The Clinical Classifications Software for Services and Procedures (CCS-Services and Procedures) 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.

The CCS-Services and Procedures is being made available for users who would like to apply the CCS procedure categories to their CPT/HCPCS-based data. We look forward to your comments and suggestions for changes and improvements.

Contents:

• Overview of CCS-Services and Procedures
• Information about CPT and HCPCS Codes in the CCS-Services and Procedures
• Description of the Software
• Details on the Process for Assigning CPT and HCPCS Codes to CCS Categories
• Downloading Information
• More Information, Comments, or Questions?
• Table 1 - CCS-Services and Procedures Procedure Categories

CCS-Services and Procedures provides a method for classifying Current Procedural Terminology (CPT®) codes and Healthcare Common Procedure Coding System (HCPCS) codes into clinically meaningful procedure categories. CPT is a proprietary coding system developed by the American Medical Association (AMA) for coding services provided by health care professionals. CPT is also referred to as HCPCS Level I. HCPCS (also referred to as HCPCS Level II) is a supplementary coding system developed by the Centers for Medicare and Medicaid Services (CMS) to account for supplies and services not accounted for in CPT (HCPCS Level I). The procedure categories are identical to the CCS with the addition of specific categories unique to the professional service and supply codes in CPT/HCPCS. CCS-Services and Procedures is current as of 2012 and can be used with any data that include CPT or HCPCS procedure information.

More than 9,000 CPT/HCPCS codes and 6,000 HCPCS codes are collapsed into 244 clinically meaningful categories that may be more useful for presenting descriptive statistics than are individual CPT or HCPCS codes. For example, CCS-Services and Procedures can be used to identify populations for procedure-specific studies or to develop statistical reports providing information (such as charges and length of stay) about relatively specific procedures.

For a list of CCS-Services and Procedures procedure categories, see Table 1.

The five-character codes included in the Clinical Classifications Software for Services and Procedures are obtained from the Current Procedural Terminology (CPT®), copyright 2012 by the American Medical Association (AMA). CPT is developed by the AMA as a listing of descriptive terms and five–character identifying codes and modifiers for reporting medical services and procedures performed by physicians.

The responsibility for the content of Clinical Classifications Software for Services and Procedures is with the U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality (AHRQ) and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Clinical Classifications Software for Services and Procedures. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. Any use of CPT outside Clinical Classifications Software for Services and Procedures should refer to the most current Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. Applicable FARS/DFARS apply.

CPT is a registered trademark of the American Medical Association.

Five character codes in the Clinical Classifications Software for Services and Procedures are also obtained from the Healthcare Common Procedure Coding System (HCPCS).

This tool includes CPT and HCPCS five-character codes. Descriptive terms for individual CPT codes are not included because CPT codes are proprietary; descriptions of individual HCPCS codes are not included as well. Any use of CPT outside CCS-Services and Procedures should refer to the most current (CPT) which contains the complete and most current listings of CPT descriptive terms and five-character identifying codes and modifiers for reporting medical services and procedures.

Certain CPT and HCPCS codes are used to code performance measurement and Medicare-approved demonstration projects; these codes are not included in the CCS-Services and Procedures. For example, a series of HCPCS codes (G8006-G9140) are used to provide information on assessments done for a Medicare-approved demonstration project on patient-reported nausea or vomiting associated with chemotherapy, and are excluded from this classification. The CPT-4 Category II codes are also excluded 0001F-6020F.

Some CCS categories do not include CPT codes because no exact matches were found for these procedures. These categories include 133 (Episiotomy) and 136 (Artificial rupture of membranes to assist delivery).

No fee schedules, basic unit values, relative value guides, conversion factors, or scales are included in any part of CPT or CCS-Services and Procedures.

The CCS-Services and Procedures consists of one translation table in Comma Separated Values (CSV) File format that creates CCS categories for data sets that contain CPT or HCPCS information. How the translation file is used will depend on the software system being used. For example, if SAS is employed, the translation table could be adapted to create a SAS PROC FORMAT. If SPSS is used, the translation table could be adapted into VALUE LABELS or into a series of recodes.

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

The CCS-Services and Procedures aggregates CPT and HCPCS codes into 244 mutually exclusive categories. Many of the categories represent unique procedure types. Some procedures that occur infrequently are grouped according to body system. Body system categories are further delineated as diagnostic or therapeutic and whether they are considered operating room or non-operating room procedures, according to Diagnosis Related Groups definitions.

