Chronic Condition Indicator The Chronic Condition Indicator for the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) 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 Chronic Condition Indicator is created to facilitate health services research on diagnoses using administrative data. This classification system allows researchers to readily determine whether a diagnosis is a chronic condition. In addition, the tool groups all diagnoses into body systems so that users can create indicators listing which specific body systems are affected by a chronic condition.
The Chronic Condition Indicator provides an easy way for users to categorize ICD-10-CM diagnosis codes into one of two categories: chronic or not chronic. Examples of chronic conditions include conditions such as malignancies, diabetes, most forms of mental illness, hypertension, many forms of heart disease, and congenital anomalies. Not chronic conditions include conditions such as infections, pregnancy, many neonatal conditions, nonspecific symptoms, and injuries. To obtain the entire listing of all conditions, view the downloadable file that contains a listing of all ICD-10-CM codes and their assignment to chronic or not chronic. Diagnosis codes for this tool are based on the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), a uniform and standardized coding system. The ICD-10-CM has a multitude of codes—over 69,800 diagnosis codes. This documentation provides an overview of the following:
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The Chronic Condition Indicator categorizes all ICD-10-CM diagnosis codes as chronic or not chronic. A chronic condition is defined as a condition that lasts 12 months or longer and meets one or both of the following tests:
(1) it places limitations on self-care, independent living, and social interactions; and (2) it results in the need for ongoing intervention with medical products, services, and special equipment.1 The identification of chronic conditions is based on all 7-digit ICD-10-CM codes. External cause of injury codes are not classified because all injuries are assumed to be not chronic. Background The algorithm originated with work reported by Hwang et al.2 in which selected 3-digit ICD-9-CM codes were classified as chronic conditions. That study used diagnosis information from the Medical Expenditure Panel Survey (MEPS), which is based on patient self-report and thus lacks the specificity of physician-assigned diagnoses. For the Hwang et al. study, a physician panel reviewed each diagnosis code that appeared in MEPS data and determined whether the code represented a chronic condition. The Hwang et al. method was enhanced for the inpatient data in this study because a large number of conditions had not been coded in MEPS data and thus were not classified. In addition, a number of ICD-9-CM codes at the 3-digit level had been designated as acute even though they may subsume more specific constituent 5-digit codes of chronic conditions. Thus, each 5-digit code was reviewed by a health services researcher with a clinical background using the Hwang et al. classification as well as other sources that provided information on the chronicity of specific conditions.3,4,5,6,7 Disagreements with the original classification of Hwang et al. were resolved in consultation with one of the original physician panel members. As a final step, an expert medical coder reviewed the assignment of all ICD-9-CM codes, resulting in the reassignment of some codes. Logic Employed for ICD-10-CM Chronic Condition Indicator Mapping In preparation for the October 2015 implementation of ICD-10-CM, the diagnosis and procedure tools from HCUP were converted to the new coding system. The mapping was completed by linking ICD-10-CM diagnosis codes to the current Chronic Condition Indicator assignments via the General Equivalence Mappings (GEMs) available from the Centers for Medicare & Medicaid Services (CMS) Web site (see http://www.cms.gov/Medicare/Coding/ICD10/2014-ICD-10-CM-and-GEMs.html for more information on GEMS). Two GEMs are available for the CM code set; ICD9 to ICD10 and ICD10 to ICD9. In order to ensure complete inclusion of both ICD-9-CM and ICD-10-CM codes, both code maps were combined and de-duplicated to form a complete many-to-many map that included all ICD-9-CM and ICD-10-CM codes. This approach was used to ensure that all applicable codes would be used in the mapping process that centered on the Chronic Condition Indicator assignments. Continuing to use the Hwang et al. designation of chronic (1) versus not chronic (0) with other references mentioned above, ICD-10-CM codes assignments were made. In addition there were a number of exceptions to the Hwang et al. designation of chronic (1) versus not chronic (0) for ICD-9-CM. These exceptions were used and updated for ICD-10-CM and are as follows:
In an effort to keep data consist across the ICD-9-CM to ICD-10-CM conversion, the body system indicator is based on the chapters of the ICD-9-CM codebook. This indicator may be useful as a means of counting the number of body systems affected by chronic conditions. Alternatively, the Clinical Classifications Software (CCS) may be used in conjunction with the Chronic Condition Indicator to obtain a count of the number of relatively discrete chronic conditions. | ||||||||||||
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System Requirements
In order to use the Chronic Condition Indicator file for ICD-10-CM, you will need a program (such as WinZip®) that will allow you to decompress or "unzip" files. You will also need approximately five megabytes of disk space available on your hard drive to accommodate the Chronic Condition Indicator file. Required Data Elements The Chronic Condition Indicator file for ICD-10-CM requires diagnosis codes (ICD-10-CM) with no embedded periods. File Layout The Chronic Condition Indicator file for ICD-10-CM is composed of four fields separated by commas. The file is organized as follows:
There is one downloadable self-extracting zipped file called cci_icd10cm_2017.zip. Users are advised to:
Using the Translation File The translation file translates specific ICD-10-CM codes into Chronic Condition Indicator and Body System categories. Your use of the file will depend on the software system being used. For example, if you are using SAS, you can adapt these translations to create a SAS PROC FORMAT. If you are working with SPSS, you can adapt these translations into VALUE LABELS or into a series of recodes. The chronic indicator is defined as either 0-not chronic condition or 1-chronic condition. The body system indicator is divided into the following categories:
In practice, ICD-10-CM diagnoses are represented by 3- to 7-character codes with explicit decimals. In the files that you downloaded and in the vast majority of data files, ICD-10-CM diagnoses are represented with implicit decimals (no decimals present). (Alphanumeric codes are always enclosed in quotation marks.) Examples are given below.
