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Mental Health and Substance Abuse Clinical Classifications Software (CCS-MHSA) The Mental Health Substance Abuse Clinical Classifications Software (CCS-MHSA) 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. HCUP databases, tools, and software inform decision making at the national, State, and community levels.
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Beginning in Fiscal Year 2008, the Mental Health Substance Abuse Clinical Classifications Software tool (CCS-MHSA) was permanently integrated into the Clinical Classifications Software tool (CCS). This enhancement affected both the CCS-MHSA general and specific stand-alone tools. The CCS-MHSA general tool now consists of 15 categories numbered 650-663, and 670. The CCS-MHSA specific tool now describes 41 classifications which are based on the multi-level category 5 found in the CCS. For more information on the integration, please see the 2009 CCS Software and User’s Guide at the link below: http://www.hcup-us.ahrq.gov/toolssoftware/ccs/ccs.jsp | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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CCS-MHSA assigns variables that identify mental health and substance abuse-related diagnoses in hospital discharge records using the diagnosis coding of ICD-9-CM (International Classification of Diseases, Ninth Edition, Clinical Modification). CCS-MHSA can be used with any data that include ICD-9-CM diagnosis information. CCS-MHSA may be used independently for studies that are concerned solely with mental health and/or substance abuse conditions, or it may be used in conjunction with pre-fy200 versions of the Clinical Classifications Software (CCS) . When used in conjunction with the older CCS versions, users have the option of either replacing the series of categories that apply to mental health and substance abuse conditions (CCS categories 65-75) or creating new CCS-MHSA category variables that exist in parallel with the original CCS category variables. CCS-MHSA is continually updated. The current version is based on ICD-9-CM codes that are valid for January 1980 through September 2009. This document describes the software that creates the CCS-MHSA categories. Select to download software. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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CCS-MHSA consists of 15 general categories of mental health conditions, as shown in Table 1. Several of the general categories can be broken down further into more specific categories. As a starting point for development of the CCS-MHSA, we used the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (APA, 1994). In addition, we consulted the ICD-9-CM code lists and classifications used in discussions with staff at the National Institutes for Mental Health (personal communication, NIMH, 2002), the Substance Abuse and Mental Health Services Administration (personal communication, SAMHSA, 2005), a peer-reviewed journal article (Pottick et al., 2000) and an algorithm developed by Billings (2004). A complete review of ICD-9-CM diagnosis codes was conducted in order to identify any diagnosis code that reflects a mental health or substance abuse condition. In general, we followed the categorization of mental health and substance abuse conditions and code assignments outlined in the DSM-IV. Additional codes, such as mental disorders in pregnancy (64840-64844), drug dependency in pregnancy (64830-64834), and additional V codes, were included as a result of communications with NIMH and SAMHSA and a review of the Billings algorithm. External cause of injury codes (E codes) that indicated the injury was self-inflicted or related to a suicide attempt were also incorporated in accordance with the Billings algorithm. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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The CCS-MHSA software consists of two translation tables in Comma Separated Values (CSV) File format (one table for general and one for specific) and two SAS programs (one program for integrating the CCS-MHSA into data sets with the original CCS and one for creating new CCS-MHSA categories). The latest version of the CCS-MHSA tool can be used with any year of data (similar to the CCS) because the tool is cumulative. How the translation files are used will depend on the software system being used. For example, if SAS is involved, these translations could be adapted to create a SAS PROC FORMAT. In SPSS, these translations could be adapted into VALUE LABELS or into a series of recodes. In Stata, the translations can be modified through a series of GENERATE and REPLACE commands. General Categories. The translation table CCS-MHSA_General_09.csv can be used to create the following 15 general CCS-MHSA categories:
Specific Categories: The translation table CCS-MHSA_Specific_09.csv can be used to create more specific CCS-MHSA categories. As of fy2008, this table is based on the multi-level CCS categorization scheme. As described above, a number of the general categories are split into more specific categories, shown in Table 1. For example, category 654, Developmental Disorders, falls under multi-level 1 category 5 (Mental Illness), multi-level 2 category 5.5 (Developmental disorders), and is further divided into the following level 3 categories: 5 Mental Illness 5.5 Developmental disorders 5.5.1 Communication disorders 5.5.2 Developmental disabilities 5.5.3 Intellectual disabilities 5.5.4 Learning disorders 5.5.5 Motor skill disorders | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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CCS-MHSA comprehensively identifies all cases with potential mental health or substance abuse disorders. In order to apply the CCS-MHSA to your data set that contains ICD-9-CM diagnosis codes, the following SAS program can be used. CCS-MHSA_Load.txt This program can be employed to create the general or specific CCS-MHSA categories, depending on which translation table is used: CCS-MHSA_General.csv will create only the general categories 650-663; CCS-MHSA_Specific.csv will create the general as well as the specific categories. How to Use CCS-MHSA with the Original CCS for Diagnoses CCS-MHSA comprehensively identifies all cases with potential mental health or substance abuse disorders. In order to use the CCS-MHSA programs in conjunction with the original CCS for diagnoses, researchers can replace the mental health categories in the CCS with the CCS-MHSA categories. The following SAS program can be utilized to integrate the CCS-MHSA with the original CCS. CCS-MHSA_Integration_09.txt Use of this program for replacement will result in the integration of CCS-MHSA general categories 650-663, and 670. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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In practice, ICD-9-CM diagnoses are represented by 3- to 5-character codes with explicit decimals. In the files you download and in the vast majority of data files, ICD-9-CM diagnosis codes are represented as 5-character alphanumeric codes with implicit decimals. (Alphanumeric codes are always enclosed in quotation marks.) Examples are given below.
For proper handling of diagnosis codes:
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American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, DC, American Psychiatric Association, 1994. Billings J. Software for Use of the Emergency Department Classification Algorithm. In Tools for Monitoring the Health Care Safety Net. (Ed. R. Weinick, J. Billings) AHRQ Publication No. 03-0027, September 2003. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/data/safetynet/tools.htm, and http://www.ahrq.gov/data/safetynet/toolsoft.htm for a SAS program that includes ICD-9-CM codes for mental health and drug- or alcohol-related conditions). Personal communication with staff at NIMH. In context of interagency collaboration on children’s hospitalizations for mental health and substance abuse conditions. August, 2002. Personal communication with staff at SAMHSA. In context of interagency collaboration on emergency department events for mental health and substance abuse conditions. Spring, 2005. Pottick KJ, McAlpine DD, Andelman RB. Changing patterns of psychiatric inpatient care for children and adolescents in general hospitals, 1988-1995. Am J Psychiatry, 2000: 157(8): 1267-1273. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Web Browser Download: Your browser may support loading the files from this Web page. To download the files from this page, click on the following links with the right mouse button and select "Save Link As" (Netscape) or "Save Target As" (Internet Explorer). After saving a file, find the file by using Windows® Explorer (Windows® 95/98/NT/2000/XP) or File Manager (Windows® 3.x) and then open it by double-clicking on the file name. The latest version of the CCS-MHSA tool (fiscal year 2008) utilizes the new categorization scheme and can be used with any year of data (similar to the CCS).
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These versions of the tool should be employed by users who want the prior categorization scheme.
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Questions regarding the CCS-MHSA may be directed to HCUP User Support through the following channels:
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| Additional information is available on the AHRQ Website. If you have comments, suggestions, and/or questions, please contact hcup@ahrq.gov. |
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Internet Citation: HCUP MHSA.
Healthcare Cost and Utilization Project (HCUP). January 2008 Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/toolssoftware/mhsa/mhsa.jsp. |
| Last modified 1/7/08 |