HCUP-US Tools & Software Page

<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN"> <!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN"> <html lang="en"> <head><script type="text/javascript" src="/_static/js/bundle-playback.js?v=HxkREWBo" charset="utf-8"></script> <script type="text/javascript" src="/_static/js/wombat.js?v=txqj7nKC" charset="utf-8"></script> <script>window.RufflePlayer=window.RufflePlayer||{};window.RufflePlayer.config={"autoplay":"on","unmuteOverlay":"hidden"};</script> <script type="text/javascript" src="/_static/js/ruffle/ruffle.js"></script> <script type="text/javascript"> __wm.init("https://web.archive.org/web"); __wm.wombat("http://www.hcup-us.ahrq.gov/toolssoftware/chronic/chronic.jsp","20140717094424","https://web.archive.org/","web","/_static/", "1405590264"); </script> <link rel="stylesheet" type="text/css" href="/_static/css/banner-styles.css?v=S1zqJCYt" /> <link rel="stylesheet" type="text/css" href="/_static/css/iconochive.css?v=3PDvdIFv" />  <title>HCUP-US Tools & Software Page</title> <link rel="stylesheet" href="/web/20140717094424cs_/http://www.hcup-us.ahrq.gov/HCUP_US.css"> <meta name="keywords" content="hcup, healthcare cost and utilization project, health, healthcare, health statistics, data analysis, analysis, data collection, data processing, databases, research">  <script type="text/javascript"> var steering = false; var team = false; var partner = false; var nhqrdr = false; </script> <script type="text/javascript" src="/web/20140717094424js_/http://www.hcup-us.ahrq.gov/menu/c_config.js"></script> <script type="text/javascript" src="/web/20140717094424js_/http://www.hcup-us.ahrq.gov/menu/c_smartmenus.js"></script>  </head> <body> <div id="skipmenu"> <a href="#skip" class="skippy">Skip Navigation</a> <a name="top"></a> </div> <div id="hideShow"> <table summary="layout" width="100%" cellspacing="2" cellpadding="0" border="0"> <tr> <td align="center" class="logoPanel" bgcolor="#006699"> <div id="logo"> <a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/"><img src="/web/20140717094424im_/http://www.hcup-us.ahrq.gov/images/HCUP_logo/hcuplogo_smaller_final.jpg" alt="Healthcare Cost and Utilization Project logo"></a> </div> </td> <td bgcolor="#66cccc" class="bannerPanel"><br> <div class="bannertitleinteriorpgs">Chronic Condition Indicator (CCI) for ICD-9-CM</div> <div class="bannertext">The CCI is one of the HCUP tools that can be applied to HCUP and other similar databases. These tools are created by AHRQ through a Federal-State-Industry partnership.</div> </td> <td bgcolor="#66cccc" valign="middle" class="searchPanel"> <form method="get" action="/web/20140717094424/http://www.hcup-us.ahrq.gov/search/Search.action"> <table cellpadding="0px" cellspacing="0px"> <tr> <td class="searchBox"> <input type="text" name="query"> </td> <td valign="middle" class="searchIcon"> <input type="image" src="/web/20140717094424im_/http://www.hcup-us.ahrq.gov/images/search-icon2.png" placeholder="Search" alt="search" class="search-icon" title="Search" width="10" height="11"> </td> </tr> </table> </form> </td> </tr> <tr> <td width="122" bgcolor="#66cccc"> </td> <td width="100%" colspan="2"><ul id="Menu1" class="MM"> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/"><br/>Home</a> <ul> <li><a class="NOLINK">What is HCUP?</a> <ul> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/overview.jsp">Overview of HCUP</a></li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/overviewcourse.jsp">On-line HCUP Overview Course</a></li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/tech_assist/faq.jsp">Frequently Asked Questions</a></li> </ul> </li> <li><a class="NOLINK">HCUP Products</a> <ul> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/databases.jsp">HCUP Databases</a></li> <li><a href="https://web.archive.org/web/20140717094424/http://hcupnet.ahrq.gov/" target="_blank">HCUPnet</a></li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/tools_software.jsp">HCUP Tools & Software</a></li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/reports.jsp">HCUP Reports</a></li> </ul> </li> <li><a class="NOLINK">HCUP Services</a> <ul> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/tech_assist/centdist.jsp">Purchase HCUP Data</a></li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/techassist.jsp">HCUP Technical Assistance</a></li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/tech_assist/tutorials.jsp">HCUP On-line Tutorials Series</a></li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/tech_assist/dua.jsp">HCUP Data Use Agreement Training</a></li> </ul> </li> </ul> </li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/databases.jsp"><br/>Databases</a> <ul> <li><a