Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses

The Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses 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.

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The Clinical Classifications Software Refined (CCSR) for ICD-10-CM diagnoses aggregates more than 70,000 ICD-10-CM diagnosis codes into over 530 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.

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 healthcare in terms of cost, utilization, and outcomes; rank utilization by diagnoses; and risk adjust by clinical condition.

The CCSR for ICD-10-CM diagnoses replaces the beta version of the CCS for ICD-10-CM. The most substantial difference in the CCSR for ICD-10-CM diagnoses compared with the beta versions of the CCS is that individual codes are no longer assigned to mutually exclusive categories (i.e., assigned to one and only one category). Mutually exclusive category assignments have been a design feature of the CCS since its initial release. 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).

For some applications, such as ranking hospitalizations by the principal diagnosis, a mutually exclusive categorization scheme is needed. To facilitate this type of analysis, the CCSR tool includes the assignment of a default CCSR for the principal diagnosis for inpatient data starting with v2020.2 and a default CCSR for the first-listed diagnosis for outpatient data starting with v2021.1. The rationale used in selecting default categories is documented in the User Guide for the CCSR. Users may choose to assign different default CCSR categories for ICD-10-CM codes, based on their own needs and preferences. For other applications, such as risk adjustment and the identification of comorbidities, the identification of all conditions related to a diagnosis code is beneficial.
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The following table provides information on where to find the various resources available for the CCSR tool. The download section includes all of the referenced materials.

Descriptions CCSR Resource
Development of CCSR for diagnoses User Guide: CCSR for ICD-10-CM Diagnoses, Description of the CCSR for ICD-10-CM and Appendix A
Default CCSR for the principal diagnosis (inpatient data) User Guide: CCSR for ICD-10-CM Diagnoses, Appendix B
Default CCSR for the first-listed diagnosis (outpatient data) User Guide: CCSR for ICD-10-CM Diagnoses, Appendix C
Comparison of the CCSR for diagnoses to the beta version of the CCS Comparison of the CCSR to the Beta Version of the CCS, report and supplemental Excel file
 
Technical guidance for applying the CCSR for ICD-10-CM diagnoses to administrative data CCSR Resource
System requirements User Guide: CCSR for ICD-10-CM Diagnoses, Using the Downloadable CCSR Files, System Requirements
Input files User Guide: CCSR for ICD-10-CM Diagnoses, Using the Downloadable CCSR Files, Downloadable Files and Data Elements Required for Input Dataset
Running the SAS program User Guide: CCSR for ICD-10-CM Diagnoses, Using the Downloadable CCSR Files, Downloadable Files and Running the SAS Program to Add CCSR Categories to Data
Output file options User Guide: CCSR for ICD-10-CM Diagnoses, Using the Downloadable CCSR Files, Flexible File Structure for Outputting the CCSR Categories
 
Additional resources CCSR Resource
List of CCSR 3-character abbreviations by body system Diagnosis CCSR Reference File, tab Naming_Conventions
Searchable list of CCSR categories Diagnosis CCSR Reference File, tab CCSR_Categories
Searchable list of ICD-10-CM diagnosis codes mapped to CCSR categories Diagnosis CCSR Reference File, tab DX to CCSR_Mapping
Searchable log of changes across versions Diagnosis CCSR Change Log
Cross-referencing the CDC injury and external cause matrices to CCSR categories User Guide: CCSR for ICD-10-CM Diagnoses, Appendix D
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The input dataset must contain certain elements that are coded in specific ways. These elements are required for the assignment of the CCSR for ICD-10-CM diagnoses.

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
DX1-DXn where n is the dimension of the diagnosis array Array of ICD-10-CM diagnoses (without decimals) used to assign CCSR categories Specify prefix for DX array using macro statement %LET DXPREFIX= I10_DX1-I10DXn in all HCUP databases starting in data year 2016
Required only if using data that is a mixture of inpatient and outpatient data: DBTYPE Flag to identify which records are inpatient and which are outpatient Specify data element name using macro statement %LET IOVAR= HCUPFILE in the HCUP Nationwide Emergency Department Sample (NEDS)
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The ZIP folder includes the CSV mapping file, a SAS mapping program, and all of the user documentation. At this time, the CCSR for ICD-10-CM diagnoses is only available as a SAS program.

CCSR v2021.2: Fiscal Year 2021, Released March 2021 - valid for ICD 10-CM diagnosis codes through September 2021 For convenience, the user documentation for the CCSR v2021.2 is also provided as separate documents:
The Comparison of the CCSR for ICD-10-CM Diagnoses, v2019.1, to the Beta Version of the CCS for ICD-10-CM Diagnoses, v2019.1, consists of the report and a supplemental Excel file:
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Copies of previous versions of the CCSR for ICD-10-CM diagnoses tool and the beta versions for ICD-10-CM are available for users who need to replace or access the old programs and documentation.
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Questions regarding the CCSR may be directed to HCUP User Support through the following channels: Phone (toll free): 1-866-290-HCUP.
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Internet Citation: Clinical Classifications Software Refined (CCSR)for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP). March 2021. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/toolssoftware/ccsr/dxccsr.jsp.
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Last modified 3/5/21