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. 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

Here are the rules for what we will code and what we won't code:

Procedures done outside the unit

Include all codable procedures done outside the patient’s unit.

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

Include all of the following codable procedures done on the unit:

• • (a) any procedure that uses an endoscope -- whether inserted through an orifice, incision or wound
  • (b) all codable Diagnostic Procedures
  • (c) all codable Imaging Procedures
  • (d) all codable Obstetric Procedures
  • (d) all codable Miscellaneous Procedures

Procedures only coded once pre ward stay

In addition to (1) and (2) code the following (and only the following) procedures done in the patient’s unit - but only the FIRST TIME (date) IT WAS DONE during the patient’s stay on that unit

• Sublist of these procedures that are chosen from the Picklist:
  • Whole body cooling
  • Whole body warming - incl extracorporeal warming of blood
  • Electroconvulsive (Shock) Therapy to Brain
  • Cardioversion -- excl defibrillation which we are not tracking separately
  • Plasmapheresis
  • Peritoneal dialysis
  • Hemodialysis (intermittent)
  • CRRT -- incl for volume removal via PRISMA device
  • Total parenteral nutrition (TPN)
  • ECMO, VV
  • ECMO, VA
  • Pacemaker insertion, permanent
  • Pacemaker insertion, temporary
  • Mechanical ventilation, noninvasive - includes CPAP, BiPAP, and classic NIV (where a mask is connected to a regular ventilator)
  • Isolation, infectious

• Sublist of these procedures that are coded in the usual CCI manner, i.e. using components:
  • PEG -- combine body part Therapeutic Intervention on Stomach, Pylorus with "what was done" as Bypass
  • Debridement -- for which you combine the body part, with the "what was done" CCI code Excision, Resection, partial
  • Tracheostomy placement (i.e. done bedside) -- combine body part Therapeutic Intervention on Trachea with "what was done" as Bypass
  • Endotracheal intubation -- combine body part Therapeutic Intervention on Trachea with "what was done" as Implantation of Internal Device
  • Chest tube (tube thoracostomy)-- combine body part Therapeutic Intervention on Pleura with "what was done" as Implantation of Internal Device
  • Intraaortic balloon pump (IABP) -- combine body part Therapeutic Intervention on Aorta, NOS with "what was done" as Implantation of Internal Device

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).
      • See CCI component 2 codes - what was done

Aborted Procedure

• See Aborted Procedure for how to code

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.
      • 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.
      • in the column on the right, pick the CCI component 2 codes - what was done.
   3. whether CCI picklist or CCI component,
      1. enter a Px_Type - " admit" or " acquired"
      2. enter a Px_Date - Date of procedure
      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 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.

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.

Procedures not coded

See CCI procedures we don't code

end of instructions, the questions below will eventually be cleared out.

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Questions?

Insert Pacemaker

ICD insertion ICD insertion was supposed to be on the picklist because they look the same done in the component entry section. Pacemaker insertion, permanent and Pacemaker insertion, temporary are in picklist now. How about the ICD? Ttenbergen 18:34, 2018 May 16 (CDT)

• SMW

• Cargo

• Categories

Closure of surgical incision that was left open

Template: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--LKolesar 13:34, 2018 April 9 (CDT)?

Are these Biopsies

Lumbar puncture

• Template:Discussion for a lumbar puncture, I put interventions on the spinal cord or spinal canal. Do I use drainage, evacuation for this? They just take a sample of CSF but there is no sample option.--LKolesar 13:32, 2018 May 2 (CDT)
  • Isn't a sample what a Biopsy is about? Ttenbergen 06:41, 2018 May 17 (CDT)
  • I copied the definition of biopsy from the internet dictionary:

    "an examination of tissue removed from a living body to discover the presence, cause, or extent of a disease".  I am not sure if this will work for taking samples of fluids also, let us know what you want us to use. --LKolesar 08:13, 2018 May 18 (CDT)

• My experience is that lumbar puncture is diagnostic for drawing a sample. For intervention, they would insert a drain.--Jpeterson 08:27, 2018 May 18 (CDT)

Bronchoscopy

• 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)
  • 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)

VAD

How do we put VAD's in the component method?

Thrombolyic agents for PE, MI, stroke

• Template:Discussion: how do we differentiate thrombolytic agents given for PE, MI or stroke? For component 1: I thought it should be "theuapeutic intervention on circulatory system" for all of these options and then "pharmacotherapy, thrombolytic agent" for component *If the patient has only one of the above diagnosis, one could assume that the treatment was related to that. Does it matter what it is given for? --LKolesar 13:02, 2018 May 10 (CDT)

Blakemore vs UGI scope for banding

• How do we differentiate a Blakemore tube from an Upper GI scope with banding or hemostasis? They both look the same in CCI: Therapeutic Intervention on Stomach, pylorus... and Control of Bleeding. --LKolesar 14:11, 2018 May 1 (CDT)

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And the content below here will need to stay as well

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

related literature

CIHI.ca coding standard CCI