HCUP Methods Series - Agency for Healthcare Research and Quality

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ABSTRACTThe Clinical Classifications Software (CCS) is a tool for clustering patient diagnoses andprocedures into a manageable number of clinically meaningful categories developed atthe Agency for Healthcare Research and Quality (AHRQ). CCS is used for groupingconditions and procedures without having to sort through thousands of codes. This"clinical grouper" makes it easier to quickly understand patterns of diagnoses andprocedures so that health plans, policymakers, and researchers can analyze costs,utilization, and outcomes associated with particular illnesses and procedures.CCS collapses diagnosis and procedure codes from the International Classification ofDiseases, 9th Revision, Clinical Modification (IDC-9-CM), which contains over 12,000diagnosis codes and 3,500 procedure codes. Without CCS, the large number of ICD-9-CM codes poses difficulties in statistical analysis and reporting.CCS consists of two related classification systems, single level and multi-level, which aredesigned to meet different needs. Single-level CCS is most useful for ranking ofdiagnoses and procedures and for direct integration into risk adjustment and othersoftware. Multi-level CCS is most useful when evaluating larger aggregations ofconditions and procedures or exploring them in greater detail.HCUP CCS 6/16/2004 2
INTRODUCTION TO THE CLINICAL CLASSIFCIATIONS SOFTWARE (CCS)2004 User's GuideOverviewClinical Classifications Software provides a way to classify diagnoses and proceduresinto a limited number of categories. CCS aggregates individual ICD-9-CM codes intobroad diagnosis and procedure groups for statistical analysis and reporting. Thisdocument provides a description of the CCS categorization scheme. Electronic filescontaining the translation of ICD-9-CM diagnosis and procedure codes into CCScategories can be downloaded from this site. (CCS was formally called CCHPR, ClinicalClassifications for Health Policy Research.)CCS is continually updated. The current version is based on ICD-9-CM codes that arevalid for January 1980 through September 2004. CCS consists of two relatedclassification systems. The first system, called the single level CCS, groups diagnosesinto mutually exclusive categories. The single-level diagnosis CCS aggregates illnessesand conditions into 260 mutually exclusive categories. Similarly, the single-levelprocedure CCS aggregates procedures into 231 mutually exclusive categories, most ofwhich are homogeneous.The second system expands the single-level CCS into a hierarchical system, called themulti-level CCS. The multi-level CCS groups single-level CCS categories into broadercategories (e.g., Infectious Diseases, Mental Disorders, and Injury). It also splits singlelevelCCS categories to provide more detail about particular groupings of codes.CCS documentation provides a listing of which ICD-9-CM codes are included in eachCCS diagnosis and procedure category.PurposeCCS categories can be employed in many types of projects analyzing data on diagnosesand procedures. For example, they can be used to:♦ identify cases for disease-specific or procedure-specific studies;♦ gain a better understanding of an institution's or health plan's distribution of patientsacross disease or procedure groupings;♦ provide statistical information on characteristics, such as charges and length of stay,about relatively specific conditions;♦ cross-classify procedures by diagnoses to provide insight into the variety ofprocedures performed for particular diagnoses.Diagnoses and procedures for hospital inpatient stays are coded using the InternationalClassification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), Fifth Edition(Public Health Service and Health Care Financing Administration, 1994). ICD-9-CMconsists of about 12,000 diagnosis codes and 3,500 procedure codes. Although it ispossible to present descriptive statistics for individual ICD-9-CM codes, it is often usefulto aggregate codes into clinically meaningful categories that group similar conditions orprocedures. For examples of the use of CCS categories, see Elixhauser and SteinerHCUP CCS 6/16/2004 3
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Page 3: Table of ContentsABSTRACT………
Page 7 and 8: All codes in the diagnosis section
Page 9 and 10: Box 3—Examples of multi-level CCS
Page 11 and 12: ICD-9-CM codes requiring special tr
Page 13 and 14: 1. Create a subdirectory (or folder
Page 15 and 16: Example—Procedure codesMulti-leve
Page 17 and 18: REFERENCESAgency for Health Care Po
Page 19 and 20: 45 Maintenance chemotherapy; radiot
Page 21 and 22: 139 Gastroduodenal ulcer (except he
Page 23 and 24: 237 Complication of device; implant
Page 25 and 26: 43 Heart valve procedures44 Coronar
Page 27 and 28: 135 Forceps; vacuum; and breech del
Page 29 and 30: 229 Nonoperative removal of foreign
Page 31 and 32: 2.7 Cancer of ovary and other femal
Page 33 and 34: 5.2.2 Substance-related mental diso
Page 35 and 36: 7.2.4.3 Other acute and subacute fo
Page 37 and 38: 9.4 Upper gastrointestinal disorder
Page 39 and 40: 10.1.8.1 Hematuria10.1.8.2 Retentio
Page 41 and 42: 12.1 Skin and subcutaneous tissue i
Page 43 and 44: 16.2.4.2 Fracture of ankle16.2.4.3
Page 45 and 46: Appendix 4Multi-Level CCS - Procedu
Page 47 and 48: 7.5 Diagnostic cardiac catheterizat
Page 49 and 50: 9.31 Other OR gastrointestinal ther
Page 51 and 52: 14.10.5 Other lower extremity amput
Page 53: 16.31 Ophthalmologic and otologic d

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