HCUP e-News: the electronic newsletter of the Healthcare Cost and Utilization Project

Spring 2021
Issue #66


News and Announcements: Notable news from HCUP
Databases and Products: New database and product releases
Publication Spotlights: Recent works incorporating HCUP data and tools
HCUP Q&A: Answers to your HCUP questions
HCUP Events: Upcoming HCUP conferences and meetings

Missed the last HCUP e-News? Read it on the HCUP-US website.

News and Announcements

Learn About HCUP During the Spring Webinar Series—Required Registration Opens April 13

From April 20 to 22, AHRQ will host a 3-day webinar series for users interested in learning more about Healthcare Cost & Utilization Project (HCUP). The series will begin on April 20 with the HCUP Database Overview, a presentation that will include an introduction to the HCUP family of databases and a discussion of how to obtain and access the data as well as other HCUP resources. On April 21, HCUP staff will provide An In-Depth Exploration of the HCUP Nationwide Ambulatory Surgery Sample (NASS), which can be used to create national and regional estimates of major ambulatory surgery encounters in hospital-owned facilities. On April 22, the series will conclude with an Overview of HCUP Products and Tools which will cover the use of HCUP software tools, supplemental files, and other products such as HCUPnet and Fast Stats to facilitate and augment research. The presentation will highlight the recently released tools: Elixhauser Comorbidity Software Refined for ICD-10-CM, Clinical Classifications Software Refined (CCSR) for ICD-10-PCS Procedures, and Procedure Classes Refined for ICD-10-PCS.

The webinars range from 1 to 1.5 hours and are open to the public. Each webinar requires separate advance registration, which will open on April 13. Additional details about the webinars are posted on the HCUP Workshops and Webinars page of the HCUP-US website.

Join Us for a Virtual HCUP Data Analytic Tools Workshop on May 26, 2021

AHRQ will sponsor an intermediate-level full day virtual HCUP Data Analytic Tools workshop on May 26, 2021. This virtual workshop will teach health services researchers and analysts how to use the HCUP analytic tools to facilitate their research on administrative data. Participants will learn how to categorize diagnosis and procedure codes into clinically meaningful categories, as well as identify comorbidities, chronic conditions, and operating room procedures. For the participants who are not familiar with HCUP databases and tools, we highly recommend attending the HCUP Spring Webinar Series presentations on April 20 and April 22, or review the Online HCUP Overview Course and HCUP Software Tools Tutorial prior to attending the workshop.

There is no fee to attend the workshop. Registration information and other workshop details will be available the second half of April on the HCUP Workshops and Webinars page.

Newly Released: Clinical Classifications Software Refined (CCSR) for ICD-10-PCS Procedures

AHRQ has released the Clinical Classifications Software Refined (CCSR) for ICD-10-PCS procedures, which aggregates more than 80,000 International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS) procedure codes into over 320 clinically meaningful categories across 31 clinical domains. This initial release of the CCSR (v2021.1) applies to all ICD-10-PCS procedure codes through fiscal year 2021 and replaces the beta version of the CCS for ICD-10-PCS procedures (v2016.1–v2020.1). It provides a means by which to identify specific types of procedures using ICD-10-PCS procedure codes and is intended to be used analytically to examine patterns of healthcare costs, utilization, and outcomes. The CCSR for ICD-10-PCS capitalizes on the taxonomy and specificity of the ICD-10-PCS coding scheme by creating new clinical categories with additional detail that did not exist in previous versions of the CCS tool. Consistent with prior versions of the CCS, the CCSR for ICD-10-PCS includes mutually exclusive category assignment.

The CCSR for ICD-10-PCS procedures can be downloaded from the Tools & Software section of the HCUP-US website.

New HCUP Summary Trend Tables

AHRQ has released a new HCUP product, the HCUP Summary Trend Tables, downloadable tabulations containing State-specific monthly trends in hospital utilization. The information is derived from the HCUP State Inpatient Databases (SID) from HCUP Partner organizations. Monthly trends in hospital utilization are provided overall as well as by three key reporting categories:

For each reporting category, the downloadable Microsoft Excel files include the monthly number of discharges, percent of discharges, average length of stay, and in-hospital mortality rate. For most files, the monthly trends begin in January 2017 and continue into data year 2020 for several States. The next update to the HCUP Summary Trend Tables is planned for Summer 2021.

The HCUP Summary Trend Tables can be downloaded from the Reports section of HCUP-US.

2017 Inpatient Community-Level and Nationwide Emergency Department Statistics Added to HCUPnet

HCUPnet, the free, online query system that provides statistics and data tables based on HCUP data, has been updated to include 2017 county- and region-level inpatient and nationwide emergency department (ED) statistics using the Clinical Classifications Software Refined (CCSR). Users can follow HCUPnet’s easy, step-by-step process to explore many healthcare topics relating to hospital inpatient discharges and ED visits. Users can also generate tables and graphs on national, regional, and county-level statistics, including hospital readmissions and trends in the United States.

Visit HCUPnet to explore the updates and start your own query.

Interested in HCUP Tools? Access the New HCUP Software Tools Tutorial

A new tutorial has been added to the HCUP Online Tutorial Series, a set of free, interactive training modules that are designed to provide data users with information about HCUP data and tools, as well as training on technical methods for conducting research using HCUP datasets. The HCUP Software Tools Tutorial includes four modules that group the HCUP tools by the following coding systems: ICD-10-Clinical Modification (CM) diagnoses, ICD-10-PCS procedures, Current Procedural Terminology® and Healthcare Common Procedure Coding System Level II codes, and ICD-9-CM diagnoses and procedures. Users will learn about the purpose of each tool throughout the course and receive technical guidance for applying the tools to their data.

