Grouping/Categorizing Systems

Grouping/Categorizing Key Points

CCS- Clinical Classifications Software

As mentioned earlier, there is a tremendous challenge of taking the 77K+ ICD10 PCS codes and categorizing them into meaningful categories at scale.
This is where a government-industry partnership called the Healthcare Cost and Utilization Project (HCUP) created a categorization system called clinical classifications software or CCS. It can be used to map diagnosis or procedure codes from ICD code sets. It has single or multi-level options for mapping these codes.

Single Level Categories

• Mutually exclusive categories
• 285 categories for diagnoses
• 231 categories for procedures

As an example using single-level codes:

• Operations on the cardiovascular system are codes 43-63
• Heart valve procedures is code 43.

Below you can see how that changes using multi-level codes.

Single level categories can be used for ranking of codes and help with risk adjustment scoring

Multi-Level Categories

CCS Multi-level categories are helpful for more detailed analysis and grouping at a more granular level. there are 4 levels for diagnosis codes and 3 levels for procedure codes.

In the above example, 7 is a broad category, but then you can see that it branches off into 7.1 and 7.2 into more detail. 7.1.

Then 7.1.X.X further break down hypertension.

7.1.2.1 = Hypertensive heart and/or renal disease (typo in image above).

CCS ICD10-PCS Category Mapping File

The CCS website presents an overview, description, technical guidance, and downloading Information for Clinical Classifications Software (CCS) for ICD-10-PCS (beta version). You can download the CCS ICD10-PCS Category Mapping File (.csv) from "Downloading Information for the CCS for ICD-10-PCS Tool" section, as shown in the snapshot below.

After downloading the zip file, and extracting it locally, you will find the following three files contained therein:

1. ccs_pr_icd10pcs_2020_1.csv - This is the CCS ICD10-PCS Category Mapping File
2. ICD10_Single_CCS_Load_Program.sas - This file is an ASCII file to be used with Statistical Analysis Software (SAS). We might not require this file.
3. LoadGuide-CCSforICD10PCS.pdf - This guide explains how to download and apply the Clinical Classifications Software (CCS) for the ICD-10-PCS

The mapping file ccs_pr_icd10pcs_2020_1.csv breaks down into the following eight fields separated by commas, as described in the image above as well:

1. ICD10 codes and their descriptions, as shown on the left table in the image above

   1. Procedure Code as 'ICD-10-PCS CODE'
   2. 'CCS CATEGORY',
   3. 'ICD-10-PCS CODE DESCRIPTION',
      

2. CCS category descriptions, Multi CCS LVL 1, and Multi Lvl 1 Label, as shown on the right table in the image above

   4. 'CCS CATEGORY DESCRIPTION',
   5. Multi-level 1 Category as 'MULTI CCS LVL 1',
   6. Multi-level 1 Category Description as 'MULTI CCS LVL 1 LABEL',
   7. Multi-level 2 Category as 'MULTI CCS LVL 2',
   8. Multi-level 2 Category Description as 'MULTI CCS LVL 2 LABEL'

It would be hard to have a medical expert categorize these at and they can change over time. Thankfully CCS maps these for us. These mappings can be helpful in reducing dimensionality.

On next page, you will have to write a program to take an input (CCS_CATEGORY_DESCRIPTION), and then map it to the CCS ICD10-PCS Category Mapping File to group/categorize with CCS.

Other Categorization Systems

• MS- DRG- Medicare Severity-Diagnosis Related Group
  • Group payment based on the principal diagnosis
  • Up to 25 secondary dx
  • Up to 25 procedures during a visit/encounter
• SNOMED CT- Systematized Nomenclature of Medicine—Clinical Terms
  • License to use
  • Helpful for making the EHR records interoperable

We will not be using these two in this course and there are many other systems as well, but knowing that they exist is good.

Additional Resources

• CCS website
• MS-DRG
• SNOMED CT

QUIZ QUESTION::

Correctly match the following statement with term or level.

ANSWER CHOICES: