title: Pediatric complex chronic conditions classification system version 2: updated for ICD-10 and complex medical technology dependence and transplantation.
abstract: BACKGROUND
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  The updated CCC v2 system is comprehensive and multidimensional, and provides a necessary update to accommodate widespread implementation of ICD-10.
authors.affiliation: Pediatric Advanced Care Team and the Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, CHOP North-Room 1523, 34th and Civic Center Blvd, Philadelphia, PA 10194, USA. feudtner@email.chop.edu.
authors.forename: Chris
authors.initials: C
authors.lastname: Feudtner
authors.forename: James A
authors.initials: JA
authors.lastname: Feinstein
authors.forename: Wenjun
authors.initials: W
authors.lastname: Zhong
authors.forename: Matt
authors.initials: M
authors.lastname: Hall
authors.forename: Dingwei
authors.initials: D
authors.lastname: Dai
mesh_terms: D020811:Biomedical Technology; D002648:Child; D002908:Chronic Disease / Q000145:classification* / Q000453:epidemiology / Q000628:therapy; D059019:Clinical Coding; D015897:Comorbidity; D016208:Databases, Factual; D006302:Health Services Research; D006801:Humans; D038801:International Classification of Diseases; D016377:Organ Transplantation; D010372:Pediatrics; D014481:United States / Q000453:epidemiology
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