Da Vinci Risk Adjustment Implementation Guide
2.0.0-preview - STU2 United States of America flag

Da Vinci Risk Adjustment Implementation Guide, published by HL7 International / Clinical Quality Information. This guide is not an authorized publication; it is the continuous build for version 2.0.0-preview built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-ra/ and changes regularly. See the Directory of published versions

Example Bundle: ra-bundle01: Risk Adjustment Bundle

Bundle ra-bundle01 of type collection

Entry 1 - fullUrl = http://example.org/fhir/MeasureReport/ra-measurereport01

Resource MeasureReport:

Generated Narrative: MeasureReport

Resource MeasureReport "ra-measurereport01"

Profile: Risk Adjustment Coding Gap MeasureReport

Risk Adjustment Clinical Data Collection Deadline: 2022-03-31

status: COMPLETE

type: INDIVIDUAL

measure: Risk Adjustment Model Version 24 - CMS Hierarchical Category Condition (CMS-HCC)

subject: See on this page: Patient/ra-patient01

date: 2021-10-18

reporter: Organization/ra-payer01 "ABC Payer"

period: 2021-01-01 --> 2021-09-30

group

id

group-001

Risk Adjustment Suspect Type: Historic Condition Category Gap (Risk Adjustment Suspect Type CodeSystem#historic)

Evidence Status: Closed Condition Category Gap (Risk Adjustment Evidence Status CodeSystem#closed-gap)

Risk Adjustment Evidence Status Date: 2021-04-01

Hierarchical Status: Hierarchies applied and Condition Category is not superseded (Risk Adjustment Hierarchical Status CodeSystem#applied-not-superseded)

code: HCC 18: Diabetes with Chronic Complications (CMS Hierarchical Condition Categories[24]#18 "Diabetes with Chronic Complications")

group

id

group-002

Risk Adjustment Suspect Type: Historic Condition Category Gap (Risk Adjustment Suspect Type CodeSystem#historic)

Evidence Status: Pending Condition Category Gap (Risk Adjustment Evidence Status CodeSystem#pending)

Risk Adjustment Evidence Status Date: 2021-09-29

Hierarchical Status: Hierarchies applied and Condition Category is not superseded (Risk Adjustment Hierarchical Status CodeSystem#applied-not-superseded)

code: HCC 111: Chronic Obstructive Pulmonary Disease (CMS Hierarchical Condition Categories[24]#111 "Chronic Obstructive Pulmonary Disease")

group

id

group-003

Risk Adjustment Suspect Type: Historic Condition Category Gap (Risk Adjustment Suspect Type CodeSystem#historic)

Evidence Status: Open Condition Category Gap (Risk Adjustment Evidence Status CodeSystem#open-gap)

Risk Adjustment Evidence Status Date: 2020-07-15

Hierarchical Status: Hierarchies applied and Condition Category is not superseded (Risk Adjustment Hierarchical Status CodeSystem#applied-not-superseded)

code: HCC 59: Major Depressive, Bipolar, and Paranoid Disorders (CMS Hierarchical Condition Categories[24]#59 "Major Depressive, Bipolar, and Paranoid Disorders")

group

id

group-004

Risk Adjustment Suspect Type: Historic Condition Category Gap (Risk Adjustment Suspect Type CodeSystem#historic)

Evidence Status: Closed Condition Category Gap (Risk Adjustment Evidence Status CodeSystem#closed-gap)

Risk Adjustment Evidence Status Date: 2021-04-27

Hierarchical Status: Hierarchies applied and Condition Category is superseded (Risk Adjustment Hierarchical Status CodeSystem#applied-superseded)

code: HCC 112: Fibrosis of lung and other chronic lung disorders (CMS Hierarchical Condition Categories[24]#112 "Fibrosis of lung and other chronic lung disorders")

group

id

group-005

Risk Adjustment Suspect Type: Historic Condition Category Gap (Risk Adjustment Suspect Type CodeSystem#historic)

Evidence Status: Pending Condition Category Gap (Risk Adjustment Evidence Status CodeSystem#pending)

