Skip Navigation

HCUP Tools Loading Tutorial - Accessible Version

HCUP Tools Loading Tutorial



Welcome

Welcome to the HCUP Tools Loading Tutorial!

Thank you for joining us for this Healthcare Cost and Utilization Project (HCUP) online tutorial.

This module covers how to:
  • Find HCUP Tools that can be used with HCUP or other administrative databases.
  • Load the HCUP Clinical Classifications Software (CCS) for ICD-10-CM/PCS.
  • Check that the CCS Tool has loaded correctly and that the most up-to-date version is being used.
This module is for individuals who:
  • Completed the HCUP Data Use Agreement.
  • Obtained their copy of an HCUP database or other administrative databases.
  • Are ready to begin their research, or want to verify that they are using the most up-to-date version of the CCS for ICD-10-CM/PCS.


Return to Contents


Navigation

Please note: There is no associated audio for this tutorial.

To play or pause the tutorial click the "Play/Pause" button in the bottom left corner of the screen.

If you would like to skip to a specific section of the module, click on a topic listed in the Table of Contents. The section will expand to offer more options.

The course Resources presents a list of additional materials to provide a deeper understanding of course content.

To navigate this module, use the buttons or play bar along the bottom of the screen.

To Exit this module click the "X" button in the lower right corner of the screen.

Use the Back and Next buttons to navigate through the course.

Return to Contents


About HCUP

The Healthcare Cost and Utilization Project (HCUP, pronounced "H-Cup") is a family of health care databases and related software tools and products developed through a Federal-State-Industry partnership and sponsored by the Agency for Healthcare Research and Quality (AHRQ).

If you are unfamiliar with HCUP or would like a refresher, consider viewing the HCUP Overview Course.

Return to Contents


Learning Objectives

There are three key learning objectives for this module.
  1. Learn about the suite of HCUP Tools that are available for use with HCUP and other administrative databases, and apply best practices when using the Tools.
  2. Understand how to download and save HCUP Tools to your computer, and then modify or adapt the software to apply it to your database.
  3. Determine if you are using the most current version of an HCUP Tool when conducting research.
This concludes the Introduction section.

Return to Contents


HCUP Tools

This section of the tutorial will introduce you to the HCUP Tools and provide information about the International Classification of Diseases (ICD) coding system, including the transition from ICD-9-CM to ICD-10-CM/PCS.

Return to Contents


About HCUP Tools

The HCUP Tools are analytic methods that, when applied to HCUP databases, systematically create new data elements from existing data, thereby enhancing a researcher's ability to conduct analyses.

While designed to be used with HCUP databases, they may be applied to other administrative databases as well.

HCUP Tools are available for use with both ICD-9-CM and ICD-10-CM/PCS coded administrative databases. It is very important to note that the HCUP Tools for ICD-10-CM/PCS are updated regularly to account for changes in coding guidance. More information about this is described in the "Best Practices with HCUP Tools" section of this tutorial.

Return to Contents


About International Classifications of Disease (ICD) Coding

The International Classification of Diseases (ICD) is a diagnosis and procedure classification scheme created and maintained by the World Health Organization, and adapted for use by member countries.

It contains codes for diseases and conditions, treatments and procedures, symptoms, external causes of injury, and social circumstances. The codes are leveraged for clinical, epidemiological, and quality purposes, including reporting and mortality and morbidity trends.

In October 2015, the United States transitioned to a modified version of the International Classification of Diseases, Tenth Revision, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS). The transition replaced the ICD-9-CM diagnosis and procedure coding system with the ICD-10-CM diagnosis coding system for most inpatient and outpatient medical encounters and the ICD-10-PCS procedure coding system for inpatient procedures.

There are several differences between the ICD-9-CM and ICD-10-CM/PCS coding systems. Four key differences include:
  1. The number of codes Diagnostic information is removed from procedure codes
  2. Procedures are no longer described with conventional procedural or surgical terms
  3. Diagnoses include combination codes for conditions and common symptoms or manifestations.
Each of these key differences are described in turn on the following slides.

