Admit Procedure

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 AND
  • (b) Was directly, causally related to the admission (this is a judgement call, see below #Causally related) OR was directly related to an Admit Diagnosis (see below #Directly related to the Admit Diagnosis)
• 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

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 directly, causally, related to the aspiration, and so would not be included as an Admit Diagnosis.
• VERY IMPORANT DISTICTION: A procedure that simply identified the presence of a problem should not be considered to have caused the problem, and so should not be put into this category.
• While causally-related 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 bin.
• And on occasion, even a diagnostic procedure could be causative --- e.g. a contrast-enhanced X-ray where the contrast caused anaphylaxis that led to ICU admission. But this kind of example is the only kind of situation in which a non-invasive diagnostic procedure should be in this bin. So, things we count, such as CXRs and blood gases, would NOT be in this bin, unless somehow they actually CAUSED a problem that led to admission (e.g. blood gas puncture injured the artery, leading to a huge bleed for which they went to ICU).

example of causally related procedures

If a patient on the From ward/unit gets a bedside debridement, during which he/she begins to hemorrhage profusely and is then transferred to the To acute ward/unit 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 procedure not causally related

If a patient on the From ward/unit gets a bedside debridement which went well, and 10 minutes later develops respiratory distress and goes to a more acute To ward/unit because of that respiratory distress, then do not code that debridement at all for the To acute ward/unit because it does not seem to be related to the admission to the To ward/unit.

Directly related to the Admit Diagnosis

• Example: 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.
• Template:Discussion Just to clarify, does this apply to tests or procedures that relate to the admission but not the primary reason? For example, the pt has chronic ascites from cirrhosis so they did a paracentesis and needed a foley inserted but had to have a cystoscopy in order to accomplish this due to swelling. (These procedures were done in ER) His actual admit diagnosis is primarily hepatorenal syndrome. So I assume we do not code these procedures, is this correct?--LKolesar 12:49, 2018 November 14 (CST)
• If a CT scan is done in ER and the pt admitted to the ward with a stroke, would this CT be put in CCI? Please make sure the instructions are clear as some are still putting in the tests done even if not causal because they are defining them as directly related to the admission.--LKolesar 12:49, 2018 November 14 (CST)

Moved patients

A procedure might be coded as an acquired on one ward and an admit on the next - the same as above applies.

example of procedures for moved patient

Example: On Medicine ward patient got bedside debridement (so of course that procedure would be coded for that ward) and then began to hemorrhage which led to ICU transfer. In this case the debridement was closely associated with the admission to ICU and so would be coded as an "admit" procedure for the ICU record. Example: On the other hand, if the ward patient got a bedside skin biopsy shortly before transfer to ICU, and the ICU transfer had nothing to do with the skin biopsy, then you would NOT record the biopsy in the ICU record.

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

• Code Surgical follow-up care
• code the CCI procedure that is being followed up as Admit Procedure, removing FOR THIS USAGE ONLY any rules that would stop you from coding a procedure as an Admit Procedure

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 code the procedure as an Admit Procedure and code the complication as the Admit Diagnosis, and as a Comorbid Diagnosis one of the "Past medical history" codes:

.

Why within 48 hrs?

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