent with each other.	implemented
Query check CCI Component unfilled	CCI Component entry with missing px, Px_Type or Px_Count	implemented
Query check CCI Picklist unfilled	CCI Picklist entry with missing px, Px_Type or Px_Count	implemented
Query check CCI Date	Px Date must be sensible when compared to first Service tmp entry and Dispo_DtTm	implemented
Query check eliminated CCI Comp	disallows any currently entered diagnosis that has been eliminated	implemented
Query check eliminated ICD10	disallows any currently entered diagnosis that has been eliminated	implemented
Query check eliminated CCI Pick	disallows any currently entered diagnosis that has been eliminated	implemented
Query check CCI each count vs LOS	Confirm that a Category:Labs Imaging count is not unreasonably high	needs review
Query check CCI CRRT vs Tmp	If CCI CRRT (incl volume removal via PRISMA device) exists there should be a tmp CRRT entry and vice versa	retired
Query NDC TISS CCI endoscopic	If pt has T26 & 27 - Endoscopy (TISS Item) then there must be an endoscopic CCI for that day.	retired
Query NDC cardioversion dx vs TISS	If pt has Acquired Procedure Cardioversion (EXCLUDE defibrillation-we are not tracking), then the TISS28 item T26 & 27 - Cardioversion (TISS Item) (T41) must be marked.	retired
Query NDC zCRRT CCI Px but no TISS	If there is a T33 - CRRT (TISS Item) then there should be a CRRT (incl volume removal via PRISMA device) CCI Px	retired
Query NDC zCRRT TISS but no CCI Px	If there is a T33 - CRRT (TISS Item) then there should be a CRRT (incl volume removal via PRISMA device) CCI Px	retired
Query NDC Trach Dx TISS	Tracheostomy ICD10s and CCIs must be consistent with Trach TISS.	retired

related literature

CIHI.ca coding standard CCI