Key Difference 1: The number of codes. The number of both diagnosis and procedure codes increased with the transition to ICD-10-CM/PCS.
  • Under the ICD-9-CM coding system there were approximately 14,000 diagnosis codes and 4,000 procedure codes.
  • The ICD-10-CM/PCS coding system is much larger, with more than 69,800 diagnosis codes and 71,900 procedure codes.
Key Difference 2: Diagnostic information is removed from procedure codes

With the transition to ICD-10-CM/PCS, diagnostic and procedure information is reported separately.

For example, codes for debridement of a wound, infection, or burn no longer exist because the same procedure could be performed for reasons other than a wound, infection or burn.

Similarly, codes for bunionectomy or repair of toe deformities (e.g., hammer toe, claw toe) no longer exist because the same procedure could be performed for reasons other than bunions or toe deformities.

Key Difference 3: Procedures are no longer described with conventional procedural or surgical terms

The descriptions of procedures are not described with conventional procedure or surgical terms in the ICD-10-CM/PCS coding system.

For example, In ICD-9-CM removal of a limb is described as an amputation, while in ICD-10-CM/PCS this is labeled as a detachment.

Key Difference 4: Diagnoses include combination codes for conditions and common symptoms or manifestations

ICD-10-CM/PCS requires more diagnosis or procedure codes than ICD-9-CM in certain cases. Additional clinical specificity is often the result. For example:
  • Under ICD-9-CM coding, skull fractures were defined by code 801.21 "Fracture of base of skull, closed, with subarachnoid, subdural, and extradural hemorrhage, with no loss of consciousness." Under ICD-10-CM/PCS coding, skull fractures are defined by code S02.19XA "Other fracture of base of skull, initial encounter for closed fracture" AND code S06.5X0A "Traumatic subdural hemorrhage without loss of consciousness, initial encounter."
  • Under ICD-9-CM coding, hysterectomy was defined by code 68.49 "Other and unspecified total abdominal hysterectomy." Under ICD-10-CM/PCS coding, hysterectomy is defined by code 0UT90ZZ "Resection of uterus, open approach" AND 0UTC0ZZ "Resection of cervix."
For more information about these and other differences, review the ICD-10-CM/PCS Resources page on the HCUP User Support Web site.

This page is being updated continuously as new information and guidance becomes available.

Return to Contents


HCUP Tools for ICD-10-CM/PCS

HCUP Tools have been translated to ICD-10-CM/PCS as part of the conversion to the new coding system on October 1, 2015.

This translation is not final and is being modified on an ongoing basis.

The Tools and supporting user documentation are accessible here on the Tools & Software page on the HCUP User Support Web site.

Several HCUP Tools for ICD-10-CM/PCS are available for download.
  1. Beta Clinical Classifications Software (CCS) for ICD-10-CM/PCS provides a method for classifying ICD-10-CM diagnoses or ICD-10-PCS procedures into clinically meaningful categories, which can be used for aggregate statistical reporting of a variety of types.
  2. Beta Chronic Condition Indicator for ICD-10-CM provides users an easy way to categorize ICD-10-CM diagnosis codes into one of two categories: chronic or not chronic. The Tool can also assign ICD-10-CM diagnosis codes into 1 of 18 body system categories.
  3. Beta Elixhauser Comorbidity Software for ICD-10-CM assigns variables that identify coexisting conditions on hospital discharge records.
  4. Beta Procedure Classes for ICD-10-PCS facilitate research on hospital services using administrative data by identifying whether an ICD-10-PCS procedure is (a) diagnostic or therapeutic, and (b) minor or major in terms of invasiveness and/or resource use.
  5. Beta Utilization Flags for ICD-10-PCS reveal additional information about use of healthcare services by combining information from UB-04 revenue codes and ICD-10-PCS procedure codes to create flags, or indicators, of utilization.
Return to Contents


Example: CCS for ICD-10-CM/PCS

This tutorial uses the Clinical Classification Software (CCS) for ICD-10-CM/PCS as an example of how to download and apply HCUP Tools to administrative databases.

This basic approach is applicable to the other HCUP Tools for ICD-10-CM/PCS. Additional documentation that is specific to each Tool is available on the HCUP User Support Web site. Links to each Tool's documentation are provided on the "Resources" tab of this tutorial.