Risk Adjustment Evidence Status Date: 2021-09-27

Hierarchical Status: Hierarchies applied and Condition Category is superseded (Risk Adjustment Hierarchical Status CodeSystem#applied-superseded)

code: HCC 19: Diabetes without Complications (CMS Hierarchical Condition Categories[24]#19 "Diabetes without Complications")

group

id

group-006

Risk Adjustment Suspect Type: Historic Condition Category Gap (Risk Adjustment Suspect Type CodeSystem#historic)

Evidence Status: Open Condition Category Gap (Risk Adjustment Evidence Status CodeSystem#open-gap)

Risk Adjustment Evidence Status Date: 2020-12-15

Hierarchical Status: Hierarchies applied and Condition Category is superseded (Risk Adjustment Hierarchical Status CodeSystem#applied-superseded)

code: HCC 84: Cardio-Respiratory Failure and Shock (CMS Hierarchical Condition Categories[24]#84 "Cardio-Respiratory Failure and Shock")

group

id

group-007

Risk Adjustment Suspect Type: Suspected Condition Category Gap (Risk Adjustment Suspect Type CodeSystem#suspected)

Evidence Status: Closed Condition Category Gap (Risk Adjustment Evidence Status CodeSystem#closed-gap)

Risk Adjustment Evidence Status Date: 2021-03-15

Hierarchical Status: Hierarchies applied and Condition Category is not superseded (Risk Adjustment Hierarchical Status CodeSystem#applied-not-superseded)

code: HCC 22: Morbid Obesity (CMS Hierarchical Condition Categories[24]#22 "Morbid Obesity")

group

id

group-008

Risk Adjustment Suspect Type: Suspected Condition Category Gap (Risk Adjustment Suspect Type CodeSystem#suspected)

Evidence Status: Pending Condition Category Gap (Risk Adjustment Evidence Status CodeSystem#pending)

Risk Adjustment Evidence Status Date: 2021-09-27

Hierarchical Status: Hierarchies applied and Condition Category is not superseded (Risk Adjustment Hierarchical Status CodeSystem#applied-not-superseded)

code: HCC 96: Specified Heart Arrhythmias (CMS Hierarchical Condition Categories[24]#96 "Specified Heart Arrhythmias")

group

id

group-009

Risk Adjustment Suspect Type: Suspected Condition Category Gap (Risk Adjustment Suspect Type CodeSystem#suspected)

Evidence Status: Open Condition Category Gap (Risk Adjustment Evidence Status CodeSystem#open-gap)

Risk Adjustment Evidence Status Date: 2020-07-15

Hierarchical Status: Hierarchies applied and Condition Category is not superseded (Risk Adjustment Hierarchical Status CodeSystem#applied-not-superseded)

code: HCC 110: Cystic Fibrosis (CMS Hierarchical Condition Categories[24]#110 "Cystic Fibrosis")

group

id

group-010

Risk Adjustment Suspect Type: Net-New Condition Category (Risk Adjustment Suspect Type CodeSystem#net-new)

Evidence Status: Pending Condition Category Gap (Risk Adjustment Evidence Status CodeSystem#pending)

Risk Adjustment Evidence Status Date: 2021-09-28

Hierarchical Status: Hierarchies applied and Condition Category is not superseded (Risk Adjustment Hierarchical Status CodeSystem#applied-not-superseded)

code: HCC 110: Cystic Fibrosis (CMS Hierarchical Condition Categories[24]#83 "Respiratory Arrest")

evaluatedResource:

Entry 2 - fullUrl = http://example.org/fhir/Condition/ra-condition33pat01

Resource Condition:

Generated Narrative: Condition

Resource Condition "ra-condition33pat01"

Profile: US Core Condition Profile

clinicalStatus: Active (Condition Clinical Status Codes#active)

verificationStatus: Confirmed (ConditionVerificationStatus#confirmed)

category: Problem (Condition Category Codes#encounter-diagnosis "Encounter Diagnosis")

code: R09.2: Respiratory arrest (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)#R09.2 "Respiratory arrest")

subject: See on this page: Patient/ra-patient01

onset: 2021-09-26

Entry 3 - fullUrl = http://example.org/fhir/Patient/ra-patient01

Resource Patient:

Eve EVERYWOMAN
Identifier12345
Address2222 Home Street
Ann Arbor MI USA
Date of birth16 January 1975

Entry 4 - fullUrl = http://example.org/fhir/Condition/ra-condition10pat01

Resource Condition:

