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

Abstract

BackgroundThe 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.ResultsThe 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.ConclusionsThe updated CCC v2 system is comprehensive and multidimensional, and provides a necessary update to accommodate widespread implementation of ICD-10.

Use of Low-Value Pediatric Services Among the Commercially Insured

“…For many of the narrow measures, we employed a modified version of a widely used administrative algorithm to exclude services received by children with a "complex chronic condition" (eg, congenital anomalies, dependence on technology, cancer). 57 These children are excluded from many clinical practice guidelines, and assessment of care appropriateness for these children may be difficult without detailed clinical information. Other restrictions were based on relevant studies, guidelines, and reports identifying each service as low-value ( Table 1).…”

Mental Health Conditions and Medical and Surgical Hospital Utilization

“…Clinical covariates included a count of the total number of complex chronic condition diagnoses and indicators for the presence of a complex chronic condition diagnosis in each of 12 organ systems. 22 …”

Improving Discharge Efficiency in Medically Complex Pediatric Patients

“…8 Patients with technology dependence "depend on medical technology to live or remain in their current state of health" (eg, tracheostomy, enteral feeding tube, cerebral spinal fluid shunt). 9,10 The majority of these children (55%) receive outpatient care at CCHMC's Complex Care Center, a medical home that provides primary care to 620 children with severe, chronic disease who receive care from ≥3 subspecialists.…”

“…However, the discharge process for medically complex patients remained inefficient; only 50% of patients on the HM service with neurologic impairment 8 and/or technology dependence 9,10 were discharged within 2 hours of meeting medical discharge goals. Preliminary work revealed that the medical team often overlooked the particular discharge needs of these medically complex patients and their families until after a child was medically ready for discharge.…”