class="NOLINK"><strong>Nationwide HCUP Databases</strong></a></li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/databases.jsp">National (Nationwide) Inpatient Sample (NIS)</a> <ul> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/nisoverview.jsp">Overview of the NIS</a> <ul> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/partners.jsp?NIS">HCUP Partners in the NIS</a></li> </ul> </li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/tech_assist/centdist.jsp">Obtaining the NIS</a> <ul> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/tech_assist/dua.jsp">HCUP Data Use Agreement Training</a></li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/team/NationwideDUA.jsp">Nationwide Data Use Agreement</a></li> </ul> </li> <li><a class="NOLINK">Using the NIS</a> <ul> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/db/nation/nis/nisdbdocumentation.jsp">NIS Database Documentation </a></li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/db/nation/nis/nisrelatedreports.jsp">NIS Related Reports</a></li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/db/publishing.jsp">Publishing with HCUP Data</a></li> </ul> </li> </ul> </li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/databases.jsp">Kids' Inpatient Database (KID)</a> <ul> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/kidoverview.jsp">Overview of the KID</a> <ul> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/partners.jsp?KID">HCUP Partners in the KID</a></li> </ul> </li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/tech_assist/centdist.jsp">Obtaining the KID</a> <ul> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/tech_assist/dua.jsp">HCUP Data Use Agreement Training</a></li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/team/NationwideDUA.jsp">Nationwide Data Use Agreement</a></li> </ul> </li> <li><a class="NOLINK">Using the KID</a> <ul> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/db/nation/kid/kiddbdocumentation.jsp">KID Database Documentation</a></li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/db/nation/kid/kidrelatedreports.jsp">KID Related Reports</a></li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/db/publishing.jsp">Publishing with HCUP Data</a></li> </ul> </li> </ul> </li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/databases.jsp">Nationwide Emergency Department Sample (NEDS)</a> <ul> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/nedsoverview.jsp">Overview of the NEDS</a> <ul> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/partners.jsp?NEDS">HCUP Partners in the NEDS</a></li> </ul> </li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/tech_assist/centdist.jsp">Obtaining the NEDS</a> <ul> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/tech_assist/dua.jsp">HCUP Data Use Agreement Training</a></li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/team/NationwideDUA.jsp">Nationwide Data Use Agreement</a></li> </ul> </li> <li><a class="NOLINK">Using the NEDS</a> <ul> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/db/nation/neds/nedsdbdocumentation.jsp">NEDS Database Documentation </a></li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/db/nation/neds/nedsrelatedreports.jsp">NEDS Related Reports</a></li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/db/publishing.jsp">Publishing with HCUP Data</a></li> </ul> </li> </ul> </li> <li><a class="NOLINK"><strong>State-Specific HCUP Databases</strong></a></li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/databases.jsp">State Inpatient Databases (SID)</a> <ul> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/sidoverview.jsp">Overview of the SID</a> <ul> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/partners.jsp?SID">HCUP Partners in the SID</a></li> </ul> </li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/tech_assist/centdist.jsp">Obtaining the SID</a> <ul> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/tech_assist/dua.jsp">HCUP Data Use Agreement Training</a></li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/team/StateDUA.jsp">State Database Data Use Agreement</a></li> </ul> </li> <li><a class="NOLINK">Using the SID</a> <ul> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/db/state/siddbdocumentation.jsp">SID Database Documentation</a></li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/db/state/sidrelatedreports.jsp">SID Related Reports</a></li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/db/publishing.jsp">Publishing with HCUP Data</a></li> </ul> </li> </ul> </li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/databases.jsp">State