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This article provides general information about collecting and coding a [[CCI Procedure]].   
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]].
They are entered in [[CCMDB.accdb]] in the [[Patient Viewer Tab CCI_Pick]] and [[Patient Viewer Tab CCI_Comp]] on the [[Patient Viewer]].


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]].
For background information, see [[CCI]] and [[Reasoning around moving to CCI and our subset of it]].


== Introduction to [[CCI]] Procedure Coding ==
== Collection instructions ==
*For all interventions we are keeping track of:
===Start Date: Jan 1, 2019 ===
**[[Px Type]] - whether the procedure was occurred ''before'' and associated with the with the patients's admission to the unit OR was done '''after''' admission.
***{{Discussion}}For interfacility transfers from units that collect data are the "before" associated procedures with patient admission considered captured by the sending facility or do these previous procedures need to be coded again by the receiving facility? Would all acquired procedures performed at the sending facility be coded by the receiving facility or limited to acquired procedures that have direct association with patient admission to the receiving facility?  [[User:Ppiche|Pamela Piche]] 08:58, 2018 April 9 (CDT)
****No, I this would be too much unnecessary double coding however, I will ask Allan Garland to weigh in on this. [[User:TOstryzniuk|Trish Ostryzniuk]] 11:19, 2018 April 9 (CDT)
***** Just discussed this with Allan Garland, and this will need to be coded according to usual rules, ie might be double coded. See [[Px Type]] for details. This question/answer can be deleted in a 3 days, just wanted to make sure everyone sees this update before deleting it. Ttenbergen 15:21, 2018 April 9 (CDT)
**[[Px_Date]] - Date of procedure
**[[Px_Count]] - the number of '''separate''' times it was done on a '''given day'''
*The categories (corresponding to [[CCI]] chapter numbers chapters) are:
**1. [[Therapeutic Procedure]]
**2. [[Diagnostic Procedure]]
**3. [[Imaging Procedure]]
**5. [[Obstetric Procedure]]
**8. [[Miscellaneous Procedure]] - currently only [[Administration of intravenous immunoglobulin]]
**It's usually easy to figure out which category to use, but sometimes an intervention can be both therapeutic and diagnostic
**Rule:  when you have a procedure that has '''both''' therapeutic and ''diagnostic'' aspects, '''ONLY code the therapeutic part'''.
***Example: diagnostic cardiac catheterization at same sitting as stent placemen -- here only code [[Coronary angioplasty with stenting]], but don't code [[Coronary angiogram (diagnostic cardiac catherization)]].


== Steps in selecting and entering CCI procedure in [[CCMDB]] ==
=== Selecting and entering [[CCI]] procedure in [[CCMDB]] ===
Follow these steps, in this order:  
Follow these steps, in this order:  
# if no procedures were performed, see [[#No Procedures Performed]]
# for every procedure:  
# for every procedure:  
## 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.  
## 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.  
Line 31: Line 15:
##* pick the left column, [[CCI component 1 codes - what organ was something done to]].
##* pick the left column, [[CCI component 1 codes - what organ was something done to]].
##** if there are too many and you only want to see e.g. the therapeutic ones and not the imaging ones, use the [[L_CCI_Component_subform#CCI_Chooser (the "?" button)]]. In the form it opens you can filter by the [[CCI Category]].
##** if there are too many and you only want to see e.g. the therapeutic ones and not the imaging ones, use the [[L_CCI_Component_subform#CCI_Chooser (the "?" button)]]. In the form it opens you can filter by the [[CCI Category]].
##* in the column on the right, pick the [[CCI component 2 codes - what was done]].
##* in the column on the right, pick the [[CCI component 2 codes - what was done]]; the component on the right has to be of the same ''diagnostic / therapeutic / imaging'' kind as the component 1 - if you try to mix types you will get an error.  
## whether CCI picklist or CCI component,  
## whether CCI picklist or CCI component,  
### enter a [[Px_Type]] - "[[Admit Diagnosis | admit]]" or "[[Acquired Diagnosis / Complication | acquired]]"
### enter a [[Px_Type]] - "admit" ([[Admit Procedure]]) or "acquired" ([[Acquired Procedure]])
### enter a [[Px_Date]] - Date of procedure
### enter a [[Px_Date]] - Date of procedure '''for acquired px only'''
### enter a [[Px_Count]] - the number of '''separate''' times it was done''' '''''on a given day
### enter a [[Px_Count]] - the number of '''separate''' times it was done''' '''''on a given day


=== Before You Decide to NOT Code a Procedure ===
==== productivity features ====
*We're not looking to code procedures that not either: (a) on the picklist, or (b) able to be constructed from it's components [e.g. a body part, and what was done to that body part].
To reduce clicks to enter same Picklist entries for additional days, there are some extra buttons:  
*The main issue here is that among the lists "what was done", we haven't included EVERY possibility.
* "x2" will duplicate this line with the next date
**For example, in the Imaging Procedures, besides some plain X-rays contained in that picklist, the "what type of imaging study was done" does NOT include plain x-rays.  Thus we're not enabling creation of a plain X-ray of other body part other than those contained in the picklist.
** "+" and "-" will up or down the date by one day, to make the copy more useful
**Similarly, for the Therapeutic Procedures, there is a list of approximately 30 items of "what was done" to the chosen body part. So some items of "what was done" are not available and you won't be able to code such procedures. 
* [[Blue button in CCI Picklist]] will fill a range of dates
***'''BUT, before you decide this is the case, you will need to become very familiar with the descriptions of EACH of the "what was done" items that ARE available'''.  For example the item '''[[Bypass]]''' includes creating a ostomy (which includes a colostomy and even a tracheostomy).
****See '''[[CCI component 2 codes - what was done]]'''


== Collection modes ==
<!--As discussed [[Task_Team_Meeting_-_Rolling_Agenda_and_Minutes#ICU_Database_Task_Group_Meeting_.E2.80.93_October_31.2C_2018]] -->
*We code CCI procedures in 5 different [[CCI Collection Mode]]s''':
{{:CCI collect each}}
{{:CCI collect count each}}
{{:CCI collect count days}}
{{:CCI collect count units}}
{{:CCI collect first}}


== Collection Instructions for Therapeutic Procedures ==
=== List of CCI Elements and their collection modes ===
=== Which therapeutic procedures to collect/include ===
{{Collapsable
*Here are the '''rules''' for what we will code and what we won't code:
| always= picklist
*1. Include ''all '''[[CCI procedures we don't code|codable]]''' therapeutic procedures'' done '''outside the patient’s unit'''.
| full=
*2. Include ''all '''[[CCI procedures we don't code|codable]]''' therapeutic procedures'' done '''using an endoscope''' (in or out of the patient's unit) - whether inserted through an orifice, incision or wound.
{{#ask: [[Has CCI Picklist Code::+]][[Has StopDate::>{{CURRENTDAY}} {{CURRENTMONTHNAME}} {{CURRENTYEAR}}]]
*3. In addition to (1) and (2) code the following (and '''only''' the following) therapeutic procedures done in the patient’s unit - but '''only the FIRST DAY it was done''' during the patient’s stay on that unit {{discussion}} Tina will need to add a hint to CCMDB to list these... is the list complete at this point? [[User:TOstryzniuk|Trish Ostryzniuk]] 18:15, 2018 April 5 (CDT) :
|?Has CCI Collection Mode
** Picklist unit items
|format=broadtable
*** [[Hemodialysis (intermittent)]]
|link=all
*** [[Peritoneal dialysis]]
|limit=1000
*** [[Plasmapheresis]]
  |class=sortable wikitable smwtable
** Component list unit items
}} }}
*** arterial catheter placement
{{Collapsable
*** PEG
| always= component 2 list
*** non-invasive mechanical ventilation - includes CPAP, BiPAP, and classic NIV (where a mask is connected to a regular ventilator)
| full=
*** debridement (which in [[CCI component 2 codes - what was done]]?)
{{#ask: [[Has CCI 2 Code::+]][[Has StopDate::>{{CURRENTDAY}} {{CURRENTMONTHNAME}} {{CURRENTYEAR}}]]
*** tracheostomy placement (i.e. done bedside) (ie [[Therapeutic Intervention on Trachea]] and then what, [[Installation of External Appliance]]?)
  |?Has CCI Collection Mode
 
  |format=broadtable
{{discussAllan|How would I code the items above that are not linked? Could not find procedures for these... Ttenbergen 15:10, 2018 April 5 (CDT)
  |link=all
**AG REPLY: I'm confused about what is meant here.  These procedures would be coded as usual for CCI chapter 1.  If we want, we could make a picklist for them instead.
|limit=1000
*** Do you mean the ones that are not linked are all component codes, ie made up out of [[CCI component 1 codes - what organ was something done to]] and [[CCI component 2 codes - what was done]]
|class=sortable wikitable smwtable
}}
}} }}
 
