Pediatric complex chronic conditions classification system version 2: updated for ICD-10 and complex medical technology dependence and transplantation

• Published in: BMC pediatrics Vol. 14; no. 1; p. 199
• Main Authors: Feudtner, Chris, Feinstein, James A, Zhong, Wenjun, Hall, Matt, Dai, Dingwei
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 08.08.2014; BioMed Central
• Subjects: Analysis; Biomedical Technology; Child; Children & youth; Chronic Disease - classification; Chronic Disease - epidemiology; Chronic Disease - therapy; Chronic diseases; Classification; Classification schemes; Clinical Coding; Comorbidity; Databases, Factual; Diagnosis; Disease control; Health aspects; Health care policy; Health Services Research; Hospitals; Humans; International Classification of Diseases; Medical technology; Mortality; Organ Transplantation; Pediatrics; Review boards; Taxonomy; Technical Advance; Technology; United States - epidemiology; United States; United States > US
• ISSN: 1471-2431; 1471-2431
• DOI: 10.1186/1471-2431-14-199

The pediatric complex chronic conditions (CCC) classification system, developed in 2000, requires revision to accommodate the International Classification of Disease 10th Revision (ICD-10). To update the CCC classification system, we incorporated ICD-9 diagnostic codes that had been either omitted or incorrectly specified in the original system, and then translated between ICD-9 and ICD-10 using General Equivalence Mappings (GEMs). We further reviewed all codes in the ICD-9 and ICD-10 systems to include both diagnostic and procedural codes indicative of technology dependence or organ transplantation. We applied the provisional CCC version 2 (v2) system to death certificate information and 2 databases of health utilization, reviewed the resulting CCC classifications, and corrected any misclassifications. Finally, we evaluated performance of the CCC v2 system by assessing: 1) the stability of the system between ICD-9 and ICD-10 codes using data which included both ICD-9 codes and ICD-10 codes; 2) the year-to-year stability before and after ICD-10 implementation; and 3) the proportions of patients classified as having a CCC in both the v1 and v2 systems. The CCC v2 classification system consists of diagnostic and procedural codes that incorporate a new neonatal CCC category as well as domains of complexity arising from technology dependence or organ transplantation. CCC v2 demonstrated close comparability between ICD-9 and ICD-10 and did not detect significant discontinuity in temporal trends of death in the United States. Compared to the original system, CCC v2 resulted in a 1.0% absolute (10% relative) increase in the number of patients identified as having a CCC in national hospitalization dataset, and a 0.4% absolute (24% relative) increase in a national emergency department dataset. The updated CCC v2 system is comprehensive and multidimensional, and provides a necessary update to accommodate widespread implementation of ICD-10.