PQI #5: How to Calculate COPD or Asthma in Older Adults Admission Rate

Chronic Obstructive Pulmonary Disease (COPD) is an umbrella term used to describe progressive lung diseases including emphysema, chronic bronchitis, refractory (non-reversible) asthma, and some forms of bronchiectasis. This disease is characterized by increasing breathlessness.

COPD affects an estimated 30 million individuals in the U.S., and over half of them have symptoms of COPD and do not know it. Early screening can identify COPD before major loss of lung function occurs.

Most cases of COPD are caused by inhaling pollutants; that includes smoking (cigarettes, pipes, cigars, etc.), and second-hand smoke.

Fumes, chemicals and dust found in many work environments are contributing factors for many individuals who develop COPD.

Genetics can also play a role in an individual’s development of COPD—even if the person has never smoked or has ever been exposed to strong lung irritants in the workplace.

How To Calculate Chronic Obstructive Pulmonary Disease (COPD) or Asthma in Older Adults Admission Rate

How the Single-level CCS Works

Single-level CCS is most useful for ranking of diagnoses and procedures and for direct integration into risk adjustment and other software. This Single-level CCS lassifies all diagnoses and procedures into unique groups, has a total of 285 mutually exclusive categories.

Now look for some Example of ‘Single-level  CCS’

CCS Category     CCS Category Desc
1        Tuberculosis
2        Septicemia (except in labor)
3        Bacterial infection; unspecified site
4        Mycoses
5        HIV infection
6        Hepatitis
7        Viral infection
8        Other infections; including parasitic
9        Sexually transmitted infections (not HIV or hepatitis)
10        Immunizations and screening for infectious disease

Now try to understand how the ICD-9 Rolled in each of the CCS Category:

CCS Category     CCS Category Desc    ICD9_diag_code    ICD-9-CM CODE DESCRIPTION

5        HIV infection        0439        ARC- UNSPECIFIED (Begin 1986 End 1994)
5        HIV infection        0420        HIV W/SPECIF INFECTIONS (Begin 1986 End 1994)
5        HIV infection        0421        HIV CAUS OTH SPEC INFECT (Begin 1986 End 1994)
5        HIV infection        0422        HIV W/SPEC MALIG NEOPLSM (Begin 1986 End 1994)
5        HIV infection        0429        AIDS- UNSPECIFIED (Begin 1986 End 1994)
5        HIV infection        0430        HIV CAUS LYMPHADENOPATHY (Begin 1986 End 1994)
5        HIV infection        0431        HIV CAUS SP CNS DISEASE (Begin 1986 End 1994)
5        HIV infection        042        HIV DISEASE (Begin 1994)
5        HIV infection        0433        HIV CAUS OTH SPECIF COND (Begin 1986 End 1994)
5        HIV infection        V08        HIV POSITIVE NOS (Begin 1994)
5        HIV infection        0440        HIV CAUS ACUTE INFECTION (Begin 1986 End 1994)
5        HIV infection        0449        HIV- UNSPECIFIED (Begin 1986 End 1994)
5        HIV infection        07953        HIV TYPE 2 (Begin 1993)
5        HIV infection        27910        IMMUNDEF T-CELL DEF NOS
5        HIV infection        27919        DEFIC CELL IMMUNITY NOS
5        HIV infection        79571        NONSPECIFIC SEROLOG HIV (Begin 1994)
5        HIV infection        7958        POSITIVE SERO/VIRAL HIV (Begin 1986 End 1994)
5        HIV infection        0432        HIV CAUS OT DISOR IMMUNE (Begin 1986 End 1994)

CCS Category     CCS Category Desc            ICD9_diag_code ICD-9-CM CODE DESCRIPTION

9    Sexually transmitted infections (not HIV or hepatitis)    0939    CARDIOVASCULAR SYPH NOS
9    Sexually transmitted infections (not HIV or hepatitis)    096    LATE SYPHILIS LATENT
9    Sexually transmitted infections (not HIV or hepatitis)    09482    SYPHILITIC PARKINSONISM
9    Sexually transmitted infections (not HIV or hepatitis)    09481    SYPHILITIC ENCEPHALITIS
9    Sexually transmitted infections (not HIV or hepatitis)    0943    ASYMPTOMAT NEUROSYPHILIS
9    Sexually transmitted infections (not HIV or hepatitis)    0942    SYPHILITIC MENINGITIS
9    Sexually transmitted infections (not HIV or hepatitis)    09484    SYPHILITIC OPTIC ATROPHY
9    Sexually transmitted infections (not HIV or hepatitis)    0940    TABES DORSALIS
9    Sexually transmitted infections (not HIV or hepatitis)    09485    SYPH RETROBULB NEURITIS
9    Sexually transmitted infections (not HIV or hepatitis)    09389    CARDIOVASCULAR SYPH NEC
9    Sexually transmitted infections (not HIV or hepatitis)    09382    SYPHILITIC MYOCARDITIS
9    Sexually transmitted infections (not HIV or hepatitis)    09381    SYPHILITIC PERICARDITIS
9    Sexually transmitted infections (not HIV or hepatitis)    09324    SYPHIL PULMONARY VALVE
9    Sexually transmitted infections (not HIV or hepatitis)    09323    SYPHIL TRICUSPID VALVE

