CACS for NACRS Level 2

The Comprehensive Ambulatory Classification System (CACS) grouping methodology for National Ambulatory Care Reporting System (NACRS) Level 2 data submissions will be available on April 1, 2018. In order to group information, the data element Emergency Department (ED) Discharge Diagnosis as well as any interventions found on the intervention pick-list must be captured. This will ensure the appropriate resource indicators are assigned to the case. Details regarding changes to the data elements and grouping methodology are outlined in the 2018 CACS Directory, as well as in the NACRS Abstracting Manual (both available in April 2018). Changes will be discussed in the March 2018 web conferences What’s New for Case Mix 2018–2019? Highlights have also been shared in previous bulletins:

CACS for NACRS Level 2 Data Submission (June 2017)

CACS Is Evolving! (September 2017)

CACS ED information: NACRS data elements

NACRS Level 3 NACRS Level 2
 ED Visit Indicator (139) ED Visit Indicator (139)
Main Problem (44) ED Discharge Diagnosis (137)
Interventions (46/47a–i)

New

  • ED Intervention Pick-List (173a–c)
  • ED Investigative Technology Pick-List (174a–c)
  • Number of ED IT Performed (175a–c)
Anaesthetic Technique (53) Anaesthetic Technique (53)
Birth Date (08) Birth Date (08)
Visit Disposition (35) Visit Disposition (35)

ED intervention pick-lists

The intervention pick-lists contain 28 categories describing ED interventions and 9 categories describing ED investigative technology (IT) interventions. IT plays the biggest role in reflecting the resources consumed during an ED visit. To accommodate this information, the additional data elements listed above have been added to the NACRS abstract.

Note: If interventions that are performed during an ED visit are not captured, the Resource Intensity Weight will not reflect the resources used.

The NACRS abstract will accommodate up to 3 occurrences for each data element. A great variety of interventions may be performed during an ED visit, but only those on the list below need to be captured.

ED Intervention Pick List (NACRS data element 173a–c)

Category ED intervention category title and description
I11

Administration of thrombolytic agent

Includes: Injection or infusion of streptokinase, anistreplase, alteplase, reteplase, tenecteplase (TNKase), tissue plasminogen activator (TPA) or urokinase
I01 Angiogram: X-rays following the intravenous injection of contrast
I02

Aspiration, incision and drainage (I & D)

Includes: Percutaneous aspiration or an incision and drainage of conditions such as cyst, hematoma, abscess, carbuncle, furuncle, boil, etc., of skin, soft tissue or joints 
I18

Assessment of life coping skills or activities of daily living (ADLs)

Includes: Assessment of client’s ability to return home with/without assistance
I03

Blood transfusion

Includes: Whole blood or blood products
I04

Cardiopulmonary resuscitation (CPR)/heart stimulation

Includes: External cardiac massage, cardioversion, defibrillation or DC shock
I26

Cricothyrotomy/tracheostomy

Includes: Surgical airway; may be performed as a short-term temporary measure until patient can return to normal breathing
I17

Counselling, mental health assessment, test, certification, diagnostic interview

Includes: Antepartum or postpartum stress counselling, counselling for interpersonal relationships, family counselling or grief counselling, or assessment for suicide risk
I05 Dialysis, hemodialysis, peritoneal dialysis 
I06 Electrocardiogram (ECG)

I08

Endoscopic inspection or biopsy of the digestive system

Includes: Endoscopic per orifice approach to view gastrointestinal tract, esophagus, stomach, large or small intestine
I13 Foley catheter insertion
I07

Foreign body removal — endoscopic per orifice approach

Includes: Respiratory system (i.e., trachea, bronchus), digestive system (i.e., esophagus, intestine), urinary system (i.e., urethra)

I24

Foreign body removal — eye

Includes: Extraction of superficial foreign body from cornea/sclera; removal of deep penetrating foreign body may involve magnet or other device
I25

Foreign body removal — skin, soft tissue

Includes: Removal with an incision to extract foreign body
I09

Insertion central line

Includes: Implantation of internal device — vena cava, insertions of central venous access device (VAD)

I10

Insertion intravenous device (IV)

Includes: Venipuncture or venous cut-down
I12

Intraosseous infusion

Includes: Percutaneous transcatheter intraosseous approach for infusion
I27

Invasive intubation/ventilation

Includes: Respiratory ventilation through endotracheal tube, tracheostomy or percutaneous approach through needle

Excludes: Respiratory ventilation without an invasive approach (see I28)
I14 Lumbar puncture/spinal tap
I16

Management of device

Includes: Adjustment, irrigation or replacement of a device such as a shunt for hydrocephalus, central venous catheter, percutaneously inserted gastric tube, etc.
I19

Nasal cautery/packing

Includes: Control of epistaxis, per orifice approach, any device (i.e., electrocautery, antihemorrhagic agent, packing)

I15 Nasogastric tube (NG tube) insertion
I20

Paracentesis/thoracentesis with or without tube insertion

Includes: Chest tube
I21

Physical or chemical restraints

Includes: Precaution personal care, physical restraint using human or mechanical binding or chemical restraint using sedation to reduce agitation or violence, or both 
I22

Repair skin

Includes: Repair, suture, using any closure device, any site (i.e., eyelid, inside mouth, hand)

Excludes: Soft tissue (see I23)
I23

Repair deep, complicated

Includes: Repair, suture of soft tissue, muscle, tendon, blood vessels, nerves, using any closure device, any site

Excludes: Skin (see I22)
I28

Ventilation via non-invasive approach

Excludes: Ventilation with an invasive approach (see I27)

If the client has more than one IT of the same site, capture the category code once and indicate the number of ITs in the accompanying NACRS data element 175.

ED Investigative Technology Pick-List (NACRS data element 174a–c) 

Category ED investigative technology category title and description
N01 Nuclear imaging — chest, spine
N02

Nuclear imaging — other specified site

Includes: Head, neck, abdomen

Excludes: Chest, spine (see N01)
M01 Magnetic resonance imaging (MRI) — any site
C01 CT scan — head/brain, neck or upper extremities
C02

CT scan — other specified sites

Includes: Chest, abdomen, lower extremities

Excludes: Head, neck, upper extremities (see C01)
U01

Ultrasound — other specified site

Includes: Chest, abdomen, lower extremities

Excludes: Head, neck, extremities (see U02)

U02

Ultrasound — head, neck or extremities

X01

X-ray — upper/lower extremities

X02

X-ray — other specified site

Includes: Chest, head

Excludes: Upper/lower extremities (see X01)

Data element 175a–c accompanies data element 174a–c to capture the number for an IT category. For example, if there were both pre– and post–Colle’s fracture reduction X-rays, data elements 174 and 175 would be captured as follows:

ED IT (174) ED IT count (175)
X01 2

Additional resources available by April 2018

  • CACS Directory 2018
  • NACRS Abstracting Manual 2018
  • What’s New for Case Mix 2018–2019? (March 7 and 21)
  • NACRS Implementation Checklist

As well, eQuery, our online repository of questions and answers on data-related topics, is always available.