Documentation

The Procedures MICA (Missouri Information for Community Assessment) database identifies operative, diagnostic and therapeutic procedures performed during a patient encounter or stay at a health care facility. Procedures that are operative or surgical in nature involve both procedural and anesthetic risk, and require specialized medical training. Surgery includes incision, excision, amputation, introduction, endoscopy, repair, destruction, suture, and manipulation. Non-operative procedures encompass diagnostic and therapeutic procedures that can be either invasive or not, and also include pre-procedure interviews, evaluations or consultations. These non-surgical procedures involve varying levels of risk, as well as varying levels and types of training for persons who perform the procedures.

The data in this MICA reflect procedures performed on Missouri residents -- not procedures performed in Missouri health care facilities. Procedures can be selected by type of procedure, as well as by type of health care setting. Inpatient procedures are those performed in general acute care hospitals. For the most part, these are in-state hospitalizations, however data for Missouri residents from some out-of-state hospitals are also included, when available. For the outpatient setting, only procedures from in-state facilities are included and only where the setting was in an Emergency Department, Outpatient Surgery Clinic, Ambulatory Surgery Center or an Outpatient Observation Stay.

The procedure MICA data are based on patient abstract records reported to the Department by in-state ambulatory surgery centers (ASCs) and by hospitals in Missouri and some surrounding states. The hospital records used are those from non-federal and non-state acute care (average length of stay less than 30 days) general and specialty hospitals whose facilities are open to the general public. Excluded are discharge records from long-term care facilities, as well as those from long-term care units within general hospitals (i.e., swing bed, skilled nursing, and intermediate care units). Also excluded are discharges from residential care facilities and residential care units within licensed hospital facilities.

Multiple procedures may be performed during a single patient health care encounter. As such, a patient abstract record may reflect up to 20 different procedures. It is important to recognize that the procedure counts in this MICA are not the same as frequency counts for patients or patient encounters.

Records of newborns and of mothers who gave birth, as well as persons hospitalized for pregnancy and childbirth-related conditions are included in the Procedures MICA. Users interested in information on pregnancy and birth events should see the Births and Pregnancies MICAs and/or the Community Data Profiles. In some instances, certain data values in the patient record are missing or miscoded. Procedures from patient records with missing or miscoded data values are included in the statewide totals, but may not be included within the displayed categories of certain variables (e.g., race, county of residence). Thus, a total of all categories of a variable may not equal the statewide total for that variable. Patient records with a missing state of residence were deleted from the analysis file. Records for patients identified as Missouri residents, but missing a county identifier, are included in the statewide totals only. Further, for outpatient encounters, facilities are required to report patient abstract records only for those patients receiving invasive procedures (ICD-9-CM codes 01.0-86.99 and CPT codes 10000-69999) and selected services and procedures defined in Administrative Rule 19-10-33.010 Exhibit A. While many facilities report all services and procedures performed, not all volunteer this information. Thus, those services and procedures above ICD-9-CM code 86.99 that are not explicitly required in the administrative rule are probably undercounted.

Procedure Codes and Clinical Classification Software

Procedures associated with hospitalizations are classified in accordance with the Ninth Revision of the International Classification of Diseases (ICD-9). The procedure groupings used in this MICA are based on the Clinical Classification Software (CCS). CCS is a tool for clustering patient diagnoses and procedures into a manageable number of clinically meaningful categories. The CCS compresses the 3,500 procedure codes of the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) into 231 mutually exclusive categories. In its multi-level mode, the system further categorizes these 231 into some 16 broader groupings.

Further information on the clinical classification, as well as the list of diagnoses and procedures utilized by CCS, can be found at http://www.hcup-us.ahrq.gov/toolssoftware/ccs/ccs.jsp.

Revised 01/10/03