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HCUP Tools for ICD-10-CM/PCS Loading Tutorial - Accessible Version

HCUP Tools for ICD-10-CM/PCS Loading Tutorial



Welcome

Welcome to the HCUP Tools for ICD-10-CM/PCS 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 an HCUP Tool: Example - Clinical Classifications Software (CCS) for ICD-10-PCS (beta version).
  • 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-PCS (beta version).
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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.

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About HCUP

The Healthcare Cost and Utilization Project (HCUP, pronounced "H-Cup") is a family of healthcare 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.

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Learning Objectives

There are three key learning objectives for this module.
  1. Learn about the suite of HCUP Tools for ICD-10-CM/PCS 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 for ICD-10-CM/PCS 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 the HCUP Tools for ICD-10-CM/PCS when conducting research.
This concludes the Introduction section.

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HCUP Tools

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

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About HCUP Tools

The HCUP Tools provide methods of systematically creating 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 for ICD-10-CM/PCS" section of this tutorial.

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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
  2. Diagnostic information is removed from procedure codes.
  3. Procedures are no longer described with conventional procedural or surgical terms
  4. 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 72,000 diagnosis codes and 80,000 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:

Examples of this are shown below:
  • Under ICD-9-CM coding, skull fractures was defined by one diagnosis 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 two diagnoses codes: 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, a hysterectomy was defined by one procedure code: 68.49 "Other and unspecified total abdominal hysterectomy." Under ICD-10-CM/PCS coding, hysterectomy is defined by two procedure codes: 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 website.

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

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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 website.

Several HCUP Tools for ICD-10-CM/PCS are available for download.
  1. Clinical Classifications Software Refined (CCSR) for ICD-10-CM aggregates over 70,000 ICD-10-CM diagnosis codes into a manageable number of clinically meaningful categories. The categories are organized across 21 body systems, which generally follow the structure of the ICD-10-CM diagnosis chapters.
  2. Clinical Classifications Software (CCS) for ICD-10-PCS (beta version) provides a method for classifying more than 77,000 ICD-10-PCS procedure codes into clinically meaningful categories and can be used to identify populations for procedure-specific studies or to develop statistical reports about relatively specific procedures.
  3. Chronic Condition Indicator for ICD-10-CM (beta version) 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.
  4. Elixhauser Comorbidity Software for ICD-10-CM (beta version) assigns variables that identify coexisting conditions on hospital discharge records.
  5. Procedure Classes for ICD-10-PCS (beta version) 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.
  6. Utilization Flags for ICD-10-PCS (beta version) 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.
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Downloading and Installing Differs by Tool

The process for downloading and installing HCUP Tools for ICD-10-CM/PCS differ by tool. This tutorial only applies to the tools in Group A.

Group A includes the Clinical Classifications Software for ICD-10-PCS (beta version), the Chronic Condition Indicator for ICD-10-CM (beta version), Procedure Classes for ICD-10-PCS (beta version), and Utilization Flags for ICD-10-PCS (beta version). The software download materials for Group A consist of 3 documents:
  1. Load Guide
  2. Tool
  3. SAS program
Group B includes the Clinical Classifications Software Refined (CCSR) for ICD-10-CM, and the Elixhauser Comorbidity Software for ICD-10-CM. The software download materials are tool-specific and the format varies according to the tool of interest.

The software download materials for the CCSR consist of 5 documents:
  1. Mapping Program
  2. Tool
  3. Reference File
  4. User Guide
  5. Appendix
The software download materials for the Elixhauser Comorbidity Software for ICD-10-CM (beta version) consist of 3 documents:
  1. Format Program
  2. Analysis Program
  3. Table of Changes
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Coming Soon: Clinical Classifications Software Refined (CCSR) for ICD-10-CM Tutorial

Released in September 2019, the CCSR is the latest HCUP Tool.

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.

A loading tutorial specific to the CCSR for ICD-10-CM diagnoses is under development. This tutorial does not apply to the CCSR.

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Example: CCS for ICD-10-PCS (beta version)

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

The approach used in this example is similar to that needed for the other HCUP Tools for ICD-10-CM/PCS listed in Group A of Slide 17.