The CCS-Services and Procedures contains CPT codes valid at any time between January 1992 and January 2012 and HCPCS codes valid at any time between January 2002 and January 2012.

Process for Assigning CCS Categories to CPT/HCPCS Codes

Two certified clinical coding specialists assigned CPT/HCPCS codes to CCS categories. These assignments were then reviewed by AHRQ staff possessing clinical and administrative data experience. One clinical coding specialist identified the initial assignments, while the second provided assistance with decision making and overall review of the assignments made.

The following iterative process was used to assign CPT/HCPCS codes to CCS categories:

• Each CPT/HCPCS code was entered into Encoder Pro Professional© (a software application from Ingenix, Inc.)
• The CPT/HCPCS Crosscoder within the software was used to identify any and all ICD-9-CM procedure codes that might be comparable to the CPT/HCPCS code.
• Each ICD-9-CM code in the original CCS software was analyzed, in order to understand how the ICD-9-CM codes had been assigned to CCS categories.
• If there were multiple CCS categories for the comparable ICD-9-CM codes, one that best fits the description of the CPT/HCPCS code was chosen.
• If there was not one best category, the second coding specialist was consulted to make the determination.
• Assignments were reviewed by AHRQ staff; questions about assignments were raised.
• CPT/HCPCS code assignments were reviewed by the coding specialists and reassignments were made.
• A final review was conducted by AHRQ staff.

Guidelines for Assigning CCS Categories to CPT/HCPCS Codes

In the course of assigning CPT/HCPCS codes to CCS categories, a series of guidelines were developed to ensure consistent code assignments:

• If the code included two OR procedures, the one that would result in the greatest morbidity, extent of surgery, or resource use took precedence.


Examples:

CPT 43305 Esophagoplasty (plastic repair or reconstruction), cervical approach; with repair of tracheoesophageal fistula.


Assigned to CCS category


94    Other OR upper GI therapeutic procedures


not

42    Other OR therapeutic procedures on respiratory system and mediastinum



Because the repair of the esophagus would result in greater morbidity or resource use than the repair of the trachea fistula.

CPT 31294 Nasal/sinus endoscopy, surgical; with optic nerve decompression


Assigned to CCS category


33    Other OR therapeutic procedures on nose, mouth and pharynx


not

9    Other OR therapeutic nervous system procedures



Because the decompression of the nerve is not as great as the surgical procedure to gain entry to the sinus cavity.

• When a CPT/HCPCS code could be assigned to a more specific category or to a more general category, we opted for the most specific.


Example:

CPT 34451 Thrombectomy, direct or with catheter; vena cava, iliac, femoropopliteal vein, by abdominal and leg incision


Assigned to CCS category


60    Embolectomy and endarterectomy of lower limbs


not

61    Other OR procedures on vessels other than head and neck



In a general sense, this procedure fits into CCS category 61; however, a more specific category is available for this procedure to remove a clot in the leg.

• Codes were assigned to the body system associated with a physician´s specialty.


Example:

CPT 33282 Implantation of patient-activated cardiac event recorder


Assigned to CCS category


62    Other diagnostic cardiovascular procedures


not

174    Other non-OR therapeutic procedures on skin and breast



Although the procedure itself includes an incision and dissection down to the subcutaneous tissue to implant the recorder, a cardiologist will most likely be performing this procedure. This categorization scheme enhances agreement in studies that compare inpatient (ICD) and ambulatory surgery (CPT) data.

• If a CPT/HCPCS code contained both diagnostic and therapeutic components, and the applicable CCS categories were split between these two types of services, the therapeutic aspect took precedence.


Examples:

CPT 22830 Exploration of spinal fusion


Assigned to CCS category


161    Other OR therapeutic procedures on bone


not

159    Other diagnostic procedures on musculoskeletal system



Although it may be diagnostic only, therapeutic repair is included in this code if defects are found and corrections are made.

CPT 29838 Arthroscopy, elbow, surgical; debridement, extensive


Assigned to CCS category


162    Other OR therapeutic procedures on joints


not

149    Arthroscopy



Because CCS categories do not allow for multiple assignments, the arthroscopy category is for minor or diagnostic codes only, and this code includes a therapeutic debridement.

• If there were both operating room (OR) and non-operating room components, the OR category was chosen.


Examples:

CPT 30110 Excision, nasal polyp(s), simple


Assigned to CCS category


33    Other OR therapeutic procedures on nose, mouth and pharynx


not

32    Other non-OR therapeutic procedures on nose, mouth and pharynx



Although this is generally performed in the office, it is done in OR as well (e.g., with children or if the polyp is large). However, it is still done with a local anesthetic and may require packing during the first 24 hours.

