July 2013 Updates CONGENITAL MALFORMATION HEIGHT/WEIGHT COLLECTION SCR ADVISORY COMMITTEE- DAILY PROCESS

Size: px

Start display at page:

Download "July 2013 Updates CONGENITAL MALFORMATION HEIGHT/WEIGHT COLLECTION SCR ADVISORY COMMITTEE- DAILY PROCESS"

Beatrix West
5 years ago
Views:

1 July 2013 Updates CONGENITAL MALFORMATION HEIGHT/WEIGHT COLLECTION SCR ADVISORY COMMITTEE- DAILY PROCESS

2 Congenital Malformation JULY 2013

3 Congenital Malformation Rationale for change: Instead of collecting all congenital malformations, the SCR s will collect only those congenital malformations that are deemed likely important for risk adjustment based on previous incidence and anatomic and/or physiologic importance. The collected malformations have been grouped into anatomic/physiologic buckets so the NSQIP analytic team can further define those malformations that make a difference in risk adjustment This will allow NSQIP-P to obtain data that is consistent with that captured in other national databases (e.g. HCUP s NIS and KID) that contain data on malformation categories

4 Congenital Malformation Intent of variable: Identify patients with, or with a history of, a congenital malformation at the time of surgery to help with risk adjustment Allow the SCR to consistently document these malformations. (Utilizing the same format as the Cardiac variable and ICD-9 code list) The SCR will utilize the provided list of ICD-9 codes of Congenital Malformations to enter the congenital malformation. Congenital Malformations have been grouped into anatomic/physiologic buckets to assist the SCR in understanding the congenital malformations and to identify the congenital malformations that may be entered in an additional preoperative variable (e.g. gastrochisis and Esophageal/Gastric Disease/Intestinal) A Do Not Collect list of Congenital Malformations will be provided for reference for the SCR. The SCR will not enter the ICD-9 code(s) from the Do Not Collect in the Congenital Malformation variable. (e.g. hypospadias, pyloric stenosis, club foot, pregnancy, etc.)

5 Congenital Malformation Defintion: A structural, functional or genetic abnormality present at birth regardless of when the diagnosis is made.

6 Congenital Malformation Criteria: Collect List Record the ICD-9 code(s) for the congenital malformation(s) present, or if there is a history of congenital malformation(s) Do Not Collect List Do Not record congenital malformation found on this list Any congenital malformation not on the Collect List and not on the Do Not Collect list should be submitted to clinical support with the name, the description and the associated ICD-9 code. These submitted congenital malformation (s) from the SCR s will be reviewed by the DDC-P and /or M&E Committee and the ACS for possible future revision of the definition

7 Congenital Malformation Workstation Congenital Malformation Variable Options: No Yes, neonate <1500g at time of surgery Yes, neonate 1500g/infant/child or teenager with a current or history of a congenital malformation at the time of surgery

8 Congenital Malformation Options: (No) if no congenital malformation or no history of congenital malformation exists (No) if congenital malformation is on the Do Not Collect List (No) if congenital malformation(s) is neither found on the Collect List nor on the Do Not Collect List. Any congenital malformation NOT on these lists should be submitted to clinical support with the name, the description, and the associated ICD-9 code. (Yes) if congenital malformation(s) is on the provided Collect List Enter the associated code or codes. Assign to appropriate Neonate category

9 Congenital Malformation Selection of Yes Option Additional Guidance: Start with the patient s diagnosis of a congenital malformation(s) or history of congenital malformation(s) and assign the associated ICD- 9 code to the congenital malformation diagnosis found on the Congenital Malformation provided Collect List Collect and document all congenital malformations by ICD - 9 codes from provided Collect List for the congenital malformation diagnoses the patient has An Excel spread sheet will be provided with ICD - 9 codes and congenital malformation for guidance for documentation Only collect the congenital malformation found on provided Collect List

10 Congenital Malformation Change in Guidance: Previous guidance was to collect a congenital malformation only if there was no other category for this condition Guidance to be utilized for Congenital Malformation Variable for cases beginning July 2013 There are specific congenital malformations collected. They will also be collected in an associated pre-operative risk factor category when appropriate

11 Congenital Malformation Change in Guidance for Congenital Malformation Variable: Guidance to be utilized for Congenital Malformation Variable for cases beginning July 2013 There are specific congenital malformations collected that will also be collected in an associated pre operative risk factor category. Only the Congenital Malformation diagnoses that are identified in the Preoperative Variable Entry column of the Collect List are recorded in the Congenital Malformation variable and also in the appropriate preoperative risk variable. Collect all Congenital Malformation diagnoses and the additional preoperative risk factors

