Skip Navigation

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses
The CCSR is one of the HCUP tools that can be applied to HCUP and other similar databases. These tools are created by AHRQ through a Federal-State-Industry partnership.
 
Clinical Classifications Software Refined (CCSR)

The Clinical Classifications Software Refined (CCSR) 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:

The Clinical Classifications Software Refined (CCSR) for ICD-10-CM diagnoses aggregates over 70,000 ICD-10-CM diagnosis codes into a manageable number of clinically meaningful categories. The CCSR is based on the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM). The categories are organized across 21 body systems, which generally follow the structure of the ICD-10-CM diagnosis chapters. This initial release of the CCSR replaces the beta version of the CCS for ICD-10-CM diagnoses and applies to all ICD-10-CM diagnosis codes through fiscal year 2019.

The CCSR for ICD-10-CM diagnoses provides a means by which to identify specific clinical conditions using ICD-10-CM diagnosis codes. The CCSR for ICD-10-CM capitalizes on the specificity of the ICD-10-CM coding scheme by creating new clinical categories that did not exist in previous versions of the CCS tool and allowing ICD-10-CM codes to be classified in more than one category. The CCSR is intended to be used analytically to examine patterns of health care in terms of cost, utilization and outcomes, rank utilization by diagnoses, and risk adjust by clinical condition.

In October 2015, the United States transitioned to a modified version of the World Health Organization International Classification of Diseases, Tenth Revision, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS), replacing the ICD-9-CM coding system with the ICD-10-CM/PCS coding system for most inpatient and outpatient medical encounters. In preparation for the October 2015 implementation of ICD-10-CM/PCS codes, the HCUP tools were converted to the new coding system. However, the development of the beta version of the CCS for ICD-10-CM/PCS was completed prior to the availability of ICD-10-CM/PCS-coded data. Once ICD-10-CM/PCS coded data became available, the beta version of the CCS was evaluated using HCUP databases and unexpected discontinuities between the ICD-9-CM and ICD-10-CM/PCS versions of the CCS were revealed. In addition, there was interest in taking advantage of the specificity built into ICD-10-CM diagnosis codes.
Return to Contents
 

The CCSR for ICD-10-CM diagnoses capitalizes on the specificity built into ICD-10-CM codes. The tool maps ICD-10-CM codes into CCSR categories to match the clinical intent of the category description. The CCSR tool creates new clinical categories that did not exist in the beta versions of the CCS for ICD-10-CM diagnoses tool.

The most substantial difference evident in the CCSR for ICD-10-CM compared with the beta versions of the CCS for ICD-10-CM is that individual ICD-10-CM codes are no longer required to be assigned to one and only one category. Mutually exclusive category assignments have been a design feature of the CCS since its initial release (i.e., each ICD-9-CM diagnosis code was included in one and only one CCS category). However, individual ICD-10-CM diagnosis codes sometimes document (1) multiple conditions or (2) a condition and a common symptom or manifestation. Assigning only one CCSR category for these codes would require prioritizing the assignment (and the preferred hierarchy of conditions might be different for different applications). In addition, ICD-10-CM coding for injuries often distinguish episodes of care (initial encounter, subsequent encounter, sequela).
Return to Contents
 

The User Guide for the CCSR for ICD-10-CM diagnoses contains:
  • A more detailed description of the tool and how it differs from previous versions of the CCS
  • Guidelines used to assign ICD-10-CM diagnosis codes to CCSR categories, both in general and for specific body systems
  • Instructions for applying the CCSR tool to your administrative data
  • An explanation of the process used to develop the CCSR tool
Downloading Information

Web Browser Download: Your browser may support loading the User Guide from this Web page. To download the User Guide from this Web page, click on the following links with the right mouse button and select "Save Link As" (Google Chrome) or "Save Target As" (Internet Explorer) to download the file to your computer. After saving a file, open the file by double-clicking on it.
Return to Contents
 

The CCSR for ICD-10-CM diagnoses ZIP file contains one comma-separated values file (CSV) that translates ICD-10-CM diagnosis codes into CCSR categories as well as assigns labels to the individual CCSR categories and a SAS mapping program that applies the CCSR to administrative data and provides users with two options for the output’s file structure. At this time, AHRQ does not have mapping program code written for other statistical software languages, such as Stata, SPSS, or R.

Contents of the CCSR for ICD-10-CM Zip File
File Name Purpose
$DXCCSRyyyy_r.csv
where yyyy represents fiscal year and r represents a release number within fiscal year
The CSV mapping file lists ICD-10-CM diagnosis codes along with a description for each ICD-10-CM diagnosis code, the CCSR categories assigned, and the full description corresponding to each CCSR category. This is a horizontal file that the SAS program uses as input to build the tool. The term horizontal is used because each individual ICD-10-CM diagnosis code is listed once (on a single row) with the information on the CCSR categories listed across the columns of the CSV file.

This file can be converted to Excel where a filter can be applied to examine individual ICD-10-CM diagnosis codes or CCSR categories.
DXCCSR_Mapping_Program.sas SAS mapping program to apply the CCSR to the user's ICD-10-CM-coded data. The mapping program includes two options for the file structure of CCSR output.
DXCCSR-Reference-File-vyyyy-r.xlsx
where yyyy represents fiscal year and r represents a release number within fiscal year
A Microsoft Excel reference file that includes two tabs:
(1) The first tab lists all ICD-10-CM diagnosis codes with descriptions and the CCSR categories assigned with descriptions. A filter is applied to examine individual ICD-10-CM diagnosis codes or CSSR categories. (2) The second tab lists CCSR categories and numbers.