CPT 50392 Introduction of intracatheter or catheter into renal pelvis for drainage and/or injection, percutaneous


Assigned to CCS category


112    Other OR therapeutic procedures of urinary tract


not

111    Other non-OR therapeutic procedures of urinary tract



This would be an OR procedure because the physician uses radiological guidance to advance the needle toward the renal pelvis.

• If a CPT/HCPCS code included the phrase "with or without" a specific additional procedure, the code was mapped to the more general category rather than the specific category in order to reduce erroneous categorization of those records that did not include the additional procedure.


Example:

CPT 54300 Plastic operation of penis for straightening of chordee (e.g., hypospadias), with or without mobilization of urethra


Assigned to CCS category


118    Other OR therapeutic procedures, male genital


not

109    Procedures on the urethra



The male genital category is chosen because the urethra procedure may or may not take place.

New CCS Categories

The following new CCS categories were added to effectively represent codes specific to CPT and HCPCS.

	232	Anesthesia
	233	Laboratory - Chemistry and Hematology
	234	Pathology
	235	Other Lab
	236	Home Health Services
	237	Ancillary Services
	238	Infertility Services
	239	Transportation - patient, provider, equipment
	240	Medications (Injections, infusions and other forms)
	241	Visual aids and other optical supplies
	242	Hearing devices and audiology supplies
	243	DME and supplies
	244	Gastric bypass and volume reduction

1. 232 Anesthesia: To capture the increased resource use of anesthesia administered by an anesthesiologist or surgeon. Examples include anesthesia for procedures on spine, perineum, and arthroscopic surgery.



2. 233 Laboratory - Chemistry and Hematology: Chemistry testing of specimens (i.e., serum, blood, feces) by a physician or a technologist under physician supervision. Examples include basic metabolic panel, blood count, and pulse oximetry. This category is for chemistry and hematology only; all other labs were assigned CCS 235. (Note: Urinalysis tests can be found in CCS 206 Microscopic Exams and CCS 200 Urinary System Measurements.)



3. 234 Pathology: Anatomic, cytopathology, and surgical pathology services provided by a physician or a technologist under physician supervision. Examples include clinical pathology consult, postmortem exam, Pap smear, and gross and microscopic surgical pathology.



4. 235 Other Lab: Non-chemistry tests on specimens by a physician or a technologist under physician supervision. This category is used to capture labs outside CCS 233 Chemistry & Hematology. Examples include thyroid panel, drug assays, and antibody tests.



5. 236 Home Health Services: For evaluation and management services provided in a private residence. Examples include home visits for respiratory therapy, chemotherapy, and counseling.



6. 237 Ancillary Services: For services performed adjunct to a basic procedure or by an ancillary healthcare worker. Examples include transportation of specimens, medical testimony, and services by a dietitian.



7. 238 Infertility Services: Includes codes for infertility care such as in vitro fertilization and ovulation induction.



8. 239 Transportation: For emergency and non-emergency transportation of patients, medical staff, equipment, and tissue.



9. 240 Medications: For the provision of medications, infusions, injections, and other pharmaceutical services.



10. 241 Visual aids and other optical supplies: For all optical supplies including eye glasses, lenses, and prosthetics.



11. 242 Hearing devices and audiology supplies: For supplies related to hearing such as ear molds and impressions, hearing aids, and batteries for hearing aids.



12. 243 DME and supplies: A miscellaneous category for other forms of durable medical equipment and supplies including power sources and batteries, cables, injectable contrast materials, implantable devices, tissues for transplantations, joint replacement devices, non-ocular prostheses, compression stockings, orthotics, orthopedic devices, casting supplies, tape, continence supplies, wound care kits and supplies, dialysis equipment and solutions, ostomy supplies, catheters and stents, pacemakers and leads, and crutches.



13. 244 Gastric bypass and volume reduction: For all procedures dealing with gastric bypass and volume reduction, primarily for the purpose of bariatric surgery. (To ensure that all codes relate to obesity surgery, this code should be used in conjunction with diagnosis codes for obesity.)

Prior to downloading the CCS-Services and Procedures, users must agree to a license agreement with the AMA for using CPT codes.

Click here to access CCS-Services and Procedures

Questions or comments regarding CCS-Services and Procedures may be directed to HCUP User Support through the following channels:

• e-mail: hcup@ahrq.gov
• Phone (toll free): 1-866-290-HCUP