Ambulatory Surgery and Services Databases (SASD)</a> <ul> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/sasdoverview.jsp">Overview of the SASD</a> <ul> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/partners.jsp?SASD">HCUP Partners in the SASD</a></li> </ul> </li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/tech_assist/centdist.jsp">Obtaining the SASD</a> <ul> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/tech_assist/dua.jsp">HCUP Data Use Agreement Training</a></li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/team/StateDUA.jsp">State Database Data Use Agreement</a></li> </ul> </li> <li><a class="NOLINK">Using the SASD</a> <ul> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/db/state/sasddbdocumentation.jsp">SASD Database Documentation</a></li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/db/state/sasdrelatedreports.jsp">SASD Related Reports</a></li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/db/publishing.jsp">Publishing with HCUP Data</a></li> </ul> </li> </ul> </li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/databases.jsp">State Emergency Department Databases (SEDD)</a> <ul> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/seddoverview.jsp">Overview of the SEDD</a> <ul> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/partners.jsp?SEDD">HCUP Partners in the SEDD</a></li> </ul> </li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/tech_assist/centdist.jsp">Obtaining the SEDD</a> <ul> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/tech_assist/dua.jsp">HCUP Data Use Agreement Training</a></li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/team/StateDUA.jsp">SEDD Data Use Agreement</a></li> </ul> </li> <li><a class="NOLINK">Using the SEDD</a> <ul> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/db/state/sedddbdocumentation.jsp">SEDD Database Documentation</a></li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/db/state/seddrelatedreports.jsp">SEDD Related Reports</a></li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/db/publishing.jsp">Publishing with HCUP Data</a></li> </ul> </li> </ul> </li> </ul> </li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/tools_software.jsp">Tools &<br/>Software</a> <ul> <li><a class="NOLINK">Favorites</a> <ul> <li><a href="https://web.archive.org/web/20140717094424/http://hcupnet.ahrq.gov/" target="_blank">HCUPNet</a></li> <li><a href="https://web.archive.org/web/20140717094424/http://qualityindicators.ahrq.gov/" target="_blank">AHRQ Quality Indicators (QIs)</a></li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/toolssoftware/monahrq/monahrq.jsp">MONAHRQ</a></li> </ul> </li> <li><a class="NOLINK">HCUP Tools & Software</a> <ul> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/toolssoftware/beta/icd_10_beta.jsp">ICD-10-CM/PCS Beta</a></li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/toolssoftware/ccs/ccs.jsp">Clinical Classifications Software (CCS) for ICD-9-CM</a></li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/toolssoftware/ccs_svcsproc/ccssvcproc.jsp">Clinical Classifications Software (CCS) for Services and Procedures</a></li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/toolssoftware/icd_10/ccs_icd_10.jsp">Clinical Classifications Software (CCS) for ICD-10</a></li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/toolssoftware/mhsa/mhsa.jsp">Clinical Classifications Software for Mental Health and Substance Abuse (CCS-MHSA)</a></li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/toolssoftware/chronic/chronic.jsp">Chronic Condition Indicator</a></li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/toolssoftware/comorbidity/comorbidity.jsp">Comorbidity Software</a></li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/toolssoftware/procedure/procedure.jsp">Procedure Classes</a></li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/toolssoftware/util_flags/utilflag.jsp">Utilization Flags</a></li> </ul> </li> <li><a class="NOLINK">HCUP Supplemental Files</a> <ul> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/db/state/costtocharge.jsp">Cost-to-Charge Ratio (CCR) Files</a></li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/toolssoftware/hms/hms.jsp">Hospital Market Structure (HMS) Files</a></li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/toolssoftware/revisit/revisit.jsp">HCUP Supplemental Variables for Revisit Analyses</a></li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/db/state/ahalinkage/aha_linkage.jsp">American Hospital Association (AHA) Linkage Files</a></li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/db/nation/nis/nisownership.jsp">NIS