This file differs from the CSV file in structure, but not in content. The mapping of the ICD-10-CM diagnosis codes to the CCSR categories is structured in a stacked (i.e. vertical) format, where cross-classified codes are listed in multiple rows for each different CCSR assignment.
DXCCSR-User-Guide.pdf A PDF User Guide for the CCSR with detailed documentation on the tool and how to use it with administrative datasets.
DXCCSR-AppendixB.pdf A PDF Appendix to the User Guide that lists the CCSR categories by body system.

Within the SAS mapping program, users are given two options for the file structure of their output once the CCSR tool is applied to the data. In the first option for the file structure of the output file with CCSR information, the SAS program creates a "vertical" file with one or more rows for each input record. The number of rows created from each input record depends on the number of CCSR categories triggered by the ICD-10-CM diagnoses on the input record. There are three data elements (i.e., columns in the vertical file): the record identifier (data element RECID), a CCSR value (data element DXCCSR), and the diagnosis position (data element DX_Position).

The second output option is to have the SAS program create a file with one row for each input record that includes the record identifier and a "horizontal" array corresponding to all CCSR categories. The SAS program assigns one of four values for each DXCCSR data element:
The following table displays a sample input record, where four ICD-10-CM diagnoses are stored in an array of data elements I10_DX1–I10_DX4 for a record with RECID equal to 1234. The subsequent two tables display an example of the vertical file output and the horizontal output file, both using this sample input record.

Sample of Input File Record

RECID I10_DX1 I10_DX2 I10_DX3 I10_DX4
1234 M84664A N184 E1122 M80862A

Row 1 of the vertical output table (below) indicates that the first diagnosis code (DX_POSITION=1) for RECID 1234 triggers one CCSR, MUS014–Pathological fracture, initial encounter (DXCCSR=MUS014). The second diagnosis also maps to only one CCSR (DXCCSR=GEN003 for Chronic kidney disease and DX_POSITION=2). The third diagnosis is cross-classified into three CCSR categories listed in rows 3–5: END003–Diabetes mellitus with complication, END005–Diabetes mellitus, Type 2, and GEN003–Chronic kidney disease. The fourth diagnosis code (Rows 6–7) is cross classified into two CCSR including the CCSR MUS014–Pathological fracture, initial encounter that is triggered also by the principal (or first-listed) diagnosis.

Example of Vertical Output File
Row RECID DXCCSR DX_POSITION
1 1234 MUS014 1
2 1234 GEN003 2
3 1234 END003 3
4 1234 END005 3
5 1234 GEN003 3
6 1234 MUS013 4
7 1234 MUS014 4
Abbreviations: DXCCSR, Diagnosis Clinical Classifications Software Refined; END, endocrine system; GEN, genitourinary system; MUS, musculoskeletal system; RECID, record identifier.

In the example of the horizontal output file (below) the fact that both the principal (or first-listed) diagnosis and a secondary diagnosis trigger MUS014 results in data element DXCCSR_MUS014 being assigned the value 2. The other "DXCCSR_" data elements triggered by a diagnosis on the sample record are assigned the value 3 because they are triggered by secondary diagnoses only (i.e., data elements I10_DX2-I10_DX4 in the sample input record table). Data element DXCCSR_BLD001 and DXCCR_SYM017 (as well as all other "DXCCSR_" data elements not shown in the horizontal output table are assigned the value 0 because they are not triggered by any ICD-10-CM diagnosis codes on the input record.

Example of Horizontal Output File

RECID DXCCSR_BLD001 ... DXCCSR_END003 ... DXCCSR_END005 ... DXCCSR_GEN003 ... DXCCSR_MUS013 DXCCSR_MUS014 ... DXCCSR_SYM017
1234 0   3   3   3   3 2   0
Abbreviations: BLD, blood and blood forming organs; DXCCSR, Diagnosis Clinical Classifications Software Refined; END, endocrine system; GEN, genitourinary system; MUS, musculoskeletal system; RECID, record identifier; SYM, signs and symptoms.
Return to Contents
 

Shift-click from this Web page: Click on each of the file names to automatically download the files for the CCSR. Alternately, click on the following links with the right mouse button and select "Save Link As" (Google Chrome) or "Save Target As" (Internet Explorer) to download the ZIP folder to your computer. After downloading the files, extract the ZIP file contents by double clicking on the ZIP folder. The ZIP folder includes the Tool, a SAS mapping program, and additional documentation on applying the tool to your data. At this time, the CCSR for ICD-10-CM diagnoses is only available as a SAS program.

CCSR for ICD-10-CM Information

CCSR Version 2020.1 Fiscal Year 2020, Updated October 2019 - valid for ICD 10-CM diagnosis codes through September 2020
Return to Contents
 

Copies of previous versions of the CCSR for ICD-10-CM diagnoses are available for users who need to replace or access the old programs.
Return to Contents
 

Copies of previous beta versions of the CCS for ICD-10-CM diagnoses are available for users who need to replace or access the old programs.
Return to Contents
 

Questions regarding the CCSR may be directed to HCUP User Support through the following channels: Phone (toll free): 1-866-290-HCUP.
Return to Contents
 

Internet Citation: Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP). October 2019. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/toolssoftware/ccsr/ccs_refined.jsp.
Are you having problems viewing or printing pages on this Website?
If you have comments, suggestions, and/or questions, please contact hcup@ahrq.gov.
Privacy Notice, Viewers & Players
Last modified 10/31/19