Comparing Complex Chronic Conditions Versions to Identify Children With Medical Complexity

The identification of children with medical complexity (CMC) from administrative data sources is essential to understanding illness severity, morbidity, mortality, and utilization patterns in this population.¹ CMC have severe chronic conditions that require multiple subspecialties, lead to functional and high impact family limitations, and are often associated with medical technology dependence.² Identifying CMC using operational definitions is important given their contribution to pediatric expenditures.³ The open-source complex chronic condition (CCC) classification system, published in 2000, and updated to version 2 in 2014, is frequently used for this purpose.^{1, 4} The CCC system is intended to identify children with medical conditions expected to last ≥12 months and affect multiple organ systems or one system severely enough to require specialty pediatric care and likely hospitalization in a tertiary care center, using diagnosis and procedure codes.^{1, 4} Another revision to the CCC (version 3) incorporated new, missing, and retired codes, and builds a separate classification for technology dependence.⁵