Hospital Ownership Files</a></li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/db/nation/nis/nistrends.jsp">Nationwide Inpatient Sample Trends (NIS-Trends) Files</a></li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/db/nation/kid/kidtrends.jsp">Kid’s Inpatient Database Trends (KID-Trends) File</a></li> </ul> </li> </ul> </li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/reports.jsp"><br/>Reports</a> <ul> <li><a class="NOLINK"><strong>Favorites</strong></a></li> <li><a class="NOLINK">HCUP Statistical Briefs</a> <ul> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/reports/statbriefs/sbtopic.jsp">Topical list</a></li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/reports/statbriefs/statbriefs.jsp">Chronological list </a></li> </ul> </li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/reports/infographics.jsp">HCUP Infographics</a></li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/reports/projections/projections_rpts.jsp">HCUP Projections</a></li> <li><a class="NOLINK"><strong>Information About Using HCUP Data</strong></a></li> <li><a class="NOLINK">HCUP Methods Series</a> <ul> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/reports/methods/methods_topic.jsp">Topical list</a></li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/reports/methods/methods.jsp">Chronological list </a></li> </ul> </li> <li><a class="NOLINK">HCUP Nationwide Database Reports</a> <ul> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/db/nation/nis/nisrelatedreports.jsp">NIS </a></li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/db/nation/kid/kidrelatedreports.jsp">KID </a></li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/db/nation/neds/nedsrelatedreports.jsp">NEDS</a></li> </ul> </li> <li><a class="NOLINK">HCUP State Database Reports</a> <ul> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/db/state/sidrelatedreports.jsp">SID</a></li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/db/state/sasdrelatedreports.jsp">SASD</a></li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/db/state/seddrelatedreports.jsp">SEDD</a></li> </ul> </li> <li><a class="NOLINK"><strong>Additional Topics</strong></a></li> <li><a class="NOLINK">Topical Reports</a> <ul> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/reports/r_e_disparities.jsp">Race/Ethnicity </a></li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/reports/mhsa.jsp">Mental and Substance Use Disorders </a></li> </ul> </li> <li><a class="NOLINK">HCUP Publications</a> <ul> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/reports/pubsearch/pubsearch.jsp">Publication search </a></li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/reports/spotlights.jsp">Research Spotlights </a></li> <li><a href="https://web.archive.org/web/20140717094424/http://www.ahrq.gov/research/publications/">AHRQ Publications</a></li> 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href="/web/20140717094424/http://www.hcup-us.ahrq.gov/datainnovations/clinicaldata/poaback.jsp">Background</a></li> <li><a class="NOLINK">Tools</a> <ul> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/datainnovations/clinicaldata/tktt.jsp">Training Tools</a></li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/datainnovations/clinicaldata/tkds.jsp">Data Standards and Transmission Tools</a></li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/datainnovations/clinicaldata/tkfeedback.jsp">Feedback and Reporting Tools</a></li> </ul> </li> <li><a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/datainnovations/clinicaldata/pilot.jsp">Pilot and Planning Projects</a></li> </ul> </li> </ul> </li> </ul> </td> </tr> <tr><td colspan="3"><a name="skip"></a></td></tr> </table> </div> <table width="100%" border="0" cellspacing="2" cellpadding="4"> <tr><td> </td></tr> <tr> <td><div class="texttitle">Chronic Condition Indicator</div><br><div class="pagetext">The Chronic Condition Indicator is one in a family of databases and software tools developed as part of the <a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/overview.jsp">Healthcare Cost and Utilization Project (HCUP)</a>, 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. <br><br> Contents:<a name="return"></a> <ul> <li><a href="#overview">Overview of the Chronic Condition Indicator </a></li> <li><a href="#purpose">Purpose</a></li> <li><a href="#description">Description</a></li> <li><a href="#pubs">Publications Using the Chronic Condition Indicator</a></li> <li><a href="#files">Chronic Condition Indicator Files</a></li> <li><a href="#time">Time Period Covered by the Chronic Condition Indicator</a></li> <li><a href="#codes">Representation of ICD-9-CM Diagnosis Codes</a></li> <li><a href="#using">Using the Translation Files</a></li> <li><a href="#download">Downloading Information</a></li> <li><a href="#references">References</a></li> <li><a href="#questions">Questions?