CCI Collection

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This article provides general information about collecting and coding a CCI Procedure.

They are entered in CCMDB.accdb in the Patient Viewer Tab CCI_Pick and Patient Viewer Tab CCI_Comp on the Patient Viewer.

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

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
CAM positive (TISS Item)CCI collect each day
CAR-T (Chimeric Antigen Receptor T-cell Immunotherapy)CCI collect each
CCI PickList ProcedureCCI collect each
CPR within past 24 hrs (TISS Item)CCI collect each day
CPR, cardiac resuscitationCCI collect first
CRRT (TISS Item)CCI collect each day
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
Central venous catheter (TISS Item)CCI collect each day
Cesarean section delivery (therapeutic)CCI collect first
Chest tube, left in placeCCI collect first
Defibrillator, insertionCCI collect first
Drug-induced immunosuppressionCCI 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
ETT Present (TISS Item)CCI collect each day
HD (Hemodialysis)CCI collect first
IABPCCI collect first
ICP monitor (Placement of implanted, invasive intracranial pressure monitoring device)CCI collect first
IV hyperalimentation (TISS Item)CCI collect each day
IVIG (IV administration of immunoglobulin)CCI collect first
Induction of labor (therapeutic)CCI collect first
Insertion of ETT (TISS Item)CCI collect each day
Intermittent hemodialysis (TISS Item)CCI collect each day
Intracranial pressure monitoring (TISS Item)CCI collect each day
Invasive Mechanical Ventilation (TISS Item)CCI collect each day
Isolation, infectiousCCI collect first
LP (lumbar puncture, diagnostic)CCI collect first
Nephrostomy placementCCI collect first
No TISS Item (TISS Item)CCI collect each day
No codable procedure done in ORCCI collect first
No procedure enteredCCI collect first
No procedure performedCCI collect first
Non-invasive CPAP or BIPAP (TISS Item)CCI collect each day
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
Patient is on isolation (TISS Item)CCI collect each day
Peripheral arterial line (TISS Item)CCI collect each day
Peritoneal dialysis (TISS Item)CCI collect each day
Planned extubation (TISS Item)CCI collect each day
PlasmapheresisCCI collect first
Postpartum surgical repair (therapeutic) -- incl episiotomyCCI collect first
Prone positioningCCI collect each day
Pulmonary arterial line (TISS Item)CCI collect each day
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
Supp O2 though any device, delivered via nose, mouth, ETT or trach (TISS Item)CCI collect each day
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
TIPS (transjugular intrahepatic portosystemic shunt)CCI collect each
TISS ItemCCI collect each day
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
Trach Tube Present (TISS Item)CCI collect each day
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
Unplanned extubation (TISS Item)CCI collect each day
Urodynamics study (cystometrogram, done by urology lab)CCI collect first
Vasoactive drug IV continuous-multiple simultaneous (TISS Item)CCI collect each day
Vasoactive drug IV continuous-single (TISS Item)CCI collect each day
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, ResectionCCI 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 first
ReattachmentCCI collect each
Release, DecompressionCCI collect each
Removal of Foreign BodyCCI collect each
RepairCCI 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 NDC Dialysis TISS CCICritical care patients who have CCI entries for a type of dialysis must have a TISS28 entry for the same type of dialysis as well, and vice versa.declined
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.declined
Query check TISS each dayThere needs to be at least one TISS entry in CCI Picklist for each day for each ICU profile.declined
Query check CCI component 1 and 2 compatibleComponent CCIs must have compatible component 1 and component 2implemented
Query check CCI TISS if no then noneIf No TISS Item (TISS Item) in CCI Picklist there must be no other entry from TISS Item List in CCI Picklist, 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
Query check CCI from OR no CCIIf from OR or PACU, must have at least 1 CCI Procedure other than No procedure performedimplemented
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 TISS NrDays GT LOSThere are more TISS Item Px_Dates than there are days between the first Service tmp entry and Dispo DtTmimplemented
Query check CCI TISS NrDays LT LOSThere are more TISS Item Px_Dates than there are days between the first Service tmp entry and Dispo DtTmimplemented
Query check CCI no admin entriesThere must be no No procedure entered/Blank procedure entry in CCI Picklist or CCI Component.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 Accept_DtTm and Dispo_DtTmimplemented
Query check eliminated ICD10disallows any currently entered diagnosis that has been eliminatedimplemented
Query check eliminated CCI Compdisallows any currently entered diagnosis that has been eliminatedimplemented
Query check eliminated CCI Pickdisallows any currently entered diagnosis that has been eliminatedimplemented
Query TISS Errors CAM positive vs DxChecks that each T9 - CAM positive (TISS Item) goes with an ICD10 code from Category:Deliriumneeds review
Check CCI CXR vs LOSConfirm that a Category:Labs Imaging count is not unreasonably highneeds review
Query check CCI TISS time means must be twoIf the Px Date component of a CCI Picklist has a time, then there must be a corresponding Boarding Loc entryneeds 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
Query check CCI vs LOS count daysConfirm that CCI Collection Mode CCI collect count days items don't have a count > LOS.ready to implement
Query NDC cardioversion dx vs TISSIf pt has Acquired Procedure Cardioversion (EXCLUDE defibrillation-we are not tracking), then the TISS28 item T41 - Cardioversion (TISS Item) (T41) must be marked.ready to implement
Query check CCI TISS matching BoardingLoc timeIf the Px Date component of a CCI Picklist has a time, then there must be a corresponding Boarding Loc entryready to implement
Query check ICD10 trach dxs consistentTracheostomy related CCI and ICD10 codes must be consistent with each other.ready to implement
Query check CCI CRRT vs TmpIf CCI CRRT (incl volume removal via PRISMA device) exists there should be a tmp CRRT entry and vice versaretired
Query NDC TISS CCI endoscopicIf pt has T43 - Endoscopy (TISS Item) then there must be an endoscopic CCI for that day.retired
Query NDC zCRRT CCI Px but no TISSIf there is a T33 - CRRT (TISS Item) then there should be a CRRT (incl volume removal via PRISMA device) CCI Pxretired
Query NDC zCRRT TISS but no CCI PxIf there is a T33 - CRRT (TISS Item) then there should be a CRRT (incl volume removal via PRISMA device) CCI Pxretired
Query NDC Trach Dx TISSTracheostomy ICD10s and CCIs must be consistent with Trach TISS.retired

Related Articles

Related articles:

related literature

CIHI.ca coding standard CCI