For proper handling of diagnosis codes, perform the following steps:
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Note: New diagnoses codes were added for Fiscal Year 2017.
Shift-click from this Web page: Your browser may support loading the file for the ICD-10-CM Chronic Condition Indicator from this Web page. To download the file from this Web page, click on the following link with the right mouse button and select Save Link As (Firefox) or Save Target As (Internet Explorer). After saving the file, find the file by using Windows® Explorer (Windows 98/95/NT/Vista/7/8/10) or File Manager (Windows 3.x), and then open it by double clicking on it. ASCII Chronic Condition Indicator for ICD-10-CM file for Use with user analytic software (i.e., SAS, STATA, or SPSS) cci_icd10cm_2017.zip (ZIP file, 494 KB). | ||||||||||||
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There are currently no publications using Chronic Condition Indicator for ICD-10-CM Tool. Selected publications that use the ICD-9-CM version of the CCI include:
Fox J P, Philip E J, Gross C P, Desai RA, Killelea B, Desai MM. 2013. "Associations between mental health and surgical outcomes among women undergoing mastectomy for cancer." Breast Journal. Hansen M, Fleischman R, Meckler G, Newgard CD. 2013. "The association between hospital type and mortality among critically ill children in US EDs." Resuscitation. Miller CM, Shi J, Wheeler KK, Yin H, Smith GA, Groner J I, Xiang H. 2013. "Chronic conditions and outcomes of pediatric trauma patients." Journal of Trauma Acute Care Surgery. Sammon J, Trinh VQ, Ravi P, Sukumar S, Gervais M K, Shariat SF, Larouche A, Tian Z, Kim SP, Kowalczyk KJ, Hu JC, Menon M, Karakiewicz PI, Trinh QD, Sun M. 2013. "Health care-associated infections after major cancer surgery: Temporal trends, patterns of care, and effect on mortality." Cancer. Sharp AL, Choi H, Hayward RA. 2013. "Don't get sick on the weekend: an evaluation of the weekend effect on mortality for patients visiting US EDs." American Journal of Emergency Medicine. Steiner CA, Friedman B. 2013. "Hospital utilization, costs, and mortality for adults with multiple chronic conditions, nationwide inpatient sample, 2009." Prev Chronic Dis. Sun GH, Auger KA, Aliu O, Patrick SW, DeMonner S, Davis MM. 2013. "Variation in inpatient tonsillectomy costs within and between US hospitals attributable to postoperative complications." Med Care. Ahuja N, Zhao W, Xiang H. 2013. "Medical errors in US pediatric inpatients with chronic conditions." Pediatrics. Friedman B, Jiang HJ, Steiner CA, Bott J. 2012. "Likelihood of hospital readmission after first discharge: Medicare Advantage vs. fee-for-service patients." Inquiry. Chi MJ, Lee CY, Wu SC. 2011. "The prevalence of chronic conditions and medical expenditures of the elderly by chronic condition indicator (CCI)." Archives of gerontology and geriatrics. Friedman B, Jiang HJ. 2010. "Do Medicare Advantage enrollees tend to be admitted to hospitals with better or worse outcomes compared with fee-for-service enrollees?" Int J Health Care Finance Econ. Friedman B, Jiang HJ, Elixhauser A, Segal A. 2006. "Hospital costs for adults with multiple chronic conditions." Medical Care Research and Review 63(3): 327-346. | ||||||||||||
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Questions regarding the Chronic Condition Indicator may be directed to HCUP User Support through the following channels:
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Internet Citation: HCUP Chronic Condition Indicator. Healthcare Cost and Utilization Project (HCUP). October 2016. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/toolssoftware/chronic_icd10/chronic_icd10.jsp. |
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Last modified 10/13/16 |