</a></li> </ul> </div> </td></tr> <tr><td><div class="texttitle"><a name="overview">Overview of the Chronic Condition Indicator</a></div> <br> <div class="pagetext">The Chronic Condition Indicator provides an easy way for users to categorize ICD-9-CM diagnosis codes into one of two categories: chronic or not chronic. <em>Examples of chronic conditions include conditions such as malignancies, diabetes, most forms of mental illness, hypertension, many forms of heart disease, and congenital anomalies. Non-chronic conditions include conditions such as infections, pregnancy, many neonatal conditions, non-specific symptoms, and injuries. To obtain the entire listing of all conditions view the downloadable file which contains a listing of all ICD-9-CM codes and their assignment to chronic or nonchronic.</em> <br><br> Diagnosis codes for this tool are based on the <em>International Classification of Diseases, 9th Revision, Clinical Modification</em> (ICD-9-CM), Fifth Edition. The ICD-9-CM consists of approximately 14,000 diagnosis codes. <br> <br> This documentation provides an overview of the following: <ul> <li>The categorization scheme used by the Chronic Condition Indicator</li> <li>A description of downloadable, electronic files that contain the translation of ICD-9-CM diagnosis codes into the Chronic Condition Indicator</li> </ul> The Chronic Condition Indicator is updated each year. The current version is based on ICD-9-CM diagnosis codes that are valid for January 1, 1980 through September 30, 2014. </div> </td></tr> <tr><td> </td></tr> <tr><td align="left" class="pagetext"><a href="#return">Return to Contents</a></td></tr> <tr><td> </td></tr> <tr><td><div class="texttitle"><a name="purpose">Purpose</a></div> <br> <div class="pagetext">The Chronic Condition Indicator is created to facilitate health services research on diagnoses using administrative data. This classification system allows researchers to readily determine if 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.</div> </td></tr> <tr><td> </td></tr> <tr><td align="left" class="pagetext"><a href="#return">Return to Contents</a></td></tr> <tr><td> </td></tr> <tr><td><div class="texttitle"><a name="description">Description</a></div> <br> <div class="pagetext">The Chronic Condition Indicator categorizes all ICD-9-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: (a) it places limitations on self-care, independent living, and social interactions; (b) it results in the need for ongoing intervention with medical products, services, and special equipment (see Perrin et al., 1993). The identification of chronic conditions is based on all 5-digit ICD-9-CM codes. E Codes, or external cause of injury codes, are not classified, because all injuries are assumed to be acute. <br> <br> The algorithm originated with work reported by Hwang et al (2001) in which selected 3-digit ICD-9-CM codes were classified as chronic conditions. That study employed 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 Hwang’s study, a physician panel reviewed each diagnosis code that appeared in MEPS data and determined whether the code represented an acute or chronic condition. <br> <br> Hwang’s 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 as acute or chronic. 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 Hwang’s classification as well as other sources that provided information on the chronicity of specific conditions (Burwell et al, 1997; Elixhauser et al, 1998; Ozminkowski et al, 2000; University of Manitoba, 2000; Wisconsin, 2004). <br><br> Disagreements with Hwang’s original classification were resolved in consultation with one of the original physician panel members. As a final step, the assignment of all ICD-9-CM codes was reviewed by an expert medical coder, resulting in the reassignment of some codes. <br><br> In general, Hwang's designation of chronic (1) versus not chronic (0) superceded other references. However, there were a number of exceptions: <ol> <li>When a 4- or 5-digit code within a 3-digit series reviewed by Hwang is explicitly chronic, the code is designated as chronic (e.g., see chronic viral hepatitis codes 070.22-070.23).</li> <br><br> <li>When a code was not reviewed by Hwang, one of the other sources was used to decide whether it was chronic or not chronic.</li> <br><br> <li>When a code was not reviewed by Hwang but is similar to other codes that were reviewed, we followed Hwang's designation (e.g., see the tuberculosis codes).