CCI Collection

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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.

Introduction to CCI Procedure Coding

  • CCI stands for Canadian Classification of Interventions. It is the standard schema used in all of Canada to code all types of medical procedures.
  • We decided to code procedures as a subset of CCI. By subset" we are referring to the fact that there are over 18,000 procedures in all of CCI; we will only be keeping track of a fairly small fraction of these.
  • We will collect procedure in two separate "bins": admit and acquired; see Px Type form more info.
    • Acquired procedures are those done AFTER admission to the ICU/ward.
    • Admit procedures are those done BEFORE admission and are relation to admission.
    • For example, with admission after a surgery, the surgery is an admit procedure.
    • NOTE: If a person is admitted and the plan is to take them to the unit first, and soon thereafter do the procedure, you should code this as acquired, not admit.
  • For all interventions we are keeping track of:
    • Px_Date - Date of procedure
    • Px_Count - the number of separate times it was done on a given day
  • When you have a procedure to code in CCI, the first thing that needs to be done is to decide the intervention category/CCI chapter:
  • It's usually easy to figure out which category to use, but sometimes an intervention can be both therapeutic and diagnostic (e.g. thoracentesis). A rule is that when you have a procedure that has both therapeutic and diagnostic aspects, ONLY code the therapeutic part. For example, for a diagnostic cardiac catheterization where at the same sitting a stent is placed, only code the stent placement.
  • The approach/rules for coding procedures are different for the different categories/chapters

Collection Instructions for Therapeutic Procedures

Which therapeutic procedures to collect/include

  • Here are the rules for what we will code and what we won't code:
  • 1. Include all codable therapeutic procedures done outside the patient’s unit.
  • 2. Include all codable therapeutic procedures done using an endoscope (in or out of the patient's unit) - whether inserted through an orifice, incision or wound.
    • Important note regarding the meaning of "ALL CODABLE therapeutic procedures" as used above. As we're not including all 18,000 CCI procedures, there are many procedures we are not seeking to capture. The way this limitation shows itself is that the 2nd level of coding of therapeutic procedures (2nd level identifies "what was done" to the body part chosen in the 1st level) does not include all available options -- some that are not included in our CCI subset are dressings, oxygenation, and many others.
  • 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:


  • Template:DiscussAllan
    • 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.
  • 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)
    • 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.
  • 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)
    • AG reply: Two things here. First, VAC dressings are just a special type of dressing. So we're not particularly interested in it. But you might then notice that would give us a problem with rule#1, to code all procedures done outside of the patient's unit. In this regard, see the "Important note" above that's in ALL BOLD.

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.
  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.

repeated CXRs - if we do collect them it will be a nuisance; if we don't they won't compare to the Labs count x-ray we are doing now, that this is supposed to replace. How should we proceed?

  • SMW


  • Cargo


  • Categories
  • 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:

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.

how to code things not on the list... should we keep Therapeutic Intervention, NOS? What would be the coding instructions so it is not used for the small and common ones we don't want to collect?

  • SMW


  • Cargo


  • Categories

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.

Procedures not coded

We don't code all procedures. Generally, if it is not on the list, we don't code it. Here are some examples of procedures we have specifically considered, and decided not to code.

Template:Discussion This is just a placeholder for now. The questions keep coming up and we need a place to put the answers. More will be added as we go.

  • EKG ***Do we code EKG in CCI=I don't think we need it. A lot are done on some patients, and in truth it's a relatively minor diagnostic test which --- if it finds something --- will be then listed in the list of diagnoses.AG Thank you Tina and Dr Garland for your information
  • Xrays other than AXR plain film, CXR plain filmInterro-01.gifwhy is there no xray under CCI component entries I want to enter acquired/ foot xray/ so I put in acquired/then DI of lower limb then I want to enter xray but there is none so then do I enter Inspection?exploration?

Questions?

Template:DiscussAllan

additional codes?

  • central lines included?
  • 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.
  • 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)
  • 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.
  • Template: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)
  • How do we code tracheostomy? Therapeutic intervention on trachea and then is it installation of internal or external device (which one?)--LKolesar 12:57, 2018 March 28 (CDT)
  • Template:DiscussionHow do we code an intubation, I used therapeutic intervention on the lung and is it an internal device or external? Lois
  • Template:DiscussionI 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??--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)

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. --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. ... --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.

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)

  • SMW


  • Cargo


  • Categories

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. --LKolesar 13:32, 2018 March 15 (CDT)

Obstetrical codes on picklist

  • ... 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.
    • We did not include the obstetric codes in CCI Component and instead only included those specific few we wanted in Picklist.

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?

Date Integrity Checks

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

Template:Discussion Will need to be implemented: to click complete:



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

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

Related Articles

Related articles:
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