CCS can be used to identify populations for disease- or procedure-specific studies or to develop statistical reports providing information (such as charges and length of stay) about relatively specific conditions. It can be a useful way to categorize conditions when exploring data and can serve as a tool for reporting statistical information on hospitalizations.

The multitude of ICD-10 codes are collapsed into a smaller number of clinically meaningful categories that are sometimes more useful for presenting descriptive statistics than are individual ICD-10-CM/PCS codes.

The CCS for ICD-10-CM aggregates diseases and conditions into 285 mutually exclusive categories, while the CCS for ICD-10-PCS contains 231 mutually exclusive categories. These categorizations were based on mappings from the original ICD-9-CM assignments. For more information about this process, please visit the "Description of CCS for ICD-10-CM/PCS" section of the CCS for ICD-10-CM/PCS Web page.

More information about the logic employed for ICD-10-CM/PCS CCS mapping is available on the Clinical Classifications Software (CCS) for ICD-10-CM/PCS page on the HCUP User Support Web site.

This concludes the background section on HCUP Tools and ICD systems.

Return to Contents


Best Practices with HCUP Tools

HCUP Tools are updated periodically to accommodate new or revised ICD-10-CM/PCS codes, as well as to add corrections or modifications based on new clinical guidance for the use of ICD-10-CM/PCS codes.

This section of the tutorial covers three best practices that are critical when using HCUP Tools:
  1. Timing of HCUP Tools releases
  2. Using the most recent version
  3. Referring to documentation on the HCUP User Support Web site.
Return to Contents


Timing of HCUP Tools Release

New or revised ICD-10-CM/PCS codes are released annually and valid for a Federal fiscal year, which runs from October 1st to September 30th. Fiscal years are identified by the year the codes end. For example, FY2018 codes are valid from October 1st, 2017 until September 30th, 2018.

Updated versions of the HCUP Tools are released in the fall (usually mid to late October), though occasionally the HCUP Tools are re-released during a Federal fiscal year to apply changes to the Tools assignment of specific codes.

Return to Contents


Using the Most Recent Version

The HCUP ICD-10-CM/PCS Tools incorporate a versioning system that acknowledge both the Federal fiscal year and an incremented release number.

Version 2018.1 of HCUP Tools was released in October 2017. The codes contained in version 2018.1 will be valid for discharges from October 1st, 2015 through September 30th, 2018.

Return to Contents


Documentation on HCUP-US

The HCUP User Support Web site contains a wealth of documentation regarding all HCUP databases, tools, and products.

Each HCUP Tool has unique user documentation. For example, the Clinical Classifications Software (CCS) for ICD-10-CM/PCS page includes:
  • An overview of the Tools
  • A description of the logic underlying the CCS generally, with detail about the translation of the CCS from ICD-9-CM to ICD-10-CM/PCS
  • Technical and implementation guidance
  • Archived copies of prior versions of the Tools.
While this is the Web page with dedicated information about the CCS for ICD-10-CM/PCS, a similar Web page is available for each HCUP Tool.

To summarize:
  • HCUP Tool releases are aligned with fiscal year coding updates
    • FY2018 codes were released on October 1st, 2017 and valid until September 30th, 2018.
    • The FY2018 CCS contains codes valid for discharges from October 1st, 2015 through September 30th, 2018.
  • Users should implement the current version
    • Using the most current version of the CCS ensures that the Tool leverages up-to-date codes.
  • Documentation is available to help apply the Tools to administrative databases.
    • Documentation can help solve common questions.
This concludes the Best Practices section.

Return to Contents


Download and Apply HCUP Tools

This section of the tutorial will walk you through the steps for downloading and applying HCUP Tools to an administrative database, including verifying that the Tools were correctly applied.

In this example we are applying the CCS for ICD-10-CM/PCS to the 2015 National Inpatient Sample (NIS).

Return to Contents


Where to Locate HCUP Tools

HCUP Tools can be accessed by visiting the HCUP Tools & Software page of the HCUP User Support Web site.

The HCUP Tools for ICD-10-CM/PCS are located on the lower right-hand portion of the screen.

