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

TLDR

The pediatric complex chronic conditions (CCC) classification system requires revision to accommodate ICD‑10 and to include new neonatal, technology‑dependence, and transplantation domains. The authors updated CCC v2 by incorporating omitted ICD‑9 codes, translating between ICD‑9 and ICD‑10 with GEMs, reviewing diagnostic and procedural codes for technology dependence and transplantation, applying the provisional system to death certificates and health‑utilization databases, correcting misclassifications, and evaluating stability across ICD versions and over time. CCC v2 shows close comparability between ICD‑9 and ICD‑10, no significant discontinuity in US death trends, and increases CCC identification by 1.0% in hospitalizations and 0.4% in emergency departments, confirming its comprehensiveness and necessity for ICD‑10 implementation.

Abstract

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