The Clinical Classifications Software (CCS) for ICD-10-PCS (beta version) is one in a family of databases and software tools developed as part of the Healthcare Cost and Utilization Project (HCUP), a Federal-State-Industry partnership sponsored by the Agency for Healthcare Research and Quality (AHRQ). HCUP databases, tools, and software inform decision making at the national, State, and community levels.

Contents:

• Overview of the CCS for ICD-10-PCS Tool (beta version)
• Description of the CCS for ICD-10-PCS (beta version)
• Technical Guidance for the CCS for ICD-10-PCS Tool (beta version)
• Downloading Information for the CCS for ICD-10-PCS Tool (beta version)
• Archives for Earlier Beta Versions of the CCS for ICD-10-PCS
• For More Information, Comments, or Questions About the CCS for ICD-10-PCS (beta version)

The Clinical Classifications Software (CCS) for ICD-10-PCS (beta version) is a procedure categorization scheme that can be employed in many types of projects analyzing data on procedures. CCS is based on the International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS), a uniform and standardized coding system for procedures. The ICD-10-PCS's multitude of codes—more than 77,000 procedure codes—are collapsed into a manageable number of clinically meaningful categories that are sometimes more useful for presenting descriptive statistics than are individual ICD-10-PCS codes. It is based on the CCS for ICD-9-CM procedures and attempts to map ICD-10-PCS codes into the same categories.

The CCS can be used to identify populations for procedure-specific studies or to develop statistical reports about relatively specific procedures. It can be a useful way to categorize procedures when exploring data and can serve as a tool for reporting statistical information on hospitalizations.

Development History of the CCS for ICD-10-PCS Procedures (beta version)

In preparation for the October 2015 implementation of ICD-10-PCS, the procedure CCS tool from HCUP were converted to the new coding system. The initial mapping was completed by linking ICD-10-PCS codes to the CCS for ICD-9-CM classification assignments via the General Equivalence Mappings (GEMs) available from the Centers for Medicare & Medicaid Services (CMS) website (see https://www.cms.gov/Medicare/Coding/ICD10/index.html for more information on GEMS). No dually coded data were available at the time the CCS categories were translated to ICD-10-PCS. The translation was based on forward and backward mapping using the GEMs.

These initial GEMs were reviewed by credentialed coders trained in both ICD-9-CM and ICD-10-PCS to ensure the validity of the map for use in formulating the CCS categories. Two coders each made a CCS assignment for each code based on the GEMs. When the coders did not initially map a code to the same CCS category, the team reviewed the discrepancies and came to consensus for the CCS assignment, with the help of a third coder if necessary. Initial maps were completed in September 2011. The accuracy of the initial assessment was verified by reviewing a 20 percent sample of the coding assignments.

In 2013, reverse mapping validation of 100 percent of the ICD-10-PCS procedure CCS assignments was conducted to verify the accuracy of mapping of the beta version of the CCS.

Preliminary findings suggest some unexpected discontinuities between the tools based on ICD-9-CM procedures and the beta version of tools based on ICD-10-PCS. Ongoing analyses are being conducted now that ICD-10-PCS-coded data is available. A fully refined version of the CCS for ICD-10-PCS procedures that capitalizes on the specificity and structure built into the ICD-10-PCS coding scheme is in development.

Procedure Codes

The ICD-10-PCS coding scheme contains over 77,000 procedure codes, and does not follow the conventions or structure of the ICD-9-CM coding scheme (which had only 3,900 codes). The following table summarizes the differences between ICD-9-CM and ICD-10-PCS procedure codes. See the ICD-10-CM/PCS Resources page for details and examples.

CCS for ICD-10-PCS Procedure Categories (beta version)

The beta versions of the CCS for ICD-10-PCS procedures contain 224 mutually exclusive categories. Seven CCS procedure categories that are found in the CCS for ICD-9-CM procedures could not be populated with any ICD-10-PCS codes and the new structure of ICD-10-PCS codes also warranted the revision of the labels for some CCS procedure categories. See the ICD-10-CM/PCS Resources page for details. Revised labels can be found below.

Revised CCS PCS labels (PDF file, 81 KB).

Every effort was made to translate the CCS system to ICD-10-PCS without making changes to the CCS categories for procedures. However, because of the new structure and expanded code availability in PCS this was difficult. In ICD-10-PCS each component of the major procedure is reported separately (this includes the surgical approach, surgical closure, etc.). This is a significant change for reporting procedures that affects not only the CCS for the procedure but also the volume of codes. In ICD-10-PCS four procedure codes may be reported, whereas only one is reported in ICD-9-CM for a single operative session. For example, ICD-9-CM code 52.7, Radical pancreaticoduodenectomy (Whipple procedure) is reported as one operative session where numerous surgical components are performed. However, in ICD-10-PCS each component of the procedure is reported with a separate code. Below are the available coding options to be selected based on the medical record documentation for the encounter. One code from each of the four categories (root operation plus body system) would be selected to fully report the procedure in ICD-10-PCS.