The HCUP Software Tools Tutorial, along with other helpful HCUP interactive courses, can be found on the HCUP Online Tutorial Series home page on the HCUP-US website.

Now Available: 2018 Nationwide Readmissions Database (NRD) and Nationwide Ambulatory Surgery Sample (NASS)

In December 2020, AHRQ released the 2018 Nationwide Readmissions Database (NRD) and Nationwide Ambulatory Surgery Sample (NASS).

The NRD is a database of all-payer hospital inpatient stays that can be used to generate national estimates of readmissions. It addresses a large gap in healthcare data—the lack of nationally representative information on hospital readmissions for all ages. Unweighted, the NRD contains data from approximately 18 million discharges each year. Weighted, it estimates roughly 35 million discharges. The NRD uses State Inpatient Databases (SID) with verified patient linkage numbers and includes discharges from community hospitals, excluding rehabilitation and long-term acute care hospitals. It includes discharges for patients with and without repeat hospital visits and for those who died in the hospital. The NRD is designed to be flexible to various types of readmission analyses. Repeat hospital visits may or may not be related.

The NASS is the largest all-payer ambulatory surgery database in the United States. The NASS can be used to create national estimates of major ambulatory surgery encounters performed in hospital-owned facilities. Unweighted, it contains approximately 8 million ambulatory surgery encounters each year and approximately 10 million ambulatory surgery procedures. Weighted, it estimates about 11 million ambulatory surgery encounters and 14 million ambulatory surgery procedures. The NASS was created to enable analyses of selected ambulatory surgery utilization patterns and to support public health professionals, administrators, policymakers, and clinicians in their decision making regarding this critical source of care. The NASS contains clinical and resource-use information that is included in a typical hospital-owned facility record, including patient characteristics, clinical diagnostic and surgical procedure codes, disposition of patients, total charges, expected source of payment, and facility characteristics.

HCUP State and nationwide databases (including the NRD and NASS) are available for purchase through the HCUP Central Distributor. Earlier years of the NRD and NASS also are available.

To keep informed on HCUP database releases, users can subscribe to the HCUP Mailing List.

HCUP's Outstanding Article of the Year Award

The nomination period for the twelfth Annual AHRQ-AcademyHealth HCUP Outstanding Article of the Year Award has closed. Applications are currently being reviewed to determine winners in the Clinical and Policy categories. The award recognizes two researchers published in peer-reviewed journals in 2020 who used HCUP databases to explore and address healthcare research topics and issues.

Award recipients will be announced during AcademyHealth's Virtual 2021 Annual Research Meeting, Exit Disclaimer taking place June 14–17 online. The winning authors will have posters of their work showcased during the conference. AHRQ will contact the finalists via email in early May 2021.

For more information on the award and to view past recipients, please visit the HCUP-US website at www.hcup-us.ahrq.gov/news/awards.jsp.

Databases and Products

Recently Released: 2019 State Databases and Additional 2018 Databases

Since December 2020, the following State databases have been released:

In addition, the 2018 NRD and NASS have been released.

Complete listings of available databases by year can be found in the Database Catalog on the HCUP-US website. Databases can be purchased online through the HCUP Central Distributor, and aggregated national and selected State statistics can be accessed via HCUPnet.

***Some HCUP Central Distributor operations have been affected by the current national emergency related to COVID-19. Please refer to the notice posted on the online HCUP Central Distributor for current status information.

Publication Spotlights

New HCUP Statistical Briefs Posted on HCUP-US

Since December 2020, the following HCUP Statistical Briefs have been released:

To access these and other Statistical Briefs, please visit the Statistical Briefs page on the HCUP-US website.


Question: Recently, I downloaded v2021.1 of the Clinical Classifications Software Refined (CCSR) for ICD-10-PCS procedures, and I have some questions about this new tool before I begin using it with my administrative data.


Is the CCSR for ICD-10-PCS intended to be used only with the HCUP databases?

No, the CCSR for ICD-10-PCS can be used with any administrative database, not just the HCUP databases. This is true for all HCUP software tools. Users do need to be mindful, however, that certain data elements are required on administrative data to apply the respective tools.

What data elements are required to apply the CCSR for ICD-10-PCS to my data?

The following data elements are required for assigning the CCSR for ICD-10-PCS to administrative data.

Data Element Name in Program Purpose How to Modify the Data Element Name Used in the Program Data Element Name in HCUP Databases
Macro data element &RECID Unique record identifier used to link files Specify name using macro statement %LET RECID= KEY in the HCUP State databases
PR1-PRn where n is the dimension of the procedure array Array of ICD-10-PCS procedures (without decimals) used to assign CCSR categories Specify prefix for PR array using macro statement %LET PRPREFIX= I10_PR1-I10_PRn in all HCUP databases starting in data year 2016

For previous analyses, I have used the CCS for ICD-9-CM to classify ICD-9-CM procedure codes into categories. Are the same categories used in the CCSR for ICD-10-PCS?

The CCS for ICD-9-CM has 224 categories, whereas the CCSR for ICD-10-PCS has more than 300 categories. While some CCSR categories retain the same clinical/surgical concepts from the CCS for ICD-9-CM, the CCSR for ICD-10-PCS took advantage of both the taxonomy and specificity of the ICD-10-PCS coding system to add more specific categories as well as reduce catch-all categories (i.e., beginning with "Other").

Is CCSR for ICD-10-PCS category assignment mutually exclusive?

Yes, the CCSR for ICD-10-PCS assignment is mutually exclusive—ICD-10-PCS procedure codes are assigned to one and only one CCSR category.

HCUP Events

For a complete list of HCUP presentations and events, visit the HCUP Events Calendar.

The HCUP e-News is available online on the HCUP-US website and distributed via the HCUP Mailing List.

For more information and questions regarding the HCUP e-News, please email hcup@ahrq.gov