CCI Collection

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.

Collection Instructions

Which procedures to collect/include

• Here are the rules for what we will code and what we won't code:
  1. Include all therapeutic procedures Template:Discussion not all procedures, only the therapeutic ones? Ttenbergen 23:54, 2018 March 14 (CDT)

done outside the patient’s unit.

• 1. Include all therapeutic Template:Discussion see above.

procedures done using an endoscope (in or out of the patient's unit) - whether inserted through an orifice, incision or wound.

• 1. 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:

Template:Discuss@task Ttenbergen 14:41, 2018 March 5 (CST)

• 1. • arterial catheter placement
     • PEG
     • Hemodialysis (intermittent)
     • Peritoneal dialysis
     • Plasmapheresis
     • non-invasive mechanical ventilation - includes CPAP, BiPAP, and classic NIV (where a mask is connected to a regular ventilator)
       • Template:Discussionwhat 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)
     • debridement
     • tracheostomy placement (i.e. done bedside)

Template:Discussion* I suggest that VAC dressing changes be put in this category because they are usually done in the OR and done numerous times in a patient's stay. --LKolesar 14:02, 2018 March 15 (CDT)

Collecting a procedure

Follow these steps, in this order:

1. if no procedures were performed, see #No Procedures Performed
2. for every procedure, check if the procedure is listed in the L_CCI_Picklist subform, the top of the tab, and enter the procedure there, else enter it in the L_CCI_Component subform at the bottom of the tab
3. in whichever form you used,
   1. enter the Px Type - "admit" or "acquired"
   2. enter the Px_Date - Date of procedure
   3. enter the Px_Count - the number of separate times it was done on a given day

Picklist Entries

Just pick the CCI Picklist entry.

Component Entries

To enter a CCI Component:

1. pick the left column, the body system: Component 1.
   • 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.
2. code what was done: Component 2.

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.

• 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.--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?

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 for more info.

Template:Discuss@task Ttenbergen 14:12, 2018 March 5 (CST)

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 L CCI Picklist subform, the top of the tab.

---

General CCI questions

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.

Questions?

• 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. --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?

• Just to check: You do not want central lines included?--LKolesar 08:07, 2018 March 7 (CST)

• In your instructions you are listing only 8 therapeutic procedures other than the ones done outside the unit or endoscope ones. However, when I look at the picklist, it lists many more therapeutic procedures. What is correct? You are contradicting your own instructions. --LKolesar 11:28, 2018 March 7 (CST)
  • Those 8 procedures would be coded even if done on unit. The rest would only be coded if done off unit. So they need to be on the picklist (or component list) to code them. Ttenbergen 00:34, 2018 March 15 (CDT)

• Is your link in this article for the picklist correct? It does not even include regular GI scopes which are very common and it is on your list of things you want. Maybe this picklist is not the real one we will be using? --LKolesar 11:41, 2018 March 7 (CST)
  • If you mean CCI Picklist, then yes, it's correct. But 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. Template:Discussion I will leave it to Allan to comment on whether or not we want to add GI Scope to the Picklist. Ttenbergen 00:34, 2018 March 15 (CDT)

• There is no mention in your instructions regarding diagnostic procedures.
  • Because they are just procedures. I also don't specifically mention Obstetrical Procedures. Is it a list of these that you are missing. We could add that, the pages that contain the subsets of the codes are as follows, I just can't think of a helpful place in the procedures to integrate them; please feel free to move them up to a useful spot:
    • Diagnostic Procedure
    • Imaging Procedure
    • Miscellaneous Procedure
    • Obstetric Procedure
    • Therapeutic Procedure

• There is a diagnostic thoracentesis on your pick list but not a therapeutic one. This should be on the picklist as it is very common.
• Where all the surgical codes on the pick list?--LKolesar 11:41, 2018 March 7 (CST)
  • I am still waiting for a bunch of therapeutic codes. Allan is aware. Ttenbergen 00:34, 2018 March 15 (CDT)

• The link in CCMDB to the CCI picklist is not working.--LKolesar 11:42, 2018 March 7 (CST)
  • Was able to replicate problem, fixed now. Ttenbergen 00:34, 2018 March 15 (CDT)

• What happened to the third component in CCI? CCMDB only has 2 components listed in the component entries section. Should be: 1. Body --LKolesar 12:26, 2018 March 20 (CDT)system or location 2. What was done 3. how it was done (open, percutaneous, etc). We need the 3 sections to get the whole picture. --LKolesar 10:44, 2018 March 8 (CST)
  • It was decided to omit the 3. component. I think it may have been discussed at a task meeting you missed. But that doesn't change that we should have explained it to those who are not at those meetings. So, good catch, it's explained now. I will take this out eventually, since it would never have been a question if an earlier draft had not included it. Ttenbergen 00:34, 2018 March 15 (CDT)

• Template:Discussion

• 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. 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?
• 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.
• 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. --LKolesar 13:32, 2018 March 15 (CDT)
• 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. --LKolesar 12:26, 2018 March 20 (CDT)
• 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??--LKolesar 12:26, 2018 March 20 (CDT)
• 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. I am pretty sure that Julie needs this data. --LKolesar 12:40, 2018 March 20 (CDT)
• ... I hope this is not the picklist because I do not see the codes we need or frequently use. Why are there so many obstetrical codes on it? These are not frequently used. 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, moved here from)

Date Integrity Checks

Template:CCMDB Data Integrity Checks - Must have at least one entry

Template: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

Template:CCMDB Data Integrity Checks - CCI Procedure vs Previous Location Cross Check

If from OR or PACU, must have at least 1 CCI