Task Team Meeting - Rolling Agenda and Minutes 2020

List of items to bring to task meeting

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Also see Task Team Meeting - Rolling Agenda and Minutes 2019

ICU Database Task Group Meeting – January 2, 2020

See Task Team Meeting - Rolling Agenda and Minutes 2019#ICU Database Task Group Meeting – December 11, 2019

• Present: Allan, Barret , Joanna, Julie, Michelle, Tina, Trish
• Absent:
• Minutes prepared by: AG
• Action items in BOLD

1. Followup about working to reduce collector workload

• Regarding obtaining CBS TraceLine for all transfusion data. Allan will follow up with Margaret Ring (margaret.ring@blood.ca) and Tony Loewen (anthony.loewen@blood.ca)
• Regarding obtaining RIS data for radiology tests. Allan will follow up with RIS administrators (Angela Charbonneau 926-9874; Randy Roels 926-9871, rroels@sharedhealth.mb.ca).
• Regarding obtaining automated ABG data at HSC and St. B -- this has been implemented, getting that data from those sites from DSM data.
• Regarding consolidating some of the “what was done” components of CCI therapeutic interventions -- the plans from the 11/11/2019 meeting have been implemented.

2. Followup on having the ICU nurses do all TISS coding -- we have not implemented this yet because:

• While we have top administrator agreement at HSC, we are waiting for Dan to arrange similar meetings at St. B and Grace

3. Followup on trying to get hospital-level data elements from EPR. Tina discovered that there is an application called Cognos which has capability to extract data elements from existing databases.

• Tina has opened incident 3845870 and is working with Alex Omsen and Mike Ocko on getting this set up; see Cognos#Phone call with Mike Ocko

4. Follow up on how to code diagnostic sampling of pericardial fluid or the pericardium. Answers are:

• for therapeutic pericardial drainage combine (T) Pericardium with Drainage, Evacuation
• for diagnostic pericardiocentesis -- we agreed today to add the “body part” item for diagnostic tests of 2.HA = pericardium. Then this is combined with the appropriate Biopsy, not via endoscope or Biopsy via endoscope depending how it was sampled. In other words, we are not distinguishing between a “fluid biopsy” of the pericardium and a true tissue biopsy of it.

5. Followup on pulling in certain lab results in addition to current counts vis re-parsing all DSM data from 1/1/2019

• Barret with help from Tina will generate a draft list of which tests to do this for, which we’ll discuss at the next Task meeting. It should include the tests needed to calculate APACHE 2. Care must be taken to balance usefulness with data storage issues.
• As part of this, we will work so that the labs values that are part of APACHE 2 no longer need to be dealt with by the data collectors.

6. Item we didn't discuss yet -- unconfirmed diagnoses with priority 0. We'll discuss next time.

7. Followup on query about coding for the myraid of other fistulas out there

• There are separate codes for all of these when nontraumatic.
• We already have codes for these: J95.03 for T-E, K31.6 for stomach or duodenum, K60.5 for anorectal, K63.2 for intestinal, N32.2 for bladder, N82 for female genital tract.
• We don’t have codes now for: K82.3 for gallbladder, M25.1 for joint, or less common ones (e.g. lacrimal duct) and have to decide whether to add either of them. We also have to decide how to handle the fact that there are always TWO things connected by the fistula. We already have a “Category:Fistula” but probably need to create a template for it too that references the category but also discusses the various issues. If Tina will do this, Allan will populate it.

8. New items:

• There is some uncertainty about what to do when in CCI, both diagnostic and therapeutic procedures are done on the same body part. We discussed this previously in the minutes, and under CCI Procedures it states when both are done to code them both.
• How to code miscellaneous neuromuscular disorders?
  • This is problematic because although they are often discussed as if they were a single category of disorders, in fact they are two separate categories, comprising nervous system disorders and muscular disorders. This is why there is no ICD10 code for miscellaneous neuromuscular disorders.
  • The example used, Kennedy’s disease, also called “Spinal and bulbar muscular atrophy”, and is a degenerative disease of the CNS that results in muscle atrophy.
  • We already have sufficient “NOS” codes within the neuro and muscular disorders to handle this when the disorder is known but we don’t have a specific code for it (as in the Kennedy disease example, where one should use Degenerative nervous system disorder, NOS). The other potentially useful NOS codes are Muscle disorder/myopathy (primary or secondary), NOS and Disorder of nervous system (any part), NOS, and for when it’s a movement disorder Movement disorder, NOS.
  • The bigger problem is when it’s not clear whether it’s a primary nervous system vs. muscle disorder. In this case, one can:
    • wait to see whether the medical teams decide on nervous vs. muscular disorder
    • use a code that represents the symptom(s) not the disease per se. For example, if the symptoms are movement-related, one can use existing code Involuntary movements, NOS. And lastly when none of this is good enough, we might consider adding the code R29.8, to be called “Other and unspecified symptoms and signs involving the nervous and musculoskeletal systems”. We’ll discuss this next meeting.
• Can ESRD be both and Admit and a Comorbid diagnosis? The answer is YES, if it was present prior to hospital admission AND it satisfies the criteria for an Admit diagnosis. This decision also answers the issue of having acute on chronic renal failure.
• What should be done when creatinine clearance is <15 ml/min but the patient is admitted for uremic symptoms? This is an issue because the definition of Chronic kidney disease (end-stage renal/kidney disease, ESRD), Stage 5, GFR LT 15 is either on dialysis or with clearance<15. But of course, there are some patients who don’t start dialysis until they have GFR<10 or sometimes even lower. The answer is to follow the definition, such a person qualifies for Stage 5 as a comorbid condition, and as directly above, that same code can be used as an Admit diagnosis, along with the specific reason for admission (e.g. hyperkalemia).