Data - Clinician Joint Call
May 26, 2015
12:30-1:30pm
Participants: Tiffany, Bobby, Pam, CJ, Hilda (CDC); Wendy, Cheryl, Rusty (Emory); Angela, Ami, Michelle, Julie
(MA); Daphne, George, Alyssa, Keewan, Marilyn (NY)
I.
Emory:
a. Revised the comorbidity crosswalk and the cardiac procedures/surgeries list for this call.
b. Updated data: found programing glitch in severity assignment and used more specific code for
the cases with 745 codes, as well as further refining of which cases were included. Total case
number dropped
c. Will share programming code for cleaning with MA or NY. Some in SAS, some in Access.
II.
MA
a. When comparing case-finding in old APCD with new improved APCD files, found similar case
numbers, so do not believe the larger than expected case number due to duplication.
b. 70-80% of cases not inpatient encounters. Outpatient encounters may use codes differently for
billing. Believe case finding algorithm is accurately picking up cases with codes, but codes may be
used incorrectly or not be truly congenital cases (e.g. congenital MR, Aortic atresia/stenosis,
coronary artery anomaly). Working to understand which codes may have more errors.
c. 17,000 cases are over 64 yrs old….. older population than EM or NY. Errors in coding may be
localized to some of the older population (even in those over 50).
d. Births in cohort 1999 compared to number of 1999 cases in CMR. Could not link cases but found
similar number of cases.
III.
NY:
a. Working to identify congenital from non-congenital cases. Same issue as MA in older population
with codes for MR, AS, and coronary artery anomaly.
b. Awaiting updated database.
IV. Max Age
a. Due to issues with codes in older population, and that EM and NY seem to have max age at 64 or
less, the proposal was brought up to set the max age for the project at 64. While there are
congenital cases >64, there may be many non-congenital in the current cohort.
b. Needs further discussion with PIs.
V.
CDC Access Database update:
a. See updated Access database.
b. Changed insurance status to checkboxes.
c. For procedure/surgery table, created CPT_surgery(1…25), CPT_procedure (1...25),
ICD_surgery(1…25), and ICD_procedure(1..25) to separate the CPT from ICD codes for surgeries
and procedures.
d. Will make further changes as result of this call.
VI. CCS comorbidities – files “CC Summary” and “CCS_Master_dxref_rev16_may22”, and Wendy’s email from
5/26 @ 7:03AM
a. For the appropriate comorbidity “box” to be checked on the CDC access database, we need to
agree how comorbidities will be defined in the context of coded data. Stayed true to CCS
categories in these groupings to avoid confusion, use published standards, and meet data transfer
requirements.
b. File “CCS summary” contains a table of the CDC comorbidity codes with the addition of a category
for venous disorders and phlebitis requested on last week’s clinician call. Table has two columnsone for the CCS codes that Emory recommend keeping in these CDC comorbidity categories. And
one for CCS codes included in the master that are to be considered for deletion from these
comorbidity categories - rationale-minor common ailments do not necessarily reflect the type of
information we want to capture in their larger co-morbidity category.
c. After discussion and review of both files, the following changes for the comorbidities was voted
and agreed on by all sites, which will be made in the drop-down menu on the CDC Access
Database:
i. Add “Conduction”, with CCS codes 105, 106, 107
ii. Add “Heart failure”, with CCS code 108
iii. Delete 105, 106, 107, 108 from the “Other Cardiovascular” and relabel as
“Stroke/Thromboembolims, Other Cardiovasc”
iv. Add “GU/Gyn”, with CCS codes 159, 160, 162, 163, 164, 165, 166, 168, 169, 170, 171,
172, 173, 174, 175, 258.
v. It was discussed trying to tease out nutritional deficits for under/over weight or issues
that may occur in pre-transplant patients. However, the CCS categories were either too
broad or unable to distinguish what was interesting, so group decided NOT to include
these in comorbidities.
VII. Procedure/Surgery/Imaging discussion – see file “Proc_Imagin_Surgery_codesMay26_2015” from Wendy’s
email 5/26 @ 11:13AM.
a. All three sites agreed to have separate tables in the CDC Access Database for Cardiac and Noncardiac proc/surgeries/imaging
i. Cardiac will be defined from the file above (with revisions per discussion)
ii. Non-cardiac will be anything that does not meet criteria for “cardiac”.
iii. Each table will have variables for ICD and CPT Procedures, surgeries, and imaging.
iv. TASK: Emory will look to see if CCS has grouping we can use for non-cardiac
proc/surg/imaging.
b. All three sites agree to report imaging cardiac codes per the tab in file, with following revisions
i. Add codes for cardiac MRI, CT, and Echo (not fetal echo)
ii. TASK: Rusty Rodrigues/Emory will look up codes to add, and find codes for excluding
EKGs, as it was agreed NOT to report EKGs.
c. TASK: Rusty will also look up CPT code for transcatheter valves to add to procedure table.
VIII. Bobby will update the CDC Access Database with agreed upon changes, review with data persons at each
site, then circulate to all.