Data Quality Task Force

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Data Quality Task Force

• Chart Review
• Postoperative Complications, April 14, 2005

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CIHI AWARENESS

• Glad to hear you've been in touch with Helen
  and Brenda - I will be bending their ear over the
  documentation issue.  Does no one dictate
  discharge summaries anymore?  From my
  perspective, the hospitals will need to work to
  improve the documentation as it seems that many
  have been trying to make it easier for the
  physicians. 

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ER SELECTIONS
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ER CONSENSUS
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CIHI Response ER portion
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NACRS Questions to CIHI

• Question Which intervention would be sequenced
  first in this chart - the 1.NF.52.CA-QN or the
  x-rays and why. If the stomach drainage
  was sequenced first, then the x-rays, which will
  the grouper select or will it loop down to the
  code that will make the difference.
• Answer The principal or first listed procedure
  is the therapeutic insertion of the NG tube which
  provided initial decompression of the
  obstruction. The radiological procedures may or
  may not be used for CACS grouping but the grouper
  will loop to determine this. Remember to use the
  correct MIS functional centre for "Radiology".
• Question NG Tube insertion (manual or
  suction) when not documented, what do we
  choose?. In a meeting, someone said they were
  told to capture the first listed. Is there a
  rule for hierarchy? Is this correct and if
  so, where can I find that documented. This
  question goes for both drainage of small
  intestine as well as drainage of stomach.
  Folio in both examples shown below in red.
  When not documented, which one is chosen? Why?
• Answer We recommend that you speak to your
  emergency room physicians to see what happens
  most often in the ER in terms of types of suction
  being used. We cannot comment on interventions
  that are not documented.

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NACRS Response to IVs

• IV insertions are a hot topic indeed!
•  
• If 1KX53 is captured as the main
  intervention the abstract would group to a
  surgical CACS cell Minor Vascular Procedure
  regardless of the main problem. This is
  concerning since IV insertions are performed
  quite regularly in an ED setting and because we
  are losing our clinical differentiation. 
  Migraines, cellulitis and pneumonia clients would
  all group to the same CACS cell when 1KX53 is
  coded as the main intervention.
•  
• CIHI will be following up with our Case Mix
  team to discuss.  This code may be slated for
  removal from CACS 26 for FY2006 and would solve
  the problem.  In the interim CIHI will need to
  determine how to direct clients.  This will
  likely come in the form of a coding standard. 
•  
• In the interim I recommend not capturing
  1KX53 unless the IV access device is "set-up"
  and will maintained over a period of time for
  continued use (e.g. a cellulitis client has an IV
  access initiated which is maintained for repeated
  visits for IV antibiotic top-ups).
•  
• Anne Cote (Brereton)
• NACRS Client Support Services Representative
•  

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• ER DISCUSSION??

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Inpatient Diagnosis Selections
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Inpatient Coding Selections
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Diagnosis Consensus
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Other Codes Used
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CIHI Response to Diagnosis
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• DIAGNOSIS
• DISCUSSION??

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INTERVENTION SELECTIONS
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Intervention Selections
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Intervention Consensus
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Other CCI Codes Used
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CIHI Response to Interventions
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• INTERVENTION
• DISCUSSION??

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Question/Answer to CIHI

• Sinus Tachycardia
• We felt that the tachycardia should be
  classified as a post-procedural condition. While
  the tachycardia may not be specifically treated,
  in this case it was persistent. As the code for
  the tachycardia is from the circulatory chapter,
  the code for tachycardia is a diagnosis type (3)
  but the code I97.8 is used first as a diagnosis
  type (2). The type of tachycardia was also
  listed in the progress notes, which is what we
  used to determine the correct code. The ECG may
  be a source of the specific condition, but should
  be used with caution, and further clarification
  obtained from the physician if necessary.

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Question/Answer to CIHI

• Dehydration
• We felt that the dehydration was an inherent
  part of the admitting diagnosis and did not code
  the dehydration. The patient did receive IV
  fluids, however, the use of this as justification
  of significance is a standard for the treatment
  of gastroenteritis.

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Question/Answer CIHI

• Other Post-Procedural Conditions
• It appears that your understanding of the
  post-procedural conditions is quite good. We
  would suggest a few modifications to the codes
  that your group selected.
• We agree with the code choice of I47.1 for the
  tachycardia, but as this condition is classified
  in the circulatory system chapter, we have paired
  it with I97.8.
• Only one external cause is required when all
  post procedural conditions are related to the
  same intervention. We have coded the urinary
  retention as significant because it was
  persistent. The Foley catheter was removed on
  day 2 following surgery but then had to be
  reinserted. The physician has clearly documented
  the retention, so we felt that the persistence of
  the condition helped to justify the qualification
  as a diagnosis type 2. The external cause code
  was added with the R33. A T-code is not used in
  this case.
• There is no explicit hierarchy for the use of the
  external cause codes in category Y83. We have
  selected Y83.2 because this intervention resulted
  in an anastomosis which is typically more intense
  that a simple excision.
• If you require further information regarding the
  classification of post-procedural conditions, you
  may wish to review query 6763.

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Question/Answer CIHI

• Interventions
• We agreed with all your intervention codes and
  have provided our thoughts in response to your
  questions.
• In this case, suctioning of the ascitic fluid is
  part of the intervention does not require coding
  as a separate intervention.
• We agree that the lysis of adhesions should be
  coded in this case. Typically, if the lysis of
  adhesions is described as tedious, extensive,
  time-consuming, or as in this case difficult, it
  should be coded. For further discussion on this
  topic, you may wish to review coding query
  11644.
• Decompression of the mid ileum by enterotomy is
  part of the resection and does not require a
  separate code
• We have also selected the code for CT of the
  chest based on the content of the report.

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• Comorbidities
• Comorbidities are all conditions that coexist at
  the time of admission or
• develop subsequently and demonstrate at least one
  of the following
• significantly affects the treatment received
• requires treatment beyond maintenance of the
  preexisting condition
• increases the length of stay (LOS) by at least 24
  hours.
• Consider the following in determining whether a
  condition qualifies as a comorbidity.
• To support a determination of significance, there
  must be documented evidence in
• the physicians notes or discharge summary that
  the condition required at least one
• of the following
• clinical evaluation/consultation, excluding
  pre-operative anesthetic consults, where a
• new or amended course of treatment is
  recommended and instituted
• therapeutic treatment/intervention with a code
  assignment of 50 or greater
• from Section 1 of CCI
• diagnostic intervention, inspection or biopsy
  with a code assignment from

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Diagnosis Type (2).Post-admit Comorbidity A
Diagnosis Type (2) is a condition that arises
post-admission, has been assigned an ICD-10-CA
code and satisfies the requirements for
determining comorbidity. Reference
Canadian Coding Standards ICD-10-CA and CCI 2004
page 10
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?? Questions ??