Additional documentation that is specific to each Tool, including the tools list in Group B of Slide 17, is available on the HCUP User Support website. Links to each Tool's documentation are provided on the "Resources" tab of this tutorial.

The CCS for ICD-10-PCS (beta version) can be used to identify populations for procedure-specific studies or to develop statistical reports providing information (such as charges and length of stay) about relatively specific procedures. It can be a useful way to categorize procedures when exploring data and can serve as a tool for reporting statistical information on hospitalizations.

The multitude of ICD-10-PCS 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-PCS codes.

The CCS for ICD-10-PCS (beta version) contains 224 mutually exclusive categories. Seven CCS procedure categories that are found in the CCS for ICD-9-CM procedures could not be populated with any ICD-10-PCS codes and the new structure of ICD-10-PCS codes also warranted the revision of the labels for some CCS procedure categories. For more information about this process, including a list of the revised labels, please visit the "Description of CCS for ICD-10-PCS (beta version)" section of the CCS for ICD-10-PCS (beta version) webpage on the HCUP User Support website.

This concludes the background section on HCUP Tools for ICD-10-CM/PCS and ICD coding.

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Best Practices with HCUP Tools for ICD-10-CM/PCS

HCUP Tools for ICD-10-CM/PCS 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 for ICD-10-CM/PCS:
  1. Timing of HCUP Tools for ICD-10-CM/PCS releases.
  2. Using the most recent version.
  3. Referring to documentation on the HCUP User Support website.
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Best Practices with HCUP Tools for ICD-10-CM/PCS: Timing

New or revised ICD-10-CM/PCS codes are released annually (usually in July) 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, FY2020 codes are valid from October 1st, 2019 until September 30th, 2020.

Updated versions of the HCUP Tools for ICD-10-CM/PCS are released in the fall (usually mid to late October), though occasionally the HCUP Tools for ICD-10-CM/PCS are re-released during a Federal fiscal year to apply changes to the Tools assignment of specific codes.

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Best Practices with HCUP Tools for ICD-10-CM/PCS: Version

The HCUP Tools for ICD-10-CM/PCS incorporate a versioning system that acknowledge both the Federal fiscal year and an incremented release number. The HCUP Tools for ICD-10-CM/PCS are designed to be backwards compatible, meaning that the most recent tools release can be used with all previous ICD-10-CM/PCS fiscal year versions.

Users should use the most recent version (currently version 2020.1) for ICD-10-CM/PCS-coded data regardless of the discharge year.

The HCUP Tools for ICD-10-CM/PCS are updated annually, however, the software is valid for codes from October 1, 2015 through September 30 of the current fiscal year. Therefore, users don’t need the previous versions of the tools even if they are working with older data.

For example, version 2020.1 of HCUP Tools for ICD-10-CM/PCS was released in October 2019. The codes contained in version 2020.1 will be valid for discharges from October 1st, 2015 through September 30th, 2020.

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Best Practices with HCUP Tools for ICD-10-CM/PCS: Documentation

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

Each HCUP Tool has unique user documentation, including:
  • An overview of the HCUP Tool.
  • A description of the logic underlying the HCUP Tool, with detail about the translation of the CCS from ICD-9-CM to ICD-10-CM/PCS.
  • Technical guidance.
  • Archived copies of prior versions of the Tools.
This is the webpage with dedicated information about the CCS for ICD-10-PCS (beta version). A similar webpage is available for each HCUP Tool.

To summarize:
  • HCUP Tools for ICD-10-CM/PCS releases are aligned with fiscal year coding updates.
  • Users should implement the current version.
  • Documentation is available to help apply the HCUP Tools to administrative databases.
This concludes the Best Practices section.

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Download and Apply HCUP Tools for ICD-10-CM/PCS

This section of the tutorial will walk you through the steps for downloading and applying HCUP Tools for ICD-10-CM/PCS to an administrative database, including verifying that the Tools were correctly applied.

