CCI Coding Structure

With the introduction of CCI as the new standard for the classification of health-related interventions, information systems currently used in Canada, to collect and store CCP and/or ICD-9-CM procedure codes, will need to be modified to accommodate the new coding structure for CCI.

Code Structure

• CCI has a totally alphanumeric structure with a code length of 10 characters, as illustrated below:

e.g. 1.CA.14.STCDR
A = Alphanumeric
B = Alphanumeric or Blank

where:

• The first character (field 1) of each code represents a CCI Section which identifies broad types of interventions contained in CCI (e.g. diagnostic, therapeutic, obstetrical, etc.)
• The next two characters (field 2) represent CCI Groups which identify logical groupings of related terms (Note: in the case of at least 3 sections, these groups are anatomy-driven, while others are section-dependent)
• The fourth and fifth characters (field 3) represent CCI Interventions which identify generic procedures/interventions contained in a given section (Note: interventions are section dependent).
• The sixth to tenth characters represent the CCI Qualifier which, for presentation purposes, may be broken into three separate fields (fields 4, 5 and 6), each of which has a discrete meaning. In the case of therapeutic interventions, the first two characters relate to the approach/technique used, the next two characters relate to devices used/implanted, and the last character relates to any tissue used (to perform the intervention).

Qualifier Example:

GQ-FV-N (where GQ = percutaneous transluminal arterial approach, FV = atherectomy device, and N = synthetic tissue)

In other sections (e.g. diagnostic imaging, obstetrics), discrete meaning will be provided for the various fields of the CCI qualifier (where required). The meaning of these "fields" will be section dependent in order to provide appropriate detail as necessary.

Presentation Format

The presentation format for a CCI code includes all six fields (10 characters) and shows a decimal after fields 1, 2 and 3 and a dash after fields 4 and 5. Where fields 5 and/or 6 are not used/required there will be no character filling. These positions should contain blanks.

With the use of alphanumeric characters, it may be difficult to distinguish between the alpha O and the numeric 0 or the alpha I or the numeric 1, therefore systems should utilize a font that will visually distinguish these characters.

Data Storage and Transmission

Decimals should not be included in coded data submitted to CIHI. CIHI will receive each CCI code as a 10 character alphanumeric (AAAAAAABBB) field. In many codes fields 5 and 6 are not defined. In these cases, trailing blanks will be part of the machine readable code.

Additional Related Data Requirements

Where appropriate, three additional data fields have been identified for use with specific CCI codes; these additional related fields are called "CCI Intervention Attributes".

CCI Intervention Attributes

• While the CCI represents a much broader classification than currently exists, CIHI has identified a number of intervention attributes which will be required to meet the information needs of its various users. These attributes, which are not part of the CCI coding structure per se, will need to be collected as separate data fields (see example below).
• While identification of these attributes has focused primarily in the area of therapeutic interventions, their use will expand to other CCI sections. Vendors should make provision for the collection of these three additional data elements where required. Sample attributes for therapeutic interventions include status, location, and extent.

 

where,

• Status attribute (2 alphanumeric characters - defined by CIHI) will be used to identify those interventions which are "Repeats or Revisions", "Abandoned after Onset", or which are part of a "Staged" process.
• Location attribute (2 alphanumeric characters - defined by CIHI) will be used to identify the anatomical side/location involved in the intervention. Examples of valid entries will include: (L)eft, (R)ight, (B)ilateral.
• Extent attribute (2 alphanumeric characters - defined by CIHI) will be used to indicate a quantitative measure related to the intervention. Examples include "Number" of lesions removed, "Length" of laceration repaired, etc.
• Mode of delivery (2 alphanumeric characters –defined by CIHI) is used to identify, where required, information related to the method of delivery of a particular intervention (e.g. direct, indirect, self-directed). These attributes are applied in the same field as the Location attribute.

Note: Not all CCI codes will require the coding of these attributes. CIHI will identify the appropriate use of the attributes in both its publications (paper and electronic) and its edit tables.

Sizing Implications (CCI Tables/Database)

• Because of its increased scope, the number of intervention codes increases to approximately 18,000 in CCI from just less than 3,500 in CCP and Volume 3 of ICD-9-CM.
• CCI currently contains 7 individual sections, with more development and enhancements planned for the future.
• The range of valid characters for each field is 00 to 99 and AA to ZZ (0 to 9 and A to Z for those fields with only one character).
• Each CCI code will have both a long and short title. The long title may reach 300 characters, while the short title will be approximately 80 characters.

Sizing Implications (Abstract Database)

Under CIHI’s existing Discharge Abstract Database (DAD), as many as twenty procedures are collected per patient abstract. The move to CCI, itself, should not change the number of procedures to collect. However, the implications of a 10-character code, each with three related attributes, should be considered when assessing the impact on abstract databases. 

Other Issues

CIHI will publish/distribute regular CCI updates to its clients. Requests for updates to CCI can be sent to CIHI through the Public Submission Process. CIHI will also assess the feasibility of using alternative mechanisms to distribute updates to its clients (e.g. internet).