The Clinical Classifications Software Refined (CCSR) for International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS)-coded procedures classifies procedures into clinically meaningful categories, provides a means by which to identify specific types of procedures using procedure codes, and can be used analytically to examine patterns in healthcare cost, utilization, and outcomes, in addition to perform rank utilization by procedures.

The CCSR balances the retention of the clinical concepts included in the CCS categories under ICD-9-CM and capitalizes on the taxonomy and specificity of ICD-10-PCS procedure codes by creating new clinical categories. The refinement process was informed by American Health Information Management Association-certified ICD-10-PCS trainers and reviewed by a team of clinical experts and surgeons. The team extensively reviewed the CCSR at each stage of its development using the HCUP State Inpatient Databases (SID) for quality control testing.

CCSR categories are organized by clinical domain. Each clinical domain is abbreviated using a three-character scheme such as CAR for Cardiovascular Procedures. Individual CCSR categories are numbered sequentially with the numbering scheme starting at "001" within each clinical domain (i.e., there is a CCSR 001 for each clinical domain).

Beginning with v2026.2 (developed for internal use in creation of 2025 HCUP databases) each data element PRCCSR_APPROACH_aaannn identifies whether the CCSR category was triggered by a procedure code on the input record and the surgical approach used. The value of AAA indicates the clinical domain. The value of nnn indicates the specific category within the clinical domain. For example, the data element PRCCSR_APPROACH_CAR003 corresponds to the CCSR category for Coronary artery bypass grafts (CABG) under the clinical domain of Cardiovascular Procedures. The value of the PRCCSR_APPROACH_AAAnnn data element indicates the following for the CCSR category identified by AAAnnn:

• Open approach: ICD-10-PCS codes in this CCSR category are reported on the record and at least one reported procedure code is open approach (value "OA").
• Minimally invasive: ICD-10-PCS codes in this CCSR category are reported on the record, no reported procedures are open approach, and at least one reported procedure code is minimally invasive (value "MI").
• Not classified: The procedure codes in this CCSR category are reported on the record, but none are classified as either an open approach or a minimally invasive approach (value "NC").
• No procedure codes present for this CCSR: ICD-10-PCS procedure codes in this CCSR category are not reported on the input record (value "ZZ").