13 Congenital Malformation Scenarios to Clarify (Assign Two Variable): A patient has a diagnosis of Multiple sclerosis, Leukodystrophies - assign Demyelinating Disease of the central nervous system and assign the pre operative risk factor of Neuromuscular Disorder. A patient has a diagnosis of Moyamoya disease, PHACES syndrome, berry aneurysms, arteriovenous fistulas, fibromuscular dysplasia assign CONGENITAL ANOMALIES OF CEREBROVASCULAR SYSTEM and Structural CNS Abnormality All Muscular Dystrophy diagnoses are assigned MUSCULAR DYSTROPHY and Neuromuscular Disorder

14 Congenital Malformation Scenarios to Clarify (Assign Two Variable): A patient has a diagnosis Craniosynostosis, Crouzon s Syndrome assign ANOMALIES SKULL/FACE BONES and Structural CNS Abnormality A patient has a diagnosis Pierre Robin Sequence, assign ANOMALIES SKULL/FACE BONES and Structural Pulmonary/Airway Abnormalities A patient has a diagnosis of Cloacal Exstrophy - assign OTH ANOMOLIES INTESTINE and Esophageal/Gastric Disease/Intestinal A patient has a diagnosis of Cloaca, Imperforate Anus or Colon Atresia - assign CONGENTIAL ATRESIA AND STENOSIS OF LARGE INTESTINE RECTUM AND ANAL CANAL and Esophageal/Gastric Disease/Intestinal

15 Congenital Malformation Scenarios to Clarify (Assign Two Variable): The diagnosis of Malrotation for any patient should be collected no matter when it is diagnosed and no matter if it associated with volvulus or not Assign congenital anomalies of intestinal fixation and the preoperative risk factor of Esophageal/Gastric Disease/ Intestinal should also be assigned.

16 Congenital Malformation Scenarios to Clarify (Assign only to Congenital Malformation Variable): A patient has a diagnosis of in utero alcohol, cocaine, heroin, etc... exposure - assign In-utero Drug or Alcohol Exposure (Workstation NOX AFFECTING NEWBORN ALCOHOL) Thoracic Insufficiency Syndrome This is a patient who frequently requires VEPTR surgery it also may be called (Jeune s Syndrome) - assign CONGENITAL MUSCULOSKELETAL DEFORMITIES OF SPINE Only assign CONDITIONS DUE TO ANOMALIES OF UNSPECIFIED CHROMOSOME for a patient with a diagnosis of CHARGE Association A patient has a diagnosis of Glycogen storage diseases - assign OTHER DIS OF CARBOHYDRATE METABOLISM

17 Congenital Malformation Scenarios to Clarify (Assign only to Congenital Malformation Variable) Scoliosis Scoliosis codes are included only if diagnosed at or before age 3 years. Any patients diagnosed at 4 years or older would not be captured in the congenital malformation variable

18 Congenital Malformation Scenarios to Clarify (Assign only to Congenital Malformation Variable) Cleft Palate Collect only the cleft palates or cleft palate with cleft lip utilizing code Do not collect any type of cleft lip without a cleft palate

19 Congenital Malformation Scenarios to clarify to Not Assign: Do not collect a congenital malformation if it is not found on the provided Collect List Do not collect a congenital malformation on the Do Not Collect list such as hypospadias or club foot Any congenital malformation not on the Collect List and the Do Not Collect list should be submitted to clinical support with the name, the description and the associated ICD 9 code. This submitted diagnoses from the SCR s will be reviewed by the DDC-P and /or M&E Committee and the ACS for possible future revision of the definition

20 Questions?

21 The codes for cortical Blindness through and Polydactyly Fingers have all shifted down and the additional code of 749 needs to be removed. The code for Quadriplegia, congenital will be added to the list.

22 Height/Length Current variable/definition: Height: Report the patient s most recent height documented in the medical record in either inches (in) or centimeters (cm). Select unknown if value option is not known. Rationale for change: The height and weight variables, at present, contain no timelines. In 2010, the timeline for each variable was within 30 days prior to operation. We recommend that these variables be rewritten for the following reasons;

23 Height/Length Rational for Change of Variable: CDC recommends that the WHO growth charts be used for children under 24 months of age. On these charts the 50 th percentile weight gain under 3 months of age is 30 Gm/day and the 50 th percentile length increase is 1.5 cm/day. In 10 days, an infant would gain >0.25 Kg and lengthen 15 cm. From 3 months to 6 months of age the 50 th percentile weight gain falls to about 11 Gm/day and the length gain decreases similarly. Therefore, the time line for the variable would be that from birth up to 3 months of age both weight and length would be collected within 7 days prior to operation. From 3 months of age on, both weight and length would be collected within 30 days prior to operation.