{{discussAllan|
*what are the rules for CPAP Bipap do we code the pt own machines or just new starts?
** we will need to discuss that in the related article, for now we have no code for this at all. Ttenbergen 14:01, 2018 March 20 (CDT)
**AG REPLY --- of course this can be coded in Chap 1 of CCI.  Again could include in a picklist.  And it'd be coded the 1st time it's used in the patient's unit regardless of who owns the machine.
*** ''How'' can it be coded? It would need to be a combination of a [[CCI component 1 codes - what organ was something done to]] ([[Therapeutic Intervention on Lung]]? [[Therapeutic Intervention on Total Body]]?) and a [[CCI component 2 codes - what was done]] (can't think which I would use...).  Ttenbergen 15:10, 2018 April 5 (CDT)}}
 
=== 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.
 
{{DiscussTask | repeated CXRs - if we do collect them it will be a nuisance; if we don't they won't compare to the labs count [[CXR]] we are doing now, that this is supposed to replace. How should we proceed? }}
*Do we have to enter a CXR for each day it is done or can we enter CXR once and then keep using the times feature?
*For longer stay patients this could be 50 entries.
*Why do we need to know what day a CXR was done on? What is wrong with using the lab count feature we now use? The same for blood gases and scans.--[[User:LBilesky|LBilesky]] 14:05, 2018 January 19 (CST)
** That is what is planned for now, but this might be worth talking about again to confirm it is worth it.
*** Does the pt travel out of the unit for this?
{{DiscussTask | repeated  ABG/VBG counts - to many rows of data in CCI & lots of rows to scroll down to check what has been entered.}}
*I have tested a few pts and included ABG/VBG counts. What is this being used for? Is the counting necessary? This is a time Counting is a time consuming task, besides counting now also entering dates. 
*Example: I had 2 pts that had 50-100 ABG/VBG's to count and enter dates for. I found there was too many rows of data in addition to the CCI being collected, so lots to scroll through to check what I had entered.  [[p:Joanna Velasco]]
 
=== Related Imaging, Diagnostic and Therapeutic procedures performed at the same time ===
Some interventions consists of imaging and/or diagnostic and/or therapeutic procedures.
 
For these, '''only code the most invasive part''' that implies the other/s. Do '''not''' code the implied codes. For endoscopic inspection/explorations, code only the '''"furthest/deepest"''' area assessed.  
 
Examples:
* for a [[Coronary angiogram (diagnostic cardiac catherization)]] where [[Coronary angioplasty with stenting]] happens in the same sitting, only code the [[Coronary angioplasty with stenting]].
* if a tissue [[Biopsy]] is done as part of an invasive [[Inspection, Exploration]] code only the [[Biopsy]].
 
=== We are not tracking all possible procedures ===
We are not tracking all possible procedures; see [[Reasoning around moving to CCI and our subset of it#Why do we not include the entire set of CCI codes]] and [[CCI procedures we don't code]] for more info.


== Special Cases ==
=== No Procedures Performed ===
=== No Procedures Performed ===
If no procedures were performed you still need to enter something so we can test that procedures were not just forgotten. Enter [[No Procedure Performed]] as an Admit procedure into the [[CCI Picklist]], the top of the tab.
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.


=== General CCI questions ===
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 [[List of CCI procedures we don't code|there]].
Collectors, please put '''general''' CCI questions here, but specific ones to their respective articles, e.g.
* CCMDB.mdb user interface concerns:
** [[L_CCI_Picklist_subform#Any_questions_or_suggestions_about_this_form_in_CCMDB.mdb]]
** [[L_CCI_Component_subform]]
** [[CCI_Chooser_form]]
* for general concerns about why CCI, or why specific dxs were not included, comment in
** [[Reasoning_around_moving_to_CCI_and_our_subset_of_it]]
* for criteria or specific comments about a specific CCI code, please comment in the page for that article; see [[CCI Picklist]] and [[CCI Component]] for complete list.


== Procedures not coded ==
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.
See [[CCI procedures we don't code]]


== Questions? ==
=== Don't code sub-procedures that are part of a larger procedure ===
{{discussAllan | various CCI questions, at least some can likely be answered on the spot, others might need to go to task }}
*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]]).


=== additional codes? ===
=== Related Imaging, Diagnostic and Therapeutic procedures performed at the same time ===
* central lines included?
*When at the same sitting both diagnostic and therapeutic procedures are done, then CODE THEM BOTH
 
{{ex|* a cardiac cath is done and then a stent is placed -- code the diagnostic cath and the therapeutic stenting.
* There is a diagnostic thoracentesis on the [[CCI Picklist]] but not a therapeutic one.  This should be on the picklist as it is very common.
* for an [[Angiogram, coronary (diagnostic cardiac catheterization)]] where [[Angioplasty, coronary (with stenting)]] happens in the same sitting, code both}}
** As opposed to coding it as [[Therapeutic Intervention on Thoracic Cavity, anything inside, NOS]], [[Drainage, Evacuation]]? Ttenbergen 16:11, 2018 April 5 (CDT)
* if a tissue [[Biopsy (non-endoscopic)]]/[[Biopsy (endoscopic)]] is done as part of an invasive [[Inspection, Exploration (non-endoscopic)]]/[[Inspection, Exploration (endoscopic)]] code both
 
*When multiple procedures are done at one sitting, code them all
* I tried putting in a diagnostic bronchoscopy. I put in Diagnostic Intervention on the lung but there is no option in the second component to capture taking a sample of secretions for culture. --[[User:LKolesar|LKolesar]] 12:26, 2018 March 20 (CDT)
{{Ex|if a CT of chest, abdomen and pelvis is done, code them all}}
** For diagnostic the only options are [[Inspection, Exploration]] and [[Biopsy]], so you are correct. Are we OK with that? Ttenbergen 19:00, 2018 March 22 (CDT)
*For endoscopic inspection/explorations, code only the '''"furthest/deepest"''' area assessed.
 
* Also, at the task group meeting, Dr Garland said that Pacemaker insertion and ICD insertion would be on the picklist because they look the same done in the component entry section.  I guess this item has not been added yet.  
 
*{{discussion}} How should I code an ECMO?--I used Therapeutic Intervention of the heart and Installation of an External appliance, which does not sound right but nothing else fit. (from Lois)
 
{{discussion}} how do we code closure of a surgical incision done later.  Many times if a patient bleeds excessively or if they expect a lot of edema or a requirement for further future surgery, they leave the surgical incision open.  When the patient eventually goes back for closure, how do we code this in CCI--[[User:LKolesar|LKolesar]] 13:34, 2018 April 9 (CDT)
*{{discussion}}How do we code an intubation, I used therapeutic intervention on the lung and is it an internal device or external? Lois
 
*{{discussion}}I cannot find [[Albumin 5pct]] and [[Albumin 25pct]] on the picklist. Are we not still counting these? Lois
 
=== Ability to differentiate in reports ===
* I do not see how we are going to differentiate a VAD from AV ECMO as they are both installation of external device on the heart??--[[User:LKolesar|LKolesar]] 12:26, 2018 March 20 (CDT)
{{discussion}}
* the instructions seem to indicate that we should not even be coding many of the codes we previously have coded like VAD's ECMO's, etc. if they are done in the unit?? I am pretty sure that Julie needs this data. --[[User:LKolesar|LKolesar]] 12:40, 2018 March 20 (CDT)
 
=== admit vs acquired dxs and the rule to only code if off unit ===
*For the procedures listed specifically like arterial lines, PEG, hemodialysis, etc.  Do you want only if done during their stay or since arrival to the hospital,  or if they already had this done prior to arrival.  There are patients in the community with a PEG and on hemodialysis for example.  --[[User:LKolesar|LKolesar]] 08:07, 2018 March 7 (CST)
** Ah! Yes, will our restrictions for procedures with [[Px Type]] "admit" be the same as for on unit?
 
