CCI Collection

From CCMDB Wiki

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

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.
    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

Collection modes

Collecting "CCI collect each" items

  • "CCI collect each" items are entered each time they happen
  • If they happen more than once on a day, enter the number of times as Px Count for that day, otherwise enter a Px Count of 1

Collecting "CCI collect count each" items

Collecting "CCI collect count days" items

Collecting "CCI collect count units" items

Collecting "CCI collect first" items

List of CCI Elements and their collection modes

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, veinCCI collect each
Angioplasty, coronary (with stenting)CCI collect each
Angioplasty, coronary (without stenting)CCI collect each
Arterial catheterization, any locationCCI collect first
Arthrocentesis, diagnosticCCI collect first
BMT (Bone marrow transplant or transfusion)CCI collect first
BiPAP, CPAP, NIV, own ventilator (Mechanical ventilation, noninvasive)CCI collect first
Blank procedure entryCCI collect each
Blood gas, arterialCCI collect count each
Blood gas, venousCCI collect count each
CPR, cardiac resuscitationCCI collect first
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 locationCCI collect first
CXR (plain film)CCI collect count each
Cardiac CT or Cardiac CT angiogram (with or without coronary arteries)CCI collect each
Cardiac MRICCI collect each
Cardiac electrophysiology studyCCI 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
Cesarean section delivery (therapeutic)CCI collect first
Chest tube, left in placeCCI collect first
Defibrillator, insertionCCI collect first
ECHO (echocardiogram of heart)CCI collect each
ECMO, VACCI collect count days
ECMO, VVCCI collect count days
ECT (Electroconvulsive shock therapy to brain)CCI collect first
EEG (electroencephalography)CCI collect first
ERCP (endoscopic retrograde cholangiopancreatography)CCI collect first
HD (Hemodialysis)CCI collect first
IABPCCI collect first
ICP monitor (Placement of implanted, invasive intracranial pressure monitoring device)CCI collect first
IVIG (IV administration of immunoglobulin)CCI collect first
Induction of labor (therapeutic)CCI collect first
Isolation, infectiousCCI collect first
LP (lumbar puncture, diagnostic)CCI collect first
No procedure enteredCCI collect first
No procedure performedCCI collect first
PD (Peritoneal dialysis)CCI collect first
PFT (pulmonary function test)CCI collect first
Pacemaker insertion, permanentCCI collect first
Pacemaker insertion, temporaryCCI collect first
Paracentesis (diagnostic)CCI collect first
PlasmapheresisCCI collect first
Postpartum surgical repair (therapeutic) -- incl episiotomyCCI collect first
Right heart catheterization, in cardiac cath labCCI collect each
SVD (Spontaneous vaginal delivery)CCI collect first
Sleep Study (Polysomnogram, done in Miseracordia Sleep lab)CCI collect first
Suppression of labor (therapeutic) - incl via pharmacologic tocolyticsCCI 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 placementCCI collect first
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
Tracheostomy creationCCI collect first
Transfusion of FFPCCI collect count units
Transfusion of PRBCCCI collect count units
Transfusion of albuminCCI collect first
Transfusion of plateletsCCI collect count units
Urodynamics study (cystometrogram, done by urology lab)CCI collect first
component 2 list   
 Has CCI Collection Mode
(T) NOSCCI collect each
AmputationCCI collect each
Biopsy (endoscopic)CCI collect each
Biopsy (non-endoscopic)CCI collect each
BypassCCI collect each
Closure of fistulaCCI collect each
Computerized Tomography (CT)CCI collect each
Construction, ReconstructionCCI collect each
Control of BleedingCCI collect each
DebridementCCI collect first
DestructionCCI collect each
DilationCCI collect each
Drainage, EvacuationCCI collect each
Excision with Reconstruction, ReplacementCCI collect each
Excision, Resection, partialCCI collect each
Excision, Resection, radicalCCI collect each
Excision, Resection, totalCCI collect each
ExtractionCCI collect each
FixationCCI collect each
FusionCCI collect each
Implantation of Internal DeviceCCI collect each
Inspection, Exploration (endoscopic)CCI collect each
Inspection, Exploration (non-endoscopic)CCI collect each
MRICCI collect each
Nuclear ImagingCCI collect each
OcclusionCCI collect each
Pharmacotherapy, thrombolytic agentCCI collect each
Procure, Harvest, Obtain for Further UseCCI collect each
Radiation TherapyCCI collect each
ReattachmentCCI collect each
Release, DecompressionCCI collect each
Removal of Foreign BodyCCI collect each
TransplantCCI collect each
UltrasoundCCI collect each

Special Cases

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.