Generated Narrative: Condition

Resource Condition "ra-condition10pat01"

Profile: US Core Condition Profile

clinicalStatus: Active (Condition Clinical Status Codes#active)

verificationStatus: Confirmed (ConditionVerificationStatus#confirmed)

category: Problem (Condition Category Codes#encounter-diagnosis "Encounter Diagnosis")

code: J44.1: Chronic obstructive pulmonary disease with (acute) exacerbation (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)#J44.1 "Chronic obstructive pulmonary disease with (acute) exacerbation")

subject: See on this page: Patient/ra-patient01

onset: 2021-09-26

Entry 5 - fullUrl = http://example.org/fhir/Encounter/ra-encounter03pat01

Resource Encounter:

Not done yet

Entry 6 - fullUrl = http://example.org/fhir/Condition/ra-condition09pat01

Resource Condition:

Generated Narrative: Condition

Resource Condition "ra-condition09pat01"

Profile: US Core Condition Profile

clinicalStatus: Active (Condition Clinical Status Codes#active)

verificationStatus: Confirmed (ConditionVerificationStatus#confirmed)

category: Problem (Condition Category Codes#encounter-diagnosis "Encounter Diagnosis")

code: B44.81: Allergic bronchopulmonary aspergillosis (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)#B44.81 "Allergic bronchopulmonary aspergillosis")

subject: See on this page: Patient/ra-patient01

onset: 2021-03-27

Entry 7 - fullUrl = http://example.org/fhir/Condition/ra-condition02pat01

Resource Condition:

Generated Narrative: Condition

Resource Condition "ra-condition02pat01"

Profile: US Core Condition Profile

clinicalStatus: Active (Condition Clinical Status Codes#active)

verificationStatus: Confirmed (ConditionVerificationStatus#confirmed)

category: Problem (Condition Category Codes#encounter-diagnosis "Encounter Diagnosis")

code: E08.29: Diabetes mellitus due to underlying condition with other diabetic kidney complication (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)#E08.29 "Diabetes mellitus due to underlying condition with other diabetic kidney complication")

subject: See on this page: Patient/ra-patient01

onset: 2021-01-31

Entry 8 - fullUrl = http://example.org/fhir/Encounter/ra-encounter11pat01

Resource Encounter:

Not done yet

Entry 9 - fullUrl = http://example.org/fhir/Observation/ra-obs21pat01

Resource Observation:

Generated Narrative: Observation

Resource Observation "ra-obs21pat01"

Profile: US Core Laboratory Result Observation Profile

status: FINAL

category: Laboratory (Observation Category Codes#laboratory)

code: Trypsin [Mass/volume] in Serum or Plasma (LOINC#33325-2)

subject: See on this page: Patient/ra-patient01: Eve Everywoman

effective: 2019-06-17

performer: Organization/ra-laboratory01: XYZ Laboratory "XYZ Laboratory"

value: 770 ng/mL

ReferenceRanges

-LowHighType
*169 ng/mL (Details: UCUM code ng/mL = 'ng/mL')773 ng/mL (Details: UCUM code mg/dL = 'mg/dL')Normal Range (Observation Reference Range Meaning Codes#normal)

Entry 10 - fullUrl = http://example.org/fhir/Condition/ra-condition18pat01

Resource Condition:

Generated Narrative: Condition

Resource Condition "ra-condition18pat01"

Profile: US Core Condition Profile

clinicalStatus: Active (Condition Clinical Status Codes#active)

verificationStatus: Confirmed (ConditionVerificationStatus#confirmed)

category: Problem (Condition Category Codes#encounter-diagnosis "Encounter Diagnosis")

code: I48.11: Longstanding persistent atrial fibrillation (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)#I48.11 "Longstanding persistent atrial fibrillation")

subject: See on this page: Patient/ra-patient01

onset: 2021-09-26

Entry 11 - fullUrl = http://example.org/fhir/Encounter/ra-encounter08pat01

Resource Encounter:

Not done yet

Entry 12 - fullUrl = http://example.org/fhir/Condition/ra-condition44pat01

Resource Condition:

Generated Narrative: Condition

Resource Condition "ra-condition44pat01"