</li> <br><br> <li>Potentially disabling codes (Burwell et al., 1997), were not considered a determining factor, unless it is clear that it will result in a chronic condition.</li> <br><br> <li>When an ICD code is listed as "not otherwise specified" or "not elsewhere classified," it is not designated as a chronic condition, unless it is clearly and explicitly a chronic condition (e.g., 246.8 disorders of the thyroid, not elsewhere classified and 246.9 disorder of the thyroid, not otherwise specified).</li> <br><br> <li>When a code is listed as "history o...," it is not designated as a chronic condition because it is assumed that the condition is no longer active.</li> <br><br> <li>All congenital anomalies were designated as chronic conditions.</li> <br><br> <li>All cancers are considered chronic except basal cell carcinomas (173.0-173.9). All benign neoplasms are considered non-chronic except benign neoplasms of the brain, cranial nerves, and cerebral meninges (225.0-225.2). Carcinomas <em>in situ</em> are considered chronic except for skin and cervix. Neoplasms of uncertain behavior are considered non-chronic except neurofibromatosis.</li> </ol> The body system indicator is based upon 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 <a href="/web/20140717094424/http://www.hcup-us.ahrq.gov/toolssoftware/ccs/ccs.jsp">Clinical Classifications Software</a> (CCS) may be used in conjunction with the Chronic Condition Indicator in order to obtain a count of the number of relatively discrete chronic conditions. </div> </td></tr> <tr><td> </td></tr> <tr><td align="left" class="pagetext"><a href="#return">Return to Contents</a></td></tr> <tr><td> </td></tr> <tr><td><div class="texttitle"><a name="pubs">Publications Using the Chronic Condition Indicator</a></div> <br> <div class="pagetext"> Chi MJ, Lee CY, Wu SC. The prevalence of chronic conditions and medical expenditures of the elderly by chronic condition indicator (CCI). <em>Archives of gerontology and geriatrics</em>, Epub ahead of print, May 10, 2010. <a href="https://web.archive.org/web/20140717094424/http://www.ncbi.nlm.nih.gov/pubmed/20452688" target="_blank">http://www.ncbi.nlm.nih.gov/pubmed/20452688</a>. <br><br> Friedman B, Jiang HJ, Elixhauser A, Segal A. 2006. "Hospital costs for adults with multiple chronic conditions." <em>Medical Care Research and Review</em> 63(3): 327-346. </div> </td></tr> <tr><td> </td></tr> <tr><td align="left" class="pagetext"><a href="#return">Return to Contents</a></td></tr> <tr><td> </td></tr> <tr><td><div class="texttitle"><a name="files">Chronic Condition Indicator File</a></div> <br> <div class="pagetext">One file is necessary to assign the Chronic Condition Indicator and to assign ICD-9-CM codes into body systems. This file is provided as an ASCII (DOS text) file. The file can be applied to designate ICD-9-CM diagnosis codes as chronic or non-chronic, or to assign a body system. The tool includes four elements: ICD-9-CM diagnosis codes, ICD-9-CM code labels, Chronic/non-Chronic assignments, and Body System assignments. <br><br> The contents of the file are described below: <br><br> <table width="90%" align="center" border="1" cellspacing="2" cellpadding="2"> <tr> <td class="pagetext"><strong>Filename</strong></td> <td class="pagetext"><strong>Purpose</strong></td> </tr> <tr> <td class="pagetext">CCI2012.CSV</td> <td class="pagetext">Comma-delimited translation file that maps ICD-9-CM diagnosis codes into the Chronic Condition Indicator and into body systems.</td> </tr> </table> <br><br> The chronic indicator is defined as either 0 - <em>non-chronic condition</em> or 1 - <em>chronic condition</em>. <br><br> The body system indicator is divided into the following categories: <br><br> 1 = Infectious and parasitic disease <br><br> 2 = Neoplasms <br><br> 3 = Endocrine, nutritional, and metabolic diseases and immunity disorders <br><br> 4 = Diseases of blood and blood-forming organs <br><br> 5 = Mental disorders <br><br> 6 = Diseases of the nervous system and sense organs <br><br> 7 = Diseases of the circulatory system <br><br> 8 = Diseases of the respiratory system <br><br> 9 = Diseases of the digestive system <br><br> 10 = Diseases of the genitourinary system <br><br> 11 = Complications of pregnancy, childbirth, and the puerperium <br><br> 12 = Diseases of the skin and subcutaneous tissue <br><br> 13 = Diseases of the musculoskeletal system <br><br> 14 = Congenital anomalies <br><br> 15 = Certain conditions originating in the perinatal period <br><br> 16 = Symptoms, signs, and ill-defined conditions <br><br> 17 = Injury and poisoning <br><br> 18 = Factors influencing health status and contact with health services </div> </td></tr> <tr><td> </td></tr> <tr><td align="left" class="pagetext"><a href="#return">Return to Contents</a></td></tr> <tr><td> </td></tr> <tr><td><div class="texttitle"><a name="time">Time Period Covered by the Chronic Condition Indicator</a></div> <br> <div class="pagetext">The ICD-9-CM codes are revised every October. New codes are added, existing codes are deleted, and definitions of current codes are changed. The four categories are revised annually, in response to ICD-9-CM changes. <strong>There were no new diagnosis codes in 2013-2014. The 2012 version of the Chronic Condition Indicator is valid for the time period January 1, 1980 through September 30, 2014.</strong> Using the current Chronic Condition Indicator files with data outside this time period may result in misclassification of ICD-9-CM codes. </div></td></tr> <tr><td> </td></tr> <tr><td align="left" class="pagetext"><a href="#return">Return to Contents</a></td></tr> <tr><td> </td></tr> <tr><td><div class="texttitle"><a name="codes">Representation of ICD-9-CM Diagnosis Codes</a></div> <br> <div class="pagetext">In practice, ICD-9-CM diagnosis codes are represented by 3-, 4-, or 5-character codes with explicit decimals. In the downloadable translation files, ICD-9-CM diagnoses are represented as 5-character alphanumeric codes with implicit decimals. These alphanumeric codes are enclosed in quotation marks in the translation files. Examples are presented below: <br><br> <table width="90%" align="center" border="1" cellspacing="2" cellpadding="2"> <tr> <td class="pagetext"><strong>Diagnosis</strong></td> <td class="pagetext"><strong>ICD-9-CM diagnosis code</strong></td> <td class="pagetext"><strong>Alpha code (implicit decimals)</strong></td> </tr> <tr> <td class="pagetext">Old myocardial infarction</td> <td align="center" class="pagetext">412</td> <td align="center" class="pagetext">'412 '</td> </tr> <tr> <td class="pagetext">Angina pectoris</td> <td align="center" class="pagetext">4139</td> <td align="center" class="pagetext">'4139 '</td> </tr> <tr> <td class="pagetext">Acute myocardial infarction, anterolateral wall, initial</td> <td align="center" class="pagetext">41001</td> <td align="center" class="pagetext">'41001'</td> </tr> </table> <br> To assure that diagnosis codes are properly processed in the Chronic Condition Indicator, the following actions must be taken: <ul> <li>Alphanumeric diagnosis codes must be left-justified. </li> <li>Two spaces must always follow a 3-character diagnosis code. </li> <li>One space must always follow a 4-character diagnosis code.</li> <li>Trailing blanks should never be zero-padded (i.e., blank spaces following a 3-character diagnosis code should not be filled with zeroes). </li> <li>Leading zeroes must be preserved; they are significant. </li> </ul> </div> </td></tr> <tr><td align="left" class="pagetext"><a href="#return">Return to Contents</a></td></tr> <tr><td> </td></tr> <tr><td><div class="texttitle"><a name="using">Using the Translation File</a></div> <br> <div class="pagetext">The Chronic Condition Indicator translation file lists the ICD-9-CM diagnosis codes and their corresponding chronic/non-chronic designation. The file also lists the body type associated with a particular diagnosis. This CSV file can be viewed in a text editor or by using Microsoft Excel. The manner in which this file may be applied varies by the type of software package. For example, in SAS, the files can be used to create a format through the command PROC FORMAT, which translates ICD-9-CM diagnosis codes into the Chronic Condition Indicator/body type. In SPSS, the translations can be adapted through the use of COMPUTE and VALUE LABELS statements or a series of RECODES. Sample <a href="#download">Stata programs</a> are provided below. <br/><br/> <strong>Calculating NCHRONIC:</strong> Users who wish to determine the number of chronic conditions on a discharge will need to do the following: <br/><br/> <ol> <li><em>The first step is to assign chronic condition indicators to a dataset using the CCI tool. This entails creating an array of chronic condition indicators on each record that is equal in size to the number of diagnoses on the record. If a user has 15 diagnoses (DX1-DX15) on a given record, then 15 chronic condition indicators should be created (CHRON1-CHRON15) . Each chronic condition indicator would be created using the corresponding diagnosis array element (CHRON5 would be created by examining the fifth diagnosis- DX5). Users should also assign the CCS