=== Coding GI Scopes ===
* ... It does not even include regular GI scopes which are very common and it is on your list of things you want.  ... --[[User:LKolesar|LKolesar]] 11:41, 2018 March 7 (CST)
** The GI Scopes are currently on the [[CCI Component]] list only and would be coded as [[Inspection, Exploration]]. The scope part would have been part 3 (how it was done) an we no longer code that.
{{DiscussTask | CCI codes GI scope as (body part), [[Inspection, Exploration]]. So, won't be able to identify those from laparoscopic surgery. Do we care? Ttenbergen 19:00, 2018 March 22 (CDT) }}
 
*{{discussion}} For upper GI scope, should it be coded diagnostic/therapeutic interventions on "stomach" or "small intestine"? (since duodenum is first part of small intestine). Also, if biopsy is done with inspection and exploration, but no interventions like clipping or to control bleeding, should that be coded as "biopsy" or "inspection, exploration"? --[[User:Malcudia|Malcudia]] 10:13, 2018 April 11 (CDT)
** Re whether to code stomach or intestine, see [[#Related Imaging, Diagnostic and Therapeutic procedures performed at the same time]] above in this document. Re whether to code biopsy or exploration. I'll leave that open for now. Ttenbergen 10:57, 2018 April 11 (CDT)
 
=== Which codes go on picklist ===
* What are the criteria for choosing the picklist items? I thought it was going to be procedures that are difficult to list by the component entry method and then more common procedures. 
* There are quite a few uncommon (rarely seen) procedures in the pick list, is there a reason for this?  Just wondering what the rationale is for these choices?  Maybe these can be left off the picklist and just left to the component entry method.  Just a suggestion.  --[[User:LKolesar|LKolesar]] 13:32, 2018 March 15 (CDT)
* I see arterial blood gases are on the picklist.  However, Dr Garland had said that arterial blood gases and venous blood gases will remain in our count list unlike all the other things we count.  Should arterial blood gases be removed from the CCI pick list?--[[User:LKolesar|LKolesar]] 13:29, 2018 April 9 (CDT)
* What about chest tubes inserted in the unit?; ECMO inserted in the unit?; CRRT done in the unit?  Intubations and central lines in the unit? Cardioversions and Defibs in the unit?; Pacemakers in the unit? IABP in the unit?--[[User:LKolesar|LKolesar]] 13:59, 2018 April 20 (CDT)
 
=== counts, and moving labs to CCI ===
* Also, I was not aware that we are moving all our count items to CCI and having to put a date for all blood products, CXR, echos, etc. This will definitely be more work than just counting the number of each.  Who is requesting dates for every single item?  Although I see almost all our count items here, I do not see Abdominal Ultrasounds which we currently count. Also there are additional diagnostic procedures on this list that we previously did not count.  At one time we did not add other diagnostic counts because the data was not requested.  Is all this additional data being requested now?  (ie:  EEG's, abdominal xrays, nuclear scans, urodynamic study, cardiac stress test, pulmonary function tests, etc).  We used to go the steering committee for requests for additional data collection items, has this now changed?
 
* In some limited testing of the entering of counted labs in CCI, I find that it takes considerably longer to do this vs just counting the number of each item as we currently do it.  For example, one patient that was in ICMS for 3 weeks on ECMO had 86 ABG's done in their admission.  It took me 15 minutes to just enter the ABG's in CCI. It only takes one minute to enter this item in the old count method off of EPR labs.  If I spent the time to enter all the blood products, tests and labs, etc. It would have taken much longer.  No one has that much extra time in their day to spend it putting in these CCI entries for every lab.  It may work for short stay patients with minimal labs and procedures but not for more complex patients. We need to discuss this.  --[[User:LKolesar|LKolesar]] 14:13, 2018 April 20 (CDT)
 
==Date Integrity Checks ==
==={{CCMDB Data Integrity Checks|ready to implement|ready to implement}} - Must have at least one entry ===
{{discussion}}
Will need to be implemented: to click complete:
* must have a other than [[No Procedure Performed]]
* code [[No Procedure Performed]] if there were no procedures


=== [[Aborted Procedure]] ===
*See [[Aborted Procedure]] for how to code


=== 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.


