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
- 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 |
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example of procedure not causally related |
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- 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.
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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 |
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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: |
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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:
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Why within 48 hrs?
This was an arbitrary decision because we needed a cut-off.