diagnosis categories to their data if they are not already present. </em></li> <br/><br/> <li><em>Once an array of chronic conditions data elements is made for each record, users should loop through said array to find any instances of a chronic condition (CHRONn=1). To avoid double counting of chronic conditions for the same CCS category, users should check the CCS array element that corresponds with a chronic condition against previous CCS array elements to ensure that the CCS value is not repeated. If the same CCS category is not repeated, then the count of chronic conditions should be incremented by one. For example, if the CHRON6 shows a chronic condition, the corresponding CCS (CCS6) should be checked against the previous CCS array elements (CCS1-CCS5) to determine whether the corresponding chronic condition has already been counted. </em></li> </ol> </div></td></tr> <tr><td> </td></tr> <tr><td align="left" class="pagetext"><a href="#return">Return to Contents</a></td></tr> <tr><td> </td></tr> <tr><td><div class="texttitle"><a name="download">Downloading Information</a></div> <br> <div class="pagetext">The translation file for use with SAS or SPSS is an ASCII (DOS text) file and is available for download as <a href="cci2012.csv" target="_blank">CCI2012.CSV.</a> <br><br> <a href="StataChronic.zip" target="_blank">Stata Chronic Condition Indicator Program</a> (ZIP file, 10 KB) </div> <br> </td></tr> <tr><td align="left" class="pagetext"><a href="#return">Return to Contents</a></td></tr> <tr><td> </td></tr> <tr><td><div class="texttitle"><a name="references">References</a></div> <br> <div class="pagetext">Burwell B, Crown W, Drabek J. (1997). "Children with Severe Chronic Conditions on Medicaid," Report prepared under contract, U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation (ASPE), Office of Disability, Aging, and Long-Term Care Policy. Report available at Website <a href="https://web.archive.org/web/20140717094424/http://aspe.hhs.gov/daltcp/reports/children.htm" target="_blank">http://aspe.hhs.gov/daltcp/reports/children.htm</a> (accessed November 14, 2005). <br> <br> Elixhauser A., Steiner C., Harris R., Coffey R.M. 1998. "Comorbidity Measures for Use with Administrative Data," <em>Medical Care</em> 36:8-27. <br><br> Hwang, W., Heller, W., Ireys, H., Anderson, G. 2001. "Out-Of-Pocket Medical Spending for Care of Chronic Conditions," <em>Health Affairs</em> 20, no. 6:267-278. <br><br> Perrin EC, Newacheck P, Pless IB, Drotar D, Gortmaker SL, Leventhal J, Perrin JM, Stein RE, Walker DK, Weitzman M. 1993. "Issues Involved in the Definition and Classification of Chronic Health Conditions," <em>Pediatrics</em> 91, no. 4:787-793. <br><br> Ozminkowski RJ, Smith MW, Coffey RM, Mark TL, Neslusan CA, Drabek J. (2000). "Private Payers Serving Individuals with Disabilities and Chronic Conditions" Report prepared under contract #HHS-100-95-0044, U.S. Department of Health and Human Services, Office of Disability, Aging and Long-Term Care Policy. <a href="https://web.archive.org/web/20140717094424/http://aspe.hhs.gov/daltcp/reports/privpay.htm" target="_blank">http://aspe.hhs.gov/daltcp/reports/privpay.htm</a> (accessed November 14, 2005). <br><br> University of Manitoba. 2000. Chronic Disease Hospitalizations. An on-line concept dictionary to assist health services researchers with some groups of chronic conditions, http://www.umanitoba.ca/ centres/mchp/concept/dict/chronic_disease.htm. (accessed November 14, 2005). <br><br> Wisconsin Department of Health and Family Services provides ICD-9-CM codes for chronic conditions http://www.dhfs.state.wi.us/localdata/chronicconditions/ CHRONICD.HTM (accessed October 18, 2004, no longer active). </div> </td></tr> <tr><td> </td></tr> <tr><td align="left" class="pagetext"><a href="#return">Return to Contents</a></td></tr> <tr><td> </td></tr> <tr><td><div class="texttitle"><a name="questions">Questions?</a></div> <br> <div class="pagetext">Questions regarding the Chronic Condition Indicator may be directed to HCUP User Support through the following channels: <ul> <li>e-mail: <a href="https://web.archive.org/web/20140717094424/mailto:hcup@ahrq.gov">hcup@ahrq.gov</a></li> <li>Phone (toll free): 1-866-290-HCUP.</li> </ul> </div> </td></tr> <tr><td align="left" class="pagetext"><a href="#return">Return to Contents</a></td></tr> <tr><td> </td></tr> </table> <hr width="75%" align="center" class="hrruleblue"> <table width="100%"> <tr> <td align="center" class="citationtext"> Internet Citation: HCUP Chronic Condition Indicator. Healthcare Cost and Utilization Project (HCUP). July 2014. 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