24 Height/Length Rational for Change of Height Variable: The CDC does not use WHO growth charts for children over 24 months of age. From 24 months of age on, the CDC uses BMI. The CDC guidelines for calculation of BMI in children require weight and height to be collected within 30 days of each other because healthy weight ranges change with each month of age for each sex and healthy weight ranges change as height increases. There is little data evaluating low BMI as a risk factor in pediatric surgical patients. However, as obesity in children (BMI > 95th percentile for age and sex) becomes more commonplace, BMI may assume greater significance as a risk factor.

25 Height/Length Intent of variable: To record the height/length of the patient in centimeters or inches to allow calculation of appropriate growth in the first 24 months of life or calculation of age and sex specific BMI from 2 years to 18 years of age. Definition: The height/length of a patient. Criteria: Report the patient s most recent height/length documented in the medical record in either inches (in) or centimeters (cm) according to the following timeline: Height Timeline Preferred Process: Birth up to 3 months of age, length documented within 7 days prior to operation. 3 months of age or greater, height/length documented within 30 days prior to operation.

26 Height/Length New Guidance: *If no height/length is documented prior to the operation: A height/length documented after the operation may be used with the following criteria: For patients birth up to 3 months, the length must be documented within 7 days of the pre-procedure documented weight. For patients 3 months of age or greater, the height/length must be documented within 30 days of the pre-procedure documented weight.

27 Height/Length Scenarios to Clarify (Assign Variable): Twenty-two day old neonate is taken to the OR for a small bowel perforation on 7/10 with weight documented as 2.6 kg on 7/9, and no height/length. Birth weight is documented as 2.1 kg and birth height/length is documented as 44 cm (DOB 6/18). On 7/12 height/length is documented as 55 cm. Enter 55 cm for the Height/Length.

28 Height/Length Rationale: There is no height/length documented within 7 days prior to the operation (only birth height/length 22 days before surgery) but there is a weight documented on the day before the operation. A height/length documented after the operation (7/12) may be used because it falls within the 7 days that the preprocedure weight was documented (7/9).

29 Height/Length Scenarios to clarify to Assign: 4 year old male is taken to the OR directly from the ER for a ruptured appendix on 6/10, with an ER documented weight of 24 kg. The last height documented in the medical record is on 5/1 of cm. On 6/18 there is a documented height of cm. Enter cm for the Height/Length.

30 Height/Length Rationale: The height/length taken on 5/1 is greater than 30 days prior to the operation so it cannot be used. The postprocedure height/length taken on 6/18 may be used because there is no acceptable prior OR height/length, and the documented weight (6/10) is within 30 days of the documented height (6/18).

31 Height/Length Scenarios to Clarify (Assign Unknown ): Ten day old neonate is brought to the OR on 8/10 with a birth weight of 3.6 kg and a birth height/length of 40 cm and no other height/length measurements are in the medical record. Enter the height/length as Unknown.

32 Height/Length Rationale: The documented height/length is not within seven days prior to the operation in an infant less than 3 months of age.

33 Height/Length 3 year old patient emergently is taken to the OR on 9/15 for a supracondylar fracture with no height/length documented in the medical record. ER weight is documented as 16 kg. At a follow up visit on 10/25 a height/length is documented as 110 cm. Enter the height/length as Unknown.

34 Height/Length Rationale: The height/length taken post-procedure (10/25) is greater than 30 days from the date the ER weight was documented (9/15) and is not acceptable.

35 Height/Length Notes: CDC recommends that the WHO growth charts be used for children under 24 months of age. On these charts the 50 th percentile weight gain under 3 months of age is 30 Gm/day and the 50 th percentile length increase is 1.5 cm/day. In 10 days, an infant would gain >0.25 Kg and lengthen 15 cm. From 3 months to 6 months of age the 50 th percentile weight gain falls to about 11 Gm/day and the length gain decreases similarly. The time line for the variable would be that from birth up to 3 months of age both weight and length would be collected within 7 days prior to operation. From 3 months of age on, both weight and length would be collected within 30 days prior to operation.