Moved patients

  • There are important issues/rules for admit procedure coding when a patient is being transferred from one unit/ward to another unit/ward -- and this is even more complicated if in between leaving one unit/ward and arriving on another unit/ward, the patient stops in a procedure area and gets one or more procedures.
  • Here are the guidelines for these situations:
    • (i) Transfer from collecting location A to collecting location B without any stop in between where procedures might occur -- all procedures done before leaving location A will be collected by location A only.
    • (ii) Transfer from collecting location A to collecting location B WITH a stop in between where procedures occur -- all procedures done before leaving location A will be collected by location A only, while procedures done at the stop in between will be coded by location B only.
    • (iii) Transfer from noncollecting location A (which includes ED) to collecting location B without any stop in between where procedures might occur -- any qualifying admit procedures done before leaving location A will be collected by location B
    • (iv) Transfer from noncollecting location A (which included ED) to collecting location B WITH a stop in between where procedures occur -- all procedures done before leaving location A or during the stop in between will be coded by location B only.

Procedures we don't code

We are not tracking all possible procedures. If a procedure can not be coded using the picklist or combined method, then we likely are not interested in coding it.

See List of CCI procedures we don't code for procedures we explicitly don't collect. If you come across a procedure you were not able to code, but think we probably should be coding, please note it there.

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.

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 (or replacement) of chest tubes, pacer wires, arterial lines, central lines, and vein harvest, but do NOT code those procedures separately, since they are "included" in the CABG code.

  • On the other hand, things done in OR that are NOT part of the standard procedure (e.g. for someone coming out from OR after CABG who now has ECMO, Swan-Ganz, IABP), you SHOULD code these as Admit Procedure).

Related Imaging, Diagnostic and Therapeutic procedures performed at the same time

  • When at the same sitting both diagnostic and therapeutic procedures are done, then CODE THEM BOTH
Example:   
Example:   

if a CT of chest, abdomen and pelvis is done, code them all

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

Aborted Procedure

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.

Data Integrity Checks

List of cross-checks   
 summaryimplementation status
Query check CCI component 1 and 2 compatibleComponent CCIs must have compatible component 1 and component 2implemented
Query NDC Dialysis TISS CCICritical care patients who have CCI entries for dialysis must have TISS28 entries as well, and vice versa.implemented
Query check CCI CRRT vs TmpIf CCI CRRT (incl volume removal via PRISMA device) exists there should be a tmp CRRT entry and vice versaimplemented
Query check CCI if no then noneIf No procedure performed in CCI Picklist there must be no other entries in CCI Picklist or CCI Componentimplemented
Check CCI vs previous locationIf from OR or PACU, must have at least 1 CCI Procedure other than No procedure performedimplemented
Query NDC cardioversion dx vs TISSIf pt has Acquired Procedure Cardioversion (EXCLUDE defibrillation-we are not tracking), then the TISS28 item Cardioversion (TISS Item) (T41) must be marked.implemented
Query NDC TISS CCI endoscopicIf pt has TISS28 item Endoscopy (any type of scope) in the ICU (T43) then there must be an endoscopic CCI for that day.implemented
Query NDC zCRRT TISS but no CCI PxIf there is a CRRT (TISS Item) then there should be a CRRT (incl volume removal via PRISMA device) CCI Pximplemented
Query NDC zCRRT CCI Px but no TISSIf there is a CRRT (TISS Item) then there should be a CRRT (incl volume removal via PRISMA device) CCI Pximplemented
Query check CCI Component duplicatesNo duplication of CCI Component Px_Type, Px_Dateimplemented
Query check CCI Picklist duplicatesNo duplication of CCI Picklist Px_Type, Px_Date, Px_Countimplemented
Sub Dx CheckerRuns most Category:Old_dx_check, Category:ICD10 Dx check, Category:CCI Px check, and a few other checks for dxsimplemented
Query check CCI no admin entriesThere must be no No procedure entered/Blank procedure entry in CCI Picklist or CCI Component.implemented
Query NDC Trach Dx TISSTracheostomy ICD10s and CCIs must be consistent with Trach TISS.implemented
Query check ICD10 trach dxs consistentTracheostomy related CCI and ICD10 codes must be consistent with each other.implemented
Query check CCI Component unfilledCCI Component entry with missing px, Px_Type or Px_Countimplemented
Query check CCI Picklist unfilledCCI Picklist entry with missing px, Px_Type or Px_Countimplemented
Query check CCI DatePx Date must be sensible when compared to Arrive_DtTm and Dispo_DtTmimplemented
Query check dispo lower acuity than locationcheck for patients going to lower level of care but without Transfer_Ready_DtTm; Check will launch an error but allow no date, ie it's just a reminder, see #hierarchy of levels of care.implemented
Check CRF vs ARF across multiple encountersIf a patient had a comorbid of CRF in any previous admission then ARF can not be an admit or complication in subsequent admissions.needs review
Query check CCI must have entryThere must be at least 1 CCI entry in L_CCI_Picklist table (which might be No procedure performed)needs review

Related Articles

Related articles:

related literature

CIHI.ca coding standard CCI