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 MeasureReport: ra-measurereport01-with-remark: Risk Adjustment Measure Report with Condition Category Remark

Generated Narrative: MeasureReport

ResourceMeasureReport "ra-measurereport01-with-remark"

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: Patient/ra-patient01 " EVERYWOMAN"

date: 2021-10-18

reporter: Organization/ra-payer01 "ABC Payer"

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

group

id

group-001

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Hierarchical Status: Hierarchies applied and Condition Category is not superseded (Risk Adjustment Hierarchical Status CodeSystem#applied-not-superseded)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Hierarchical Status: Hierarchies applied and Condition Category is not superseded (Risk Adjustment Hierarchical Status CodeSystem#applied-not-superseded)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

Condition Category Remark

url

author

value: United States National Provider Identifier/1234567890

url

authorDatetime

value: 2021-11-01

url

text

value: Diagnosis added

url

code

value: Assessed and present (Coding Gap Remark CodeSystem#assessed-present)

url

relatedDataIdentifier

value: http://example.org/fhir/myclaimno/CLM23333

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 Condition Category Type: Historic Condition Category Gap (Risk Adjustment Condition Categoryy 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 Condition Category Type: Historic Condition Category Gap (Risk Adjustment Condition Categoryy 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 Condition Category Type: Historic Condition Category Gap (Risk Adjustment Condition Categoryy 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)

Condition Category Remark

url

author

value: United States National Provider Identifier/1234567890

url

authorDatetime

value: 2021-11-01

url

text

value: Continue evaluation

url

code

value: Deferred (Coding Gap Remark CodeSystem#deferred)

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 Condition Category Type: Suspected Condition Category Gap (Risk Adjustment Condition Categoryy 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 Condition Category Type: Suspected Condition Category Gap (Risk Adjustment Condition Categoryy 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 Condition Category Type: Suspected Condition Category Gap (Risk Adjustment Condition Categoryy 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)

Confidence Scale: Medium (SNOMED CT#255508009)

Condition Category Remark

url

author

value: United States National Provider Identifier/1234567890

url

authorDatetime

value: 2021-11-01

url

text

value: Not diagnosed

url

code

value: Assessed and not present (Coding Gap Remark CodeSystem#assessed-not-present)

url

relatedDataIdentifier

value: http://example.org/fhir/mychart/432203939

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

group

id

group-010

Risk Adjustment Condition Category Type: Net-New Condition Category (Risk Adjustment Condition Categoryy 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 83: Respiratory Arrest (CMS Hierarchical Condition Categories[24]#83 "Respiratory Arrest")

evaluatedResource: