The Clinical Classification System - Evidence Based Coding
CCC Manual

About

Introduction

The Clinical Care Classification (CCC) System (version 2.5) provides a standardized framework and a unique coding structure for assessing, documenting, and classifying patient care by nurses and other clinical professionals in any health care setting. The CCC system consists of two interrelated terminologies:
  • CCC of Nursing Diagnoses consists of 176 (60 major & 116 subcategories).
  • CCC of Nursing Interventions/Actions consists of 804 Concepts (201 Core Interventions [77 major & 124 subcategories)].

The two terminologies are both classified by 21 Care Components that represent the Functional, Health Behavioral, Physiological, and Psychological Patterns of Patient Care.

Care Components
Activity Medication Self-Care
Bowel/Gastric Metabolic Self-Concept
Cardiac Nutritional Sensory
Cognitive/Neuro Physical Regulation Skin Integrity
Coping Respiratory Tissue Perfusion
Fluid Volume Role Relationship Urinary Elimination
Health Behavior Safety Life Cycle

The coding structure for the two terminologies is based on the ICD-10 (International Statistical Classification of Diseases and Health-Related Problems, 1990) consisting of five alphanumeric characters for information exchange among health care terminologies promoting interoperability. They are used to track and measure patient/client care holistically over time, across settings, population groups, and geographic locations. An in-depth explanation of the coding structure may be found in the Framework section of this website.

Status

The CCC System is recognized as the terminology of choice for documenting the essence of patient care in the electronic health record (EHR) systems. It meets all the features of a concept-oriented terminology and has been formally accepted by the various standards organizations. They include:

  • Formally 'recognized' in 1991 and reaffirmed in 1998, by the American Nurses Association (ANA) as nursing classifications critical to representing clinical nursing practice in computer-based clinical information systems.
  • Registered as HL7 languages promoting interoperability.
  • Integrated into SNOMED CT & previously SNOMED RT.
  • Integrated in Metathesaurus of Unified Medical Language System (UMLS) of the National Library of Medicine (NLM).
  • Indexed in CINAHL (Cumulative Index for Nursing and Allied Health Literature).
  • Clinical LOINC (Logical Observations, Identifiers, Names and Codes) has integrated the CCC of Nursing Diagnoses Outcomes in its clinical application.
  • ABC Codes for Complimentary and Alternative Medicine (CAM) has adapted selected CCC of Nursing Interventions for billing codes.
  • Listed in the American National Standards Institute (ANSI) Healthcare Informatics Standards Technical Panel (HISTP) Inventory of Standards Library.
  • Formed the basis for the original International Classification of Nursing Practice (ICNP) developed by the International Council of Nurses (ICN).
  • Conforms to the criteria for the Integration of a Reference Terminology Model for Nurses (IS 18104) Standard approved by the International Standards Organization (ISO) Technical Committee (TC) 215 Working Group 3 - Concept Representation in October 2003, in Oslo, Norway
  • Links home health agencies implementing Medicare Rules Coverage and Conditions of Participation, to HCFA Form 485, and to Outcome and Assessment Information Set (OASIS), and OASIS Prospective Payment System (PPS).
  • Copyrighted and is free but requires written permission (RTF 16k).

Uses

The CCC System is being used to document nursing care in the electronic health record (EHR) computer-based patient record (CPR) and Personal Health Record (PHR) Systems. It serves as a language for nursing and other health care providers such as physical, occupational, and speech therapists, medical social workers, etc. The CCC System is used to:

  • Document integrated patient care processes
  • Classify and track clinical care
  • Develop evidence-based practice models
  • Analyze patient profiles and populations
  • Predict care needs, resources, and costs

They are also used to develop clinical plans of care, clinical pathways and guidelines as well as for research and educational purposes.