Click on the link for the Clinical Classifications Software (CCS) for ICD-10-CM/PCS to access the Tool and associated documentation.

Once on the CCS for ICD-10-CM/PCS Web page, select "Downloading Information" to jump to the portion of the page where the Tool can be downloaded.

There are three CCS Tools:
  1. The CCS for diagnosis codes (ICD-10-CM)
  2. The CCS for procedure codes (ICD-10-PCS)
  3. The Multi-Level CCS for ICD-10-CM/PCS
To download the CCS for ICD-10-PCS, right-click on the Tool link and select "Save Link As" (Google Chrome, Mozilla Firefox) or "Save Target As" (Internet Explorer) from the menu.

In the Explorer window, navigate to the location where you want to save the file. Make note of the location where you save the Tool, as you will need to both unzip the folder and later specify the full path of these files in your statistical software load programs.

Return to Contents


Extracting from ZIP File

After saving the ZIP file that contains the ICD-10-PCS Tool, navigate to the file and extract the contents by double clicking on it.

As before, make sure to extract the files to a location on your computer where you can access them in the future because you will need to specify the full path of these files in your statistical software load programs.

Repeat this process of downloading and extracting for the HCUP Tools that you need to complete your research. For CCS, this could include downloading files that correspond to the other two CCS Tools:
  1. CCS for diagnosis codes (ICD-10-CM)
  2. Multi-Level CCS for ICD-10-CM/PCS.
Extracting the downloaded CCS Tools files reveals their contents. There are two primary files for the ICD-10-CM/PCS Tools, with a third file in the Multi-Level CCS for ICD-10-CM/PCS folder.
  1. One or more translation files in the ASCII format that can be used with SAS, SPSS, or other analytic software. These are Comma Separated Value (.csv) text files. These files are the HCUP Tools.
  2. A SAS Load program which can be modified to apply the Tool to your administrative database.
  3. A 1-2 page Load Guide that contains information about downloading and applying each HCUP Tool.
  4. A SAS Summary program (for the Multi-Level for ICD-10-CM/PCS only) which is run after the SAS Load program and is used to assess the application of the Tool.
As an example, the CCS for ICD-10-PCS Tool includes three files.
  1. One Load Guide titled "CCS Load Guide.pdf."
  2. One translation file in .csv format. The file titled "ccs_dx_icd10pcs_2018_1.csv" contains the CCS for ICD-10-PCS Tool.
  3. One SAS load program titled "ICD10_Single_CCS_Load_Program.sas."
Return to Contents


Modify the SAS Load Program

The SAS Load Program provides the basic programming code needed to apply the CCS to your administrative database.

The additional steps required to apply the CCS to your administrative database depend on the statistical software you use to analyze your data:
  • If you are using SAS, the Load Program needs to be modified to specify the full paths of all input and output files, as well as the number and names of data variables.
  • If you are using a different statistical software (e.g., SPSS, Stata), the Load Programs need to be adapted to reflect their specific coding language and commands and modified to specify the full paths of all input and output files, as well as the number and names of data variables.
To modify the Load Program to run in SAS, first open the program in a text editing software (e.g., Notepad).

Using the "ICD10_Single_CCS_Load_Program.sas" file as an example, four types of modifications are needed.

First, modify the input tool file paths to reflect the location on your computer where you saved the Tool.

The CCS for ICD-10-PCS file path is located directly below the program header.

It can also be found by searching for the phrase "FILENAME INRAW1".

Second, modify the library paths to reflect the location of your administrative database and where the output files should be saved.

The library paths are located below the program header.

They can also be found by searching for the phrases "LIBNAME IN1" and "LIBNAME OUT1".

Third, modify the program to reflect the maximum number of diagnoses and procedures present on each record in your database. In the HCUP databases, this is "NUMDX" and "NUMPR".

Diagnoses and procedures are represented by the macro variables "NUMDX" and "NUMPR", respectively. The Load Program defaults to 15.

To modify these definitions, search for the phrases "%LET NUMDX=" and "%LET NUMPR=".

Finally, identify the name of your administrative database by modifying the macro variable "CORE".

The name of your database is represented by the macro variable "CORE". This is located below the diagnosis and procedure code macro variables.

