Admit Procedure

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This page explains when a CCI Procedure that is part of CCI Collection would be coded with Px Type Admit. The instructions are the same for medicine an critical care. The other option for type is Acquired Procedure.

Collection Instructions

  • Code a procedure as Px_Type admit if it was:
    • (a) Performed within 48 hrs BEFORE the Arrive DtTm
    • (b) AND Was performed in a unit or location that we DO NOT COLLECT, see below #Moved patients
    • (c) AND
  • Was directly, causally related to the admission (this is a judgement call, see below #Causally related)
  • OR
  • If an admit procedure that qualifies is done more than once on two different calendar days, enter it once and set the count to the appropriate number

Moved patients

See CCI Collection#Moved patients

Admission solely for follow up care

If

  • a patient is admitted to our ward/unit solely for Surgical follow-up care
  • the procedure itself would not have been coded by us because the first post-procedure ward was not one where we collect (or wasn't even at a WPG hospital)

Then

Example:   
  • Patient returns from organ transplant in Toronto without any major complications, just to continue recovery before eventual successful discharge.

For this usage, there is no time limit on when the procedure was done but nonetheless it must include the judgement that the reason for this admission was "routine" followup surgical care related to that procedure --- AS OPPOSED TO admission for some complication of that procedure.

If instead the admission was for a complication of that procedure, and not routine followup surgical care, then don't code the procedure itself and instead code the complication as the Admit Diagnosis, and as a Comorbid Diagnosis one of the "Past medical history" codes:

Past medical history codes:

.

Causally related

  • It won't always be so clear if a procedure is related to the admission, and you may have to use your judgement.
  • Regarding a string of causal events: A causes B causes C causes the reason for admission. We will take account of C, but NOT A or B. The rationale is that using a string of events may never end.
    • Thus if a patient had a surgery 2 months ago and due to pain got addicted to narcotics, and due to the narcotics aspirated --- then the primary diagnosis for THIS admission is the aspiration, and the narcotic addiction would be a comorbid, but the surgical procedure that led to all of this is not, by our definition here, directly, causally, related to the aspiration, and so would not be included as an Admit Diagnosis.
  • VERY IMPORANT DISTICTION: A procedure done before admission that simply IDENTIFIED the presence of a problem did not CAUSE the problem, and so should not be coded as an admit procedure.
    • e.g. a chest imaging study done in ED that demonstrated a bad pneumonia for which the patient got admitted is not causally related to the admission, and since it was done prior to the admission, it should not be coded as an admit procedure
    • e.g. person came to ED with suspected stroke, and head CT done while in ED showed that they did have a stroke -- this does NOT qualify as an admit procedure
  • While causally-related admit procedures will USUALLY be invasive procedures, they do not NEED to be -- e.g. if a person is admitted for expressly Isolation, infectious, this could be in this Dx Type.
  • The only way that a diagnostic procedure can be causative is if it caused a complication that was part of the admission diagnoses (does not necessarily have to be the MAIN admit dx)
    • e.g. contrast-enhanced X-ray where the contrast caused anaphylaxis that was the main cause of the admission
    • e.g. a diagnostic EGD was complicated by esophageal perforation which was the main cause of the admission
    • e.g. a patient with a bug UGI bleed, had a diagnostic EGD in the ED that was complicated by esophageal perforation -- while the UGI bleed would be the primary admit diagnosis here, the iatrogenic esophageal perf would ALSO be an admit diagnosis, and THEN the EGD (as the cause of that admit diagnosis) should be coded as an admit procedure
    • THUS, diagnostic procedures such as CXR or ABG done prior to admission should only be included as an admit procedure if they caused a complication that is legitimately on the list of admit diagnoses.
  • Example of Causally Related:
    • If a patient on the a surgical ward gets a bedside debridement, during which he begins to hemorrhage profusely and is then transferred to the to the ICU because of that hemorrhage, then code that procedure, as Px_Type = Admit.
    • Even diagnostic procedures can be causally related to an admission, if a complication occurred:
      • a contrast CT that led to contrast-induced anaphylaxis that was the reason for admission
      • a diagnostic upper endoscopy that caused an esophageal perforation that was the reason for admission.
  • Example of Not causally related
  • If a patient on the surgical ward gets a bedside debridement which went well, and 2 hours later develops respiratory distress and goes to ICU because of the respiratory distress, then do not code that debridement at all for the ICU admission because it does not seem to be related to the admission to the ICU.

Directly related to the Admit Diagnosis

  • These are procedures that didn't CAUSE the admission but are DIRECTLY related to one of the admit diagnoses
  • The basic guidance for this is to include therapeutic procedures related to the admission diagnosis.
    • e.g. Patient came to ED with bleeding esophageal varices and in ED got EGD with banding. Here the procedure did not cause the admission, but it was certainly related to the admission diagnosis
    • e.g. Patient got an elective CABG for chronic ischemic heart disease/CAD -- the CABG is directly related to the CAD and so should be included as an admit procedure
    • a more complicated example: Patient with cirrhosis with ascites is admitted with hepatorenal syndrome. While in ED the staff couldn't insert a Foley due to a urethral stricture, so urology came down to ED and did a cystoscopy to dilate the urethra and pass the Foley. Here admit diagnoses include: Hepatorenal syndrome and the Urethra, urethral stricture, and in this case the therapeutic cystoscopic dilation (coded by components with (T) Ureter, Bladder or Urethra and Dilation) is directly related to the stricture, in much the same way that the CABG is directly related to the CAD in the above example.
  • Just as above in the section on causally-related procedures, purely diagnostic procedures done prior to admission -- including procedures that merely demonstrated the presence of an admit diagnosis -- should not be coded as an admit procedure.
    • Indeed, the only diagnostic-only procedures that would be included as admit procedures are those that caused a complication that then required treatment --- e.g. a central line placement that led to a perforation -- and even here, this would then really come under the item above of "Was directly, causally related to the admission".
  • A few additional notes on this:
    • Do NOT COUNT or INCLUDE BEFORE admission as a procedure unless they caused a complication:
      • transfusions (a complication of transfusion would be, for example; transfusion reaction, CHF)
      • central lines (even vascaths), (a complication of line insertion would be, for example; vessel performation)

Why within 48 hrs?

This was an arbitrary decision because we needed a cut-off.

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