==={{CCMDB Data Integrity Checks|ready to implement|ready to implement}} - CCI Procedure vs [[Previous Location]] Cross Check ===
==Data Integrity Checks ==
If from OR or PACU, must have at least 1 CCI
{{Collapsable
| always= List of cross-checks
| full= {{#ask: [[DICSummary::+]] [[Category: CCI Px check]]
|?DICSummary = summary
|?DICStatus = implementation status
|sort=DICStatus, DICSummary
|default=No corresponding old article found
|format=broadtable
|limit=100
|link=all
|headers=show}} }}


== Related Articles ==
== Related Articles ==
Line 185: Line 116:


== related literature ==
== related literature ==
[https://secure.cihi.ca/free_products/Coding%20standard_EN_web.pdf CIHI.ca coding standard CCI]
[https://secure.cihi.ca/free_products/CodingStandards_v2018_EN.pdf CIHI.ca coding standard CCI]





Latest revision as of 15:56, 2023 October 31

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

Start Date: Jan 1, 2019

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

productivity features

To reduce clicks to enter same Picklist entries for additional days, there are some extra buttons:

  • "x2" will duplicate this line with the next date
    • "+" and "-" will up or down the date by one day, to make the copy more useful
  • Blue button in CCI Picklist will fill a range of dates

Collection modes

Collecting "CCI collect each" items

Collecting "CCI collect count each" items

Blood gas, arterial, and Blood gas, venous are not manually counted at HSC or STB sites, as it is automatically uploaded from DSM Lab Extract.

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
Capsule EndoscopyCCI collect 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
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 each
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 through 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
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 PRBCCCI collect count units
Transfusion of albuminCCI collect first
Transfusion of plasma productsCCI collect count units
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 check CCI TISS CAM positive vs DxChecks that each T9 - CAM positive (TISS Item) goes with an ICD10 code from Category:Deliriumdeclined
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 CCI TISS time means must be twoIf certain Px Dates have a time component, then there should also be a matching CCI Picklist without the timedeclined
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 vs LOS count days picklistConfirm that CCI Collection Mode for CCI Picklist CCI collect count days items don't have a count > LOS.implemented
Query check CCI vs LOS count days componentConfirm that CCI Collection Mode or CCI Component CCI collect count days items don't have a count > LOS.implemented
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 TISS matching BoardingLoc timeIf the Px Date component of a CCI Picklist has a time, then there must be a corresponding Boarding Loc entryimplemented
Query check ICD10 trach has trach but no TISSIf there is a Tracheostomy, has one (Z93.0) ICD10, there should likely be a T23 - Trach Tube Present (TISS Item)implemented
Query check ICD10 trach create but no TISSIf there is an acquired Tracheostomy creation there also has to be a Trach Tube Present (TISS Item)implemented
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 must have entryThere must be at least 1 CCI entry in L_CCI_Picklist table (which might be No procedure performed)implemented
Query check CCI Component no admin entriesThere must be no No procedure entered/Blank procedure entry in CCI Component.implemented
Query check CCI Picklist if no admin entriesThere must be no No procedure entered/Blank procedure entry in CCI Picklist.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 first Service tmp entry and Dispo_DtTmimplemented
Query check eliminated CCI Compdisallows any currently entered diagnosis that has been eliminatedimplemented
Query check eliminated ICD10disallows any currently entered diagnosis that has been eliminatedimplemented
Query check eliminated CCI Pickdisallows any currently entered diagnosis that has been eliminatedimplemented
Query check CCI CXR vs LOSConfirm that a Category:Labs Imaging count is not unreasonably highneeds review
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 T26 & 27 - Endoscopy (TISS Item) then there must be an endoscopic CCI for that day.retired
Query NDC cardioversion dx vs TISSIf pt has Acquired Procedure Cardioversion (EXCLUDE defibrillation-we are not tracking), then the TISS28 item T26 & 27 - Cardioversion (TISS Item) (T41) must be marked.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