Reasoning around moving to CCI and our subset of it

This article explains our choice of CCI as a procedure coding schema and of the subset of codes we include.

Why are we moving to a new procedure coding schema?

• Our old diagnosis list was made in-house designed mostly for the Critical Care setting where our database started out. In that data set we combined diagnoses and procedures.
• A serious limitation of the current/old system is that it did not distinguish procedures from diagnoses. For example, CABG was considered as a diagnosis, when it's actually a procedure done for a diagnosis of Coronary artery disease, chronic (atherosclerosis, chronic ischemic heart disease).

Why are we moving to CCI rather than a different coding schema?

• Going along with the diagnosis coding in ICD10, the Canadian national standard usrd by CIHI for coding of procedures of all types is Canadian Classification of Interventions (CCI)

Why do we not include the entire set of CCI codes

• We have made a number of adaptations so we don't need to use all 18,000 codes.
• Small and common procedures can be so frequent that collecting all would have significantly increased collection efforts.
• It's OK to exclude these because if something important comes of them, it will be reflected in the ICD10 collection.
• For a listing of procedures that we have consciously chosen not to code, see List of CCI procedures we don't code.
• See List of CCI procedures we don't code#Background for some additional related info.

Why are we including the subset of procedures that we do

• The current list of procedures we're seeking to code is based on: (a) the procedures that were being coded in the past, (b) user input, and (c) to allow coding of all relevant procedures that satisfy the rules in CCI Collection.
• It may well happen that as more users utilize our databases that the list of procedures we want to code will increase.

Why some things are CCI Picklist codes and some CCI Component codes

By default, codes will be coded as CCI Components. Codes will be implemented as CCI Picklist entries:

• because they are very specific (i.e. have long sub-codes) and we want that level of detail (e.g. Cardiac electrophysiology study)
• because they contain a CCI component 2 codes - what was done that only applies to few organ systems ( e.g. ECT (Electroconvulsive shock therapy to brain))
• they are not Therapeutic Procedures, Diagnostic Procedures or Imaging Procedures (Misc Procedure contains oddballs that don't lend themselves to component coding, and Obstetric Procedure don't apply to other organ systems)

Why do we have some "routes" or "methods" of procedures available for some diagnostic codes but not for others?

• The FULL list of CCI codes would allow us to code not only "body part" + "what was done", but also "how it was done". As this adds up to over 18,000 distinct CCI codes, we decided on the following simplifying choices:
  • For CCI Chapter 1, therapeutic interventions, we completely eliminated coding of "how it was done".
  • For CCI Chapter 1, therapeutic interventions, we did not include every allowable "what was done". Specifically we do not include things that we believe are less important and interesting to users.
  • For CCI Chapter 2, nonradiologic diagnostic interventions, we decided to include only 2 options of "what was done" -- i.e. "Biopsy" and "Inspection/exploration". And we decided to include only 2 options for "how it was done", i.e. "Endoscopic" and "Nonendoscopic". This is how we got to the coding for CCI Chapter 2 that only has 4 options of the combiation, i.e. Biopsy (non-endoscopic), Biopsy (endoscopic), Inspection, Exploration (non-endoscopic) and Inspection, Exploration (endoscopic)

Coding example

Example:

I have a patient that had laser surgery on the larynx, pharynx area to remove a mass (SCC). I put in Glottis, Larynx, Related Structures (T) as "Extraction" and then I put in another one with the same anatomic location using this endoscopic option because they used an endoscope to do this procedure. I put this as therapeutic also. However when I try to check it off I get an error message that won't let me use endoscopic as a therapeutic measure. I think in this case both options are therapeutic. They used the endoscope purely to access the tumor for removal. We need to fix this error message. I copied the error message below: "Patient has inconsistent CCI Component entries, e.g a diagnostic organ system and an imaging body part."--LKolesar 12:50, 2019 January 14 (CST) What I am doing right now for this issue is: I put two entries, the endoscopy option I leave as "diagnostic" and then I put a second entry which is therapeutic and specifically put in what was done on the anatomic site. This gets around the problem if this is OK.--LKolesar 11:06, 2019 January 16 (CST) AG REPLY -- Yes, as indicated in what I've written above, the coding for therapeutic interventions DOES NOT include "how it was done" , e.g. endoscopically. This is because if we get to the additional layer of "how it was done" in the therapeutic interventions, we then end up with >10,000 CCI codes. And for nonradiologic diagnostic interventions, as stated above we limited the combo of "what was done" + "how it was done" to only 4 options -- because we decided we didn't really care about the others. So Laura, the way you're doing it is right. On the other hand, lets say somebody has a laparascopic cholecystectomy, here it'd be just fine to combine, (T) Gallbladder, Bile Ducts with Excision, Resection, total -- in not recording "how it was done" for therapeutic interventions, we decided that we didn't care that much.

Why is there some duplication between TISS and CCI

Some items on the TISS sheet are also done on Medicine wards, others are only done in ICU. We wanted to keep the CCI collection instructions consistent between Medicine and Critical Care, so where procedures are done in Medicine and would not be collected on TISS there, we included the procedures in CCI, and they should be coded in both Medicine and Critical Care. Where procedures are only done in ICU, and are already coded on the TISS, we have excluded them from CCI. The exception to this is CRRT (incl volume removal via PRISMA device) which is on TISS and only done in ICU, but we included to not cause any confusion with PD (Peritoneal dialysis) and HD (Hemodialysis).