Task Team Meeting - Rolling Agenda and Minutes 2019
List of items to bring to task meeting
Add to this by adding the following to the article where the problem is documented:
{{DiscussTask | explanation}}
| Question | Modification date"Modification date" is a predefined property that corresponds to the date of the last modification of a subject and is provided by Semantic MediaWiki. | |
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| Hemothorax or hemopneumothorax, nontraumatic | Just wondering whether this code could be combined with iatrogenic causes similar to the guideline for:
Guideline for Iatrogenic Pneumothorax According to our general rule of not coding iatrogenic events as traumas, code an iatrogenic pneumothorax as
Plus the most appropriate of the following; Pneumothorax, tension, nontraumatic Pneumothorax, nontension, nontraumatic Pneumothorax, nontraumatic, NOS Thanks, Pamela Piche 08:55, 2024 March 19 (CDT)
| 5 April 2024 20:03:05 |
| Iatrogenic, mechanical complication/dysfunction, internal prosthetic device or implant or graft NOS | At our last TASK meeting the decision was made to exclude spontaneous rupture of an ETT cuff or cuff leak, but we are wondering if this is correct based on what is listed in the includes section of this page and what is in Iatrogenic, mechanical complication/dysfunction, internal orthopedic prosthetic device or implant or graft or bone device and Iatrogenic, mechanical complication/dysfunction, cardiac or vascular prosthetic device or implant or graft, NOS Lisa Kaita 12:37, 2024 March 20 (CDT) | 20 March 2024 17:37:32 |
| Myocardial infarction, acute (AMI), NOS | ICD 10 has this code for STEMI:
2024 ICD-10-CM Diagnosis Code I21.3
ICD 10 has this code for NSTEMI: 2024 ICD-10-CM Diagnosis Code I21.4
Would it be less labor intensive for collectors to be able to use these codes instead of MI codes dependent upon development (or not) of Q waves as this is problematic to determine. Thank you, Pamela Piche 07:49, 2024 April 5 (CDT)
| 5 April 2024 20:10:42 |
| STB ICUs VAP Rate, CLIBSI Rate Summary |
| 8 April 2024 16:27:53 |
See Task Team Meeting - Rolling Agenda and Minutes 2018 for previous year's minutes.
ICU Database Task Group Meeting – February 6, 2019
- Present: Allan, Con, Joanna, Michelle, Tina, Trish
- Absent: Julie, Laura
- Minutes prepared by: AG
- Action items in BOLD
1. Further consideration of reinstating CCI code Pharmacotherapy, antineoplastic agent, whole body for chemotherapy: We decided not to do so. The rationale is that what is considered chemotherapy is not quite confusing since: (a) many cytotoxic drugs are given for indications other than cancer, and (b) increasingly the drugs used for cancer are not cytotoxic but are biologics. - Tina updated Pharmacotherapy, antineoplastic agent, whole body with this info
2. Further consideration of adding a specific ICD10 code for Intravenous drug abuse (IVDA) -- There is no ICD10 code for IVDA and at this time we decided not to add a custom code unless some user really wants this information. - Tina has added this to List of ICD10 Diagnoses we don't code
3. Regarding coding of FFP and albumin transfusions:
- Transfusion of FFP: After discussion we decided that when stickers are not used, that the number of units will be determined by the current procedures of Canadian Blood Services that 1 unit is approximately 250 mL.
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as per your request that page is still waiting for an edit from you |
- Transfusion of albumin: Because it comes in different concentrations, given Laura’s concerns, we will change CCI Collection Mode to CCI collect first - Tina has updated Transfusion of albumin and CCMDB.mdb with this.
- There was discussion about seeking to obtain all CBS data to merge in an ongoing way with our databases. Their database is called Traceline. Allan will contact Anthony Loewen (anthony.loewen@blood.ca) at CBS to pursue this.
4. Regarding CAM coding. The current methods of collecting this data is in TISS and on the ICU flowsheet.
- To even be evaluable for CAM assessment, a patient must be conscious. Thus, in reality, a given CAM assessment has 3 possible findings: (i) not evaluable, (ii) evaluable and CAM-positive, or (iii) evaluable and CAM-negative.
- CAM status is currently recorded in ICUs in two places:
- On the ICU flowsheet, as an indication of CAM-positive versus not being CAM-positive; as above the latter includes evaluable and CAM-negative or not evaluable. Of note, the ICU nurses evaluate for delerium multiple times per day.
- On the TISS sheet, as a bubble for being CAM-positive versus not being CAM-positive. Here there is just a single yes/no bubble, so that NOT being CAM-positive can mean either that there were no evaluable assessments during that day or that there was at least one evaluable assessment and all of those were CAM-negative.