The Other ICD-9 Codes that also used in CCS category 9 are:
09322,0941,0952,0900,0958,0957,0956,0955,09483,0953,0931,0951,0950,0949,09489,09487,09486, 0954,09049,0912,0911,0910,0909,0907,09321,0905,09150,09042,09041,09040,0903,0902,0901,0906, 0917,0970,0930,0929,0920,0919,09189,0913,09181,0914,09169,09162,09161,09152,09151,09320, 09182,09886,0959,0994,0993,0992,0991,09941,09889,09949,09885,09884,09883,09882,09881, 0987,0990,09956,79675,79519,79515,79505,0999,09940,09959,09853,09955,09954,09953,09952, 09951,09950,0998,09813,09830,0982,09819,09817,09816,0986,09814,09833,09812,09811,09810, 0980,0979,0971,09815,09840,79679,09852,09851,09850,09849,09843,09831,09841,09832,09839, 09837,09836,09835,09834,09859,09842

Know About CCS Or Clinical Classifications Software

Clinical Classifications Software (CCS) is another commonly used term in health care sector. CCS collapses diagnosis and procedure codes from the ICD-9 Codes, which contains more than 14,000 diagnosis codes and 3,900 procedure codes.

This can be employed in many types of projects analyzing data on diagnoses and procedures. CCS can be used to identify populations for disease- or procedure-specific studies or to develop statistical reports providing information about relatively specific conditions.

Developed at the Agency for Healthcare Research and Quality (AHRQ), the Clinical Classifications Software (CCS) makes

CCS classification systems:
1.    Single-level
2.    Multi-level
Single-level :  Single-level CCS is most useful for ranking of diagnoses and procedures and for direct integration into risk adjustment and other software. This Single-level CCS lassifies all diagnoses and procedures into unique groups, has a total of 285 mutually exclusive categories.
Multi-level: Multi-level CCS is most useful when evaluating larger aggregations of conditions and procedures or exploring them in greater detail. The multi-level CCS expands the single-level CCS into a hierarchical system. The multi-level CCS groups single-level CCS categories into broader body systems or condition categories. It also splits single-level CCS categories to provide more detail. The multi-level system has four levels for diagnoses and three levels for procedures, which provide the opportunity to examine general groupings or to assess very specific conditions and procedures.

Use of CCS:

CCS can be used with all clinical data that are coded using ICD-9-CM codes.
•    Managed care plans utilize CCS to rank hospitalizations by type of condition. Managed care plan used CCS to examine numbers of cases, length of stay, and total costs, to better understand which conditions and procedures were associated with the highest resource use.
•    Insurers use CCS to develop clinically-based utilization profiles.
•    Researchers use CCS to explore the types of conditions and procedures that are most frequent in their study populations or to compare alternative treatments for similar conditions.
•    Researchers also use CCS in risk adjustment models and as a way to predict future health resource utilization.

it easier to quickly understand patterns of diagnoses and procedures so that health plans, policy makers, and researchers can analyze costs, utilization, and outcomes associated with particular illnesses and procedures.

What IS CCS Classification!!

Clinical Classifications Software (CCS) is a tool for clustering patient diagnoses and procedures into a manageable number of clinically meaningful categories. This was developed by Agency for Healthcare Research and Quality (AHRQ).

CCS is used to analyze costs, usage, and outcomes associated with patient diagnoses and procedures.

CCS is composed of diagnoses and procedures categories, which are organized in two related classification systems. The single-level system consists of 285 mutually-exclusive diagnosis categories, 231 mutually-exclusive procedure categories, and no hierarchical structure. The multi-level system uses the single-level categories and International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes in a hierarchical system consisting of four levels for diagnoses and three levels for procedures. This "clinical grouper" makes it easier to quickly understand patterns of diagnoses and procedures so that health plans, policy makers, and researchers can analyze costs, utilization, and outcomes associated with particular illnesses and procedures.

How Often id Updates?
CCS is updated annually.

How Is CCS Used?

Clinical Classifications Software can be used with all clinical data that are coded using ICD-9-CM codes. CCS is used in a variety of ways:

Managed care plans utilize CCS to rank hospitalizations by type of condition. One managed care plan used CCS to examine numbers of cases, length of stay, and total costs, to better understand which conditions and procedures were associated with the highest resource use.
Insurers use CCS to develop clinically-based utilization profiles. For example, one insurer integrated CCS into in-house software that develops profiles of patient populations and purchasers.
Researchers use CCS to explore the types of conditions and procedures that are most frequent in their study populations or to compare alternative treatments for similar conditions. In one study of differences in use of procedures among payers, CCS procedure categories provided a convenient grouping scheme.
Researchers also use CCS in risk adjustment models and as a way to predict future health resource utilization. Investigators in one study found that categorizing patients using CCS predicted more than 40 percent of the subsequent year's medical expenses.