It can be found by searching for the phrase "%LET CORE=".

The SAS Load Program can be adapted to run in other statistical software by editing to reflect that software program’s specific coding language and commands. SPSS and Stata are commonly used statistical software options in health research.
  • To adapt the SAS Load Program for use in SPSS, use the SPSS Value Labels statement to apply the CCS labels. If you have specific questions about this process, contact SPSS directly for technical assistance.
  • To adapt the SAS Load Program for use in Stata, use the Dictionary Command to apply the CCS labels. If you have specific questions about this process, use the Stata "help" function for more information or contact Stata directly for technical assistance.
After adapting the SAS Load Program to run in your statistical software, make the previously described modifications to specify the full paths for all input and output files and the number and names of data variables.

Return to Contents


Apply Tool to Discharge Records

Once the Load Program is modified and/or adapted for use, run the program to apply the Tool to the records in your administrative database. Using SAS, this requires three steps:
  • Transforming the .csv files into a SAS dataset
  • Converting the SAS dataset into a SAS format
  • Running the Load Program.
Similar actions can be performed using other statistical analysis software, including SPSS and Stata.

Return to Contents


Check Tool Application

Three steps are recommended for verifying that the Tool was appropriately applied to your administrative database.

These include checking that:
  1. The new data element DXCCS1 and/or PRCCS1 were appended to your database, and exhibit a range of variation.
  2. The column containing data elements DXCCS1 and/or PRCCS1 is populated with numeric values.
  3. The frequency of the first diagnosis code (e.g., HCUP data element DX1) is equal to the frequency of DXCCS1. Because each ICD-10-CM/PCS code is mapped to the CCS individually, the number of records with DX1 (and/or PR1) should be equal to the number of records with DXCCS1 (and/or PRCCS1).
This concludes the Download and Apply HCUP Tools section.

Return to Contents


Confirm HCUP Tool Version

This section of the tutorial will walk you through confirming the version of the Tool that you have downloaded, including verifying that it is the most current version.

In this example we are examining the CCS for ICD-10-PCS.

Return to Contents


Locate Version in Tool

The version number is saved in the file name of the ZIP file and the .csv file. The version is formatted as YYYY_N, where YYYY denotes the fiscal year of the file and N denotes the version of the Tool within that fiscal year.

This concludes the Confirm HCUP Tool Version section.

Return to Contents


Verify Version on HCUP-US

Before finalizing your analyses, it is important to verify that the version of the Tool you applied to your administrative database is the most current version.

New versions are released periodically to address updated coding guidance, and minimally annually to reflect the release of new fiscal year ICD-10-CM/PCS codes.

These are updated on each Tools' individual page on the HCUP User Support Web site. The most current version is listed in the "Downloading Information" section of the Tool Web page, while earlier versions are maintained in the "Archives" section of the Tool Web page.

Examples are shown on the following slides for the CCS for ICD-10-CM/PCS Tools.

The link to download the current version of the CCS for ICD-10-CM/PCS Tool is located in the "Downloading Information" section. In this example, Version 2018.1 is the current version.

Researchers should always use the version saved in this location.

Earlier versions of the CCS for ICD-10-CM/PCS Tool are located in the "Archives" section.

These versions should no longer be used, as the more recent versions remain applicable to all prior fiscal years.

Return to Contents


Wrap Up

This tutorial described how to:
  • Find HCUP Tools that can be used with HCUP or other administrative databases
  • Load the HCUP Clinical Classifications Software (CCS) for ICD-10-CM/PCS
  • Check that the CCS Tool has loaded correctly and that the most up-to-date version is being used.
In addition, the tutorial provided a high-level overview of how the transition from ICD-9-CM to ICD-10-CM/PCS impacts users of HCUP Tools.

For more information about the HCUP Tools, please click the "Resources" button in the lower left corner of the screen. Technical support is available by contacting HCUP User Support: Return to Contents


Additional Resources

Return to Contents



Internet Citation: HCUP Tools Loading Tutorial - Accessible Version. Healthcare Cost and Utilization Project (HCUP). March 2018. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/tech_assist/toolstutorial/508/508course.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 3/7/18