CCI Collection: Difference between revisions

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{{Discuss | who = Allan | question =  
{{Discuss | who = Allan | question =  
*How do we put the procedure: thrombectomy of the femoral artery for a blocked vascular graft (axillo-femoral graft).  Please advise. --[[User:LKolesar|LKolesar]] 13:14, 2018 December 11}}
*How do we put the procedure: thrombectomy of the femoral artery for a blocked vascular graft (axillo-femoral graft).  Please advise. --[[User:LKolesar|LKolesar]] 13:14, 2018 December 11
*AG REPLY --- in general it appears that procedures performed on vascular grafts (either synthetic grafts or vessels harvested from elsewhere for use) are coded just as you would if the same thing was done to the native vessel.  So this would be 1.KG.57 = therapeutic EXTACTION procedure [which includes thrombectomy] on arteries of the leg NOS [which includes the femoral arteries] }}


=== No Procedures Performed ===
=== No Procedures Performed ===

Revision as of 11:57, 2018 December 13

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

Determining if the procedure you found is one we collect

  • There are THREE subsets of procedures we 'will code
    • Procedures done outside the unit
    • Procedures done on the unit including an endoscope
    • A select group of other procedures done on the unit.

(A) Procedures done outside the unit

Include all codable procedures that meet the definition of one of the Px Types that are done outside the patient’s unit.

(B) Procedures done on the unit (endoscope or non-therapeutic)

  • This includes both diagnostic and therapeutic procedures done with an endoscope -- and that scope may be inserted through an oriface, incision or wound.
  • Includes all of the following codable procedures done on the unit:

(C) Other on-unit procedures

CCI Procedures coded once per ward admission

Some procedures are only coded the first time they happen. See CCI Procedures coded once per ward admission.

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 of chest tubes, pacer wires, and vein harvest, but do NOT code those procedures separately, since they are "included" in the CABG code.

Before You Decide to NOT Code a Procedure

  • 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].
  • The main issue here is that among the lists "what was done", we haven't included EVERY possibility.
    • 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.
    • 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.
      • 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).

Aborted Procedure

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

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.

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

Some intervention are both diagnostic/imaging and therapeutic. For those situations, only code the therapeutic part.

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

Examples:

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 List of CCI procedures we don't code for more info.

  • How do we put the procedure: thrombectomy of the femoral artery for a blocked vascular graft (axillo-femoral graft). Please advise. --LKolesar 13:14, 2018 December 11
  • AG REPLY --- in general it appears that procedures performed on vascular grafts (either synthetic grafts or vessels harvested from elsewhere for use) are coded just as you would if the same thing was done to the native vessel. So this would be 1.KG.57 = therapeutic EXTACTION procedure [which includes thrombectomy] on arteries of the leg NOS [which includes the femoral arteries]
  • SMW


  • Cargo


  • Categories

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.

Procedures not coded

See List of CCI procedures we don't code

Proposed tweak

As discussed Task_Team_Meeting_-_Rolling_Agenda_and_Minutes#ICU_Database_Task_Group_Meeting_.E2.80.93_October_31.2C_2018:

  • After discussion we recognized that we will need to create machinery to code 3 different categories of such procedures:
    • (i) Those coded every time they occur -- recorded with dates. Example is EGD
    • (ii) Those for which we mainly want total counts -- record the first date in which done, plus the total count over the entire admission. Example is CXR, ABG. For this one there is needed software/data entry “machinery” that Tina/Trish/etc will talk about offline.
    • (iii) Those for which we would ‘’prefer’’ the # of days on which it was done. Examples are noninvasive mechanical ventilation, dialysis, ECMO. However, after discussion we decided that in order to reduce the workload on the data collectors, we will only collect the date of the first use. We could reconsider adding # of days for these at a later point in time.
  • Thoughts?
  • SMW


  • Cargo


  • Categories

Data Integrity 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