Profile: US Core Condition Profile

clinicalStatus: Active (Condition Clinical Status Codes#active)

verificationStatus: Confirmed (ConditionVerificationStatus#confirmed)

category: Problem (Condition Category Codes#encounter-diagnosis "Encounter Diagnosis")

code: B44.81: Allergic bronchopulmonary aspergillosis (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)#B44.81 "Allergic bronchopulmonary aspergillosis")

subject: See on this page: Patient/ra-patient01

onset: 2017-01-18

Entry 13 - fullUrl = http://example.org/fhir/Encounter/ra-encounter02pat01

Resource Encounter:

Not done yet

Entry 14 - fullUrl = http://example.org/fhir/Encounter/ra-encounter44pat01

Resource Encounter:

Not done yet

Entry 15 - fullUrl = http://example.org/fhir/Condition/ra-condition08pat01

Resource Condition:

Generated Narrative: Condition

Resource Condition "ra-condition08pat01"

Profile: US Core Condition Profile

clinicalStatus: Active (Condition Clinical Status Codes#active)

verificationStatus: Confirmed (ConditionVerificationStatus#confirmed)

category: Problem (Condition Category Codes#encounter-diagnosis "Encounter Diagnosis")

code: Bipolar disorder, current episode mixed, mild (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)#F31.61)

subject: See on this page: Patient/ra-patient01

onset: 2017-02-03

Entry 16 - fullUrl = http://example.org/fhir/Condition/ra-condition43pat01

Resource Condition:

Generated Narrative: Condition

Resource Condition "ra-condition43pat01"

Profile: US Core Condition Profile

clinicalStatus: Active (Condition Clinical Status Codes#active)

verificationStatus: Confirmed (ConditionVerificationStatus#confirmed)

category: Problem (Condition Category Codes#encounter-diagnosis "Encounter Diagnosis")

code: E08.29: Diabetes mellitus due to underlying condition with other diabetic kidney complication (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)#E08.29 "Diabetes mellitus due to underlying condition with other diabetic kidney complication")

subject: See on this page: Patient/ra-patient01

onset: 2019-02-10

Entry 17 - fullUrl = http://example.org/fhir/Condition/ra-condition03pat01

Resource Condition:

Generated Narrative: Condition

Resource Condition "ra-condition03pat01"

Profile: US Core Condition Profile

clinicalStatus: Active (Condition Clinical Status Codes#active)

verificationStatus: Confirmed (ConditionVerificationStatus#confirmed)

category: Problem (Condition Category Codes#encounter-diagnosis "Encounter Diagnosis")

code: J44.1: Chronic obstructive pulmonary disease with (acute) exacerbation (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)#J44.1 "Chronic obstructive pulmonary disease with (acute) exacerbation")

subject: See on this page: Patient/ra-patient01

onset: 2021-09-26

Entry 18 - fullUrl = http://example.org/fhir/Condition/ra-condition11pat01

Resource Condition:

Generated Narrative: Condition

Resource Condition "ra-condition11pat01"

Profile: US Core Condition Profile

clinicalStatus: Active (Condition Clinical Status Codes#active)

verificationStatus: Confirmed (ConditionVerificationStatus#confirmed)

category: Problem (Condition Category Codes#encounter-diagnosis "Encounter Diagnosis")

code: J81.0: Acute pulmonary edema (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)#J81.0 "Acute pulmonary edema")

subject: See on this page: Patient/ra-patient01

onset: 2020-11-02

Entry 19 - fullUrl = http://example.org/fhir/Encounter/ra-encounter43pat01

Resource Encounter:

Not done yet

Entry 20 - fullUrl = http://example.org/fhir/Encounter/ra-encounter09pat01

Resource Encounter:

Not done yet

Entry 21 - fullUrl = http://example.org/fhir/Condition/ra-condition17pat01

Resource Condition:

Generated Narrative: Condition

Resource Condition "ra-condition17pat01"

Profile: US Core Condition Profile

clinicalStatus: Active (Condition Clinical Status Codes#active)

verificationStatus: Confirmed (ConditionVerificationStatus#confirmed)

category: Problem (Condition Category Codes#encounter-diagnosis "Encounter Diagnosis")

code: Z68.42: Body mass index [BMI] 45.0-49.9, adult (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)#Z68.42 "Body mass index [BMI] 45.0-49.9, adult")

subject: See on this page: Patient/ra-patient01

onset: 2021-01-31