In this example we are applying the CCS for ICD-10-PCS (beta version) to the 2016 National Inpatient Sample (NIS). This example mirrors the process for the CCI for ICD-10-CM, Procedure Classes for ICD-10-PCS, and the Utilization Flags for ICD-10-PCS. A different process is necessary for the CCSR for ICD-10-CM and the Elixhauser Comorbidity Software for ICD-10-CM.

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Where to Locate HCUP Tools for ICD-10-CM/PCS

HCUP Tools for ICD-10-CM/PCS can be accessed by visiting the HCUP Tools & Software page of the HCUP User Support website.

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

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

Once on the CCS for ICD-10-PCS (beta version) webpage, select "Downloading Information" to jump to the portion of the page where the HCUP Tool can be downloaded.

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Downloading the CCS for ICD-10-PCS (beta version)

To download the CCS for ICD-10-PCS (beta version), right-click on the HCUP 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 HCUP 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.

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Extracting the CCS for ICD-10-PCS (beta version)

After saving the ZIP file that contains the beta version of the CCS for 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.

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Contents of the beta version of the CCS for ICD-10-PCS Tool

Extracting the downloaded beta version of the CCS for ICD-10-PCS Tool files reveals their contents.
  1. A 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. This file is the HCUP Tool.
  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.
As an example, the beta version of the CCS for ICD-10-PCS Tool includes three files.
  1. One SAS load program titled "ICD10_Single_CCS_Load_Program.sas."
  2. One Load Guide titled "Load Guide-CCSforICD10PCS.pdf."
  3. One translation file in .csv format. The file titled "ccs_pr_icd10pcs_2020_1.csv" contains the beta version of the CCS for ICD-10-PCS Tool..
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Modify the SAS Load Program

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

The additional steps required to apply the HCUP Tool 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 Program needs to be adapted to reflect the 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 (beta version) 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 "I10_NPR".

Procedures are represented by the macro variable "NUMPR". The Load Program defaults to 15.

To modify these definitions, search for the phrases "%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 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.

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Apply the HCUP Tool to Discharge Records

Once the Load Program is modified and/or adapted for use, run the program to apply the HCUP 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.

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Verify that the HCUP Tool was Loaded Properly

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

These include checking that:
  1. The new data element PRCCS1 were appended to your database and exhibits a range of variation.
  2. The column containing data element PRCCS1 is populated with numeric values.
  3. The frequency of the first procedure code (e.g., HCUP data element 1I0_PR1) is equal to the frequency of PRCCS1. Because each ICD-10-PCS code is mapped to the CCS individually, the number of records with I10_PR1 should be equal to the number of records with PRCCS1.
This concludes the Download and Apply HCUP Tools section.

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Confirm HCUP Tool Version

This section of the tutorial will walk you through confirming the version of the HCUP 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 (beta version).

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Locate Version in HCUP Tool for ICD-10-CM/PCS

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 release number of the HCUP Tool within that fiscal year.

This concludes the Confirm HCUP Tool Version section.

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Verify Version on the HCUP User Support Website

Before finalizing your analyses, it is important to verify that the version of the HCUP 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 HCUP Tools' individual page on the HCUP User Support website. The most current version is listed in the "Downloading Information" section of the Tool webpage, while earlier versions are maintained in the "Archives" section of the HCUP Tool webpage.

Examples are shown on the following slides for the beta versions of the CCS for ICD-10-PCS Tool.

The link to download the current version of the CCS for ICD-10-PCS Tool (beta version) is located in the "Downloading Information" section. In this example, Version 2020.1 is the current version.

Researchers should always use the version saved in this location.

Earlier versions of the CCS for ICD-10-PCS Tool (beta vertsion) 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.

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Wrap Up

This tutorial described how to:
  • Find HCUP Tools for ICD-10-CM/PCS that can be used with HCUP or other administrative databases.
  • Load the HCUP Clinical Classifications Software (CCS) for ICD-10-CM/PCS (beta version).
  • Check that the HCUP 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




Internet Citation: HCUP Tools for ICD-10-CM/PCS Loading Tutorial - Accessible Version. Healthcare Cost and Utilization Project (HCUP). December 2019. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/tech_assist/toolstutorial/508/508course.jsp.
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Last modified 12/10/19