36 Height/Length Notes: The CDC does not use WHO growth charts for children over 24 months of age. From 24 months of age on, the CDC uses BMI. The CDC guidelines for calculation of BMI in children require weight and height to be collected within 30 days of each other because healthy weight ranges change with each month of age for each sex and healthy weight ranges change as height increases

37 Weight Current variable/definition: Weight: Report the patient s most recent weight documented in the medical record in either pounds (lbs.), or kilograms (kg). Select unknown if value option is not known. Rationale for change: The weight and height variables, at present, contain no timelines. In 2010, the timeline for each variable was within 30 days prior to operation. We recommend that these variables be rewritten for the following reasons;

38 Weight Rational for Change in variable: CDC recommends that the WHO growth charts be used for children under 24 months of age. On these charts the 50 th percentile weight gain under 3 months of age is 30 Gm/day and the 50 th percentile length increase is 1.5 cm/day. In 10 days, an infant would gain >0.25 Kg and lengthen 15 cm. From 3 months to 6 months of age the 50 th percentile weight gain falls to about 11 Gm/day and the length gain decreases similarly. Therefore, the time line for the variable would be that from birth up to 3 months of age both weight and length would be collected within 7 days prior to operation. From 3 months of age on, both weight and length would be collected within 30 days prior to operation.

39 Weight Rational for Change in variable: The CDC does not use WHO growth charts for children over 24 months of age. From 24 months of age on, the CDC uses BMI. The CDC guidelines for calculation of BMI in children require weight and height to be collected within 30 days of each other because healthy weight ranges change with each month of age for each sex and healthy weight ranges change as height increases. There is little data evaluating low BMI as a risk factor in pediatric surgical patients. However, as obesity in children (BMI > 95th percentile for age and sex) becomes more commonplace, BMI may assume greater significance as a risk factor.

40 Weight Intent of variable: To record the weight of the patient in kilograms or pounds to allow calculation of appropriate growth in the first 24 months of life or calculation of age and sex specific BMI from 2 years to 18 years of age. Definition: The weight of a patient. Criteria: Report the patient s most recent weight documented in the medical record in either kilograms (kg) or pounds (lbs) according to the following timeline:

41 Weight Weight Timeline: Birth up to 3 months of age, weight documented within 7 days prior to operation. 3 months of age or greater, weight documented within 30 days prior to operation

42 Weight Scenarios to Clarify (Assign Variable): Forty-five day old preterm neonate is taken to the OR for a small bowel perforation on 4/10 with weight documented as kg on 4/9. Enter 1.69 kg for the weight. Rationale: Round weight to nearest hundredth place.

43 Weight Scenarios to Clarify to Assign: 5 year old male is taken to the OR for a g-tube revision and Nissen on 3/10. The most recent weight is 20.2 kg documented on 2/12. Enter 20.2 kg for the weight. Rationale: Weight can be used because it is within 30 days prior to the operation for a patient 3 months of age or greater

44 Weight Scenario to clarify to Assign: Fifteen day old infant presents to the OR for a bowel resection; the patient is in acute renal failure and extremely edematous. On the day of surgery the patient s weight is 3.00 kg, while two days before it was 2.5 kg. In this case, do not assign 3.00 kg, as it is clearly a reflection of the edema and not a true weight for the patient. Enter the weight of 2.5 kg which is the true dry weight.

45 Weight Rationale: In cases where a patient is clearly extremely edematous, attempt to find a recorded weight before the patient was clinically edematous (dry weight).

46 Weight Scenarios to Clarify (Assign Unknown ): A two month old patient presents to the OR for a pyloromyotomy on 10/7 with the most recent weight documented on 9/28 of 2.33 kg. Enter the weight as Unknown. Rationale: Weight must be documented within seven days prior to the operation on an infant from birth up to 3 months of age.

47 Weight Scenarios to clarify Assign Unknown 8 year old patient emergently is taken to the OR on 7/15 for a femur fracture with no weight documented in the medical record prior to the operation. A weight is documented on the afternoon of the second postoperative day at 32.1 kg. Enter Unknown. Rationale: Weight must be documented prior to the operation.

48 Weight Notes: CDC recommends that the WHO growth charts be used for children under 24 months of age. On these charts the 50 th percentile weight gain under 3 months of age is 30 Gm/day and the 50 th percentile length increase is 1.5 cm/day. In 10 days, an infant would gain >0.25 Kg and lengthen 15 cm. From 3 months to 6 months of age the 50 th percentile weight gain falls to about 11 Gm/day and the length gain decreases similarly. The time line for the variable would be that from birth up to 3 months of age both weight and length would be collected within 7 days prior to operation. From 3 months of age on, both weight and length would be collected within 30 days prior to operation.

49 Weight Notes: The CDC does not use WHO growth charts for children over 24 months of age. From 24 months of age on, the CDC uses BMI. The CDC guidelines for calculation of BMI in children require weight and height to be collected within 30 days of each other because healthy weight ranges change with each month of age for each sex and healthy weight ranges change as height increases.

50 Questions Comments on Wound Disruption

Variable Updates January 2014

Variable Updates January 2014 Surgeon National Provider Identifier (NPI) Variable Name: Surgeon NPI Intent of Variable: For sites to have the ability to track each surgeon s surgical cases. Definition: