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Pediatric Complex Chronic Condition System Version 3.

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The updated pediatric complex chronic condition (CCC) V3 system accurately reflects evolving ICD-10-CM codes, showing similar performance to V2 in explaining hospital outcomes. Continuous updates to V3 are recommended for accurate clinical condition representation.

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Area of Science:

  • Pediatric Health Informatics
  • Clinical Classification Systems
  • Health Services Research

Background:

  • The International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) has introduced numerous new codes.
  • The pediatric complex chronic condition (CCC) system required an update from V2 to V3 to align with ICD-10-CM changes.

Purpose of the Study:

  • To update the CCC system to V3, incorporating new, missing, or retired ICD-10-CM codes.
  • To re-evaluate the use of technology codes within the CCC system.
  • To compare the performance of CCC V3 against CCC V2.

Main Methods:

  • A repeated cross-sectional study analyzed US pediatric hospitalization data (2009-2019) from the Pediatric Health Information System (PHIS) and Medicaid Merative MarketScan Research Databases.
  • Complex chronic conditions (CCCs) were identified using both CCC V2 and V3 systems.
  • Key outcomes compared included the percentage of hospitalizations with CCCs, the number of CCC body-system categories per patient, and the systems' explanatory power for length of stay and in-hospital mortality.

Main Results:

  • CCC V2 identified 40.1% of PHIS hospitalizations with CCCs versus 38.3% by V3. V3 identified more transplant cases (2.0% vs 1.4%) but fewer technology codes (11.2% vs 12.7%) compared to V2.
  • Both V2 and V3 demonstrated similar capabilities in categorizing CCCs and explaining variations in hospital length of stay (10.0%) and in-hospital mortality (12.0%).
  • Similar patterns were observed in the MarketScan database, with V2 identifying 25.3% of hospitalizations with CCCs compared to 23.9% by V3.

Conclusions:

  • The CCC V3 system is recommended for identifying pediatric complex chronic conditions.
  • Regular, transparent updates to the CCC V3 system are crucial to maintain accuracy with evolving ICD-10-CM codes.
  • The V3 system effectively captures the spectrum of clinical conditions in pediatric hospitalizations.