- The users of this data (including Rakesh Arora in ICCS) are mainly counting the number of ICU days in which a patient is CAM-positive -- which of course only includes days on which there is at least one CAM-evaluable assessment.
- Allan has updated CAM positive (TISS Item) with this info
5. The data collectors made clear that it would be highly desirable for Wiki searching to be enhanced. Tina will ponder this and has started page Searching the wiki to document.
6. The idea was floated to (somehow) enhance the inclusion in Wiki pages of synonyms for diagnoses. We’ll come back to this sometime later. - See Searching the wiki
7. New question about how to code mets to the pancreas. Answer is Gastrointestinal system NOS, metastatic malignancy to it (also code primary site) and that page has been updated.
8. New question about whether it is OK to code bacterial Colonized with organism (not infected) as a comorbid. Answer is Yes.
9. After discussion relating to how diabetes might disappear, Allan has added Past history, transplanted pancreas or islet cells.
10. New question of situation whereby: Patient with ESRD is admitted for a kidney transplant -- gets the TP -- and kidney has trouble leading to acute renal failure/insufficiency in the transplanted organ. A number of questions arose with the following answers:
- This person should have Chronic kidney disease (end-stage kidney disease, ESRD), Stage 5 as a comorbid, then have CCI coding for the transplant, and THEN as an acquired diagnosis can have things like: Kidney, acute renal failure NOS and Kidney transplant, failure or rejection or unspecified complication . Allan has modified this latter article to make clear that it includes injury to the transplanted kidney of any level, total or partial or temporary. Tina will ensure that the error trapping in place allows an individual to have ESRD as a comorbid and AKI in the same record only if the person also has a CCI code for the kidney transplant OR has the ICD10 code of Past history, transplanted kidney.
- But should not use Kidney, acute renal failure, postprocedural -- as this code is for kidney failure from another type of procedure. Allan has now modified that article to make that clear.
11. New question. There appear to be two conflicting ways that the Wiki indicates to code HAP. One listed in Iatrogenic, complication of medical or surgical care NOS and the other in Hospital-acquired pneumonia (HAP) in ICD10. Allan has fixed this with the correct approach being listed in the latter Wiki page.
Next Task Group Meeting: February 13, 2019 at 11am
ICU Database Task Group Meeting – January 24, 2019
- Present: Allan, Con, Joanna, Julie, Tina, Trish
- Absent: Laura
- Minutes prepared by: AG
- Action items in BOLD
1. There is still concern about the extra workload of ICD10/CCI. We will continue to monitor this and seek pithy suggestions for reducing the workload with minimal loss of content/value.
2. Consideration of adding Pharmacotherapy, antineoplastic agent, whole body back to the CCI list. This CCI picklist code would be 1.ZZ.35.HA-M0. At the Dec 7, 2018 task meeting we decided to eliminate it, though that item doesn’t explain why. We’ll reconsider at the next task.
3. Consideration of adding a specific ICD10 code for IVDA -- There is no ICD10 code for IVDA. The drug abuse codes go by the drug, not the route. If we decide we really need/want this, we can add a custom code. At the next meeting we’ll discuss this.
4. After discussion of whether we want to code CMV(+) status for organ transplants, we decided that we do not.
5. FFP does not have stickers that come with it from Blood Services. This led to a question of how to quantify FFP for coding Transfusion of FFP.
- Allan called the Winnipeg office of Canadian Blood Services and was told that for full units (approx. 250 mL) they do have stickers, but when they send half units that those do not have stickers. A solution appears to be to count the stickers, which should be there for whole units, but for half units, count them manually -- as 0.5 of a unit. We’ll discuss this more at the next Task meeting.
6. Question arose of how to code Factor V Leiden mutation. Allan will look into this ---> DONE, as the Wiki page indicates this is covered in Primary hypercoagulability (thrombophilia).
7. A complex question was raised about coding/counting CCI admit procedures that are done prior to admission, especially if done in a procedure suite on the way from one hospital ward or ICU to another hospital ward or ICU.
- Our current criteria are listed in CCI Collection and that works fine when the patient comes to out ICU/ward from the ED or another location where we do not collect.
- But, it’s complicated by the fact that is a patient goes from one to another of our collecting locations, that they might be counted in each place. Furthermore, a person being transferred from location A to location B may, in between, go to a procedure suite and get admit-type procedures.
- We agreed to make 4 general rules for procedures:
- (i) Transfer from collecting location A to collecting location B without any stop in between where procedures might occur -- all procedures done before leaving location A will be collected by location A only
- (ii) Transfer from collecting location A to collecting location B WITH a stop in between where procedures occur -- all procedures done before leaving location A will be collected by location A only, while procedures done at the stop in between will be coded by location B only.
- (iii) Transfer from noncollecting location A (which includes ED) to collecting location B without any stop in between where procedures might occur -- any qualifying admit procedures done before leaving location A will be collected by location B
- (iv) Transfer from noncollecting location A (which included ED) to collecting location B WITH a stop in between where procedures occur -- all procedures done before leaving location A or during the stop in between will be coded by location B only.
- Allan put the updated information on the wiki, and Tina moved it to CCI_Collection#Moved_patients from Admit Procedure since it applies to both admit and acquired.
8. Tina raised the issue of the possibility of the following true timing of events: First patient accepted for admission; Second patient deemed transfer ready to a lower level of care; Last is patient arrives. It’s an issue because the current cross-check Function Dispo Chronological() does not allow Transfer Ready DtTm to occur prior to Arrival D/T. After discussion (which unfortunately Tina was not present for), we agreed that the rule should be that Transfer Ready D/T can only be coded at or after Arrival D/T. The rationale has to do with the main desire for avoidable days to refer to actual bed occupancy days avoidable.
9. Discussion about coding Bacteremia. Although this is a finding and not an actual disease, because of it’s importance, we agreed that even though the general role is that coding findings/signs/symptoms is optional when the underlying cause is known, that for bacteremia we should ALWAYS code it when present. Furthermore, that at the discretion of the data collector, it can be linked to another presumed infection (e.g. Klebsiella pneumonia linked to Klebsiella bacteremia), but if it’s not completely clear that they’re related, to leave the bacteremia as “free standing”. Allan will modify the wiki page for Bacteremia, the sepsis template -- DONE.
Next Task Group Meeting: February 6, 2019 at 11am
ICU Database Task Group Meeting – January 9, 2019
- Present: Allan, Con, Joanna, Julie, Tina, Trish
- Absent: Laura
- Minutes prepared by: AG
- Action items in BOLD
1. Through discussion it became clear that there’s a need to modify the Kidney, renal tubular acidosis (RTA, all types) wiki page to clarify that by definition it is not an RTA if renal failure (acute or chronic) is present. Said another way, an RTA is a metabolic acidosis due to an inability of the renal tubules to excrete hydrogen ions in the presence of a normal creatinine clearance, as indicated usually by a normal creatinine. Allan will add this to the wiki article -- DONE.
2. There was substantial concern voiced by Con and Joanna about how long the new system is taking to code. At this point it’s as much as 4-fold longer than before. We discussed possible reasons, which include:
- ICD10 coding, though this is possibly less burdensome than is CCI coding.
- The biggest single issue raised was that among the 5 CCI Collection Modes:
- Collecting "CCI collect each" items
- Collecting "CCI collect count each" items
- Collecting "CCI collect count days" items
- Collecting "CCI collect count units" items
- Collecting "CCI collect first" items
- We recognized that we probably could downgrade most of ‘1’ to be one of the others
- And that for at least some of ‘2’, '3' and '4' we could downgrade to ‘5’
- We decided today to do that for HD, PD, CRRT and ICP monitoring (Done - Tina)
- Allan will take a look at the entire list, especially CCI Picklist, and consider further items that can be downgraded.
- Other options for reducing workload for CCI include: (i) compressing the number of body parts, (ii) reducing and/or compressing the number of “what was done to the body part” items.
- We’ll discuss all this at next Task meeting.
3. Julie raised the question of Charlson items -- specifically that previously most such items were allowed to be listed either as Admit Diagnosis or Comorbid Diagnosis. (See also Controlling Dx Type for ICD10 codes) The question is what do we want to do now about this. Allan will review both Charlson’s original description, and Quan’s administrative data implementation to see what THEY did regarding this --> DONE. The intention of this coding is to identify conditions that are present prior to admission. Thus, we should include admit and even acquired (post-admit) diagnoses for those Charlson items where it's pretty clear that the condition was almost certainly present prior to admission, even if that wasn't recognized -- and th is applies for 16 of the 17 Charlson conditions, i.e. all except "Myocardial infarction", and the only reason for that one being an exception is that there is an ICD10 code for Past history, myocardial infarction (old MI).
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Charlson Admit Como - I have put several related pages on your list that start with the same words as this one. We need to update them to make sense with any change to this. Some still had other questions in them anyway.
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4. It was noted that the Template:ICD10 Guideline Como vs Admit is very confusing. Allan will work on it. (Template was added to Allan's list)