Da Vinci Risk Adjustment Implementation Guide
2.0.0 - STU2
Da Vinci Risk Adjustment Implementation Guide
2.0.0 - STU2
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 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
{
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"id" : "ra-measurereport02",
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🔗 "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-measurereport"
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"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: MeasureReport ra-measurereport02</b></p><a name=\"ra-measurereport02\"> </a><a name=\"hcra-measurereport02\"> </a><a name=\"ra-measurereport02-en-US\"> </a><p><b>Measure Report Category</b>: <span title=\"Codes:{http://hl7.org/fhir/CodeSystem/measurereport-category ra}\">Risk Adjustment</span></p><p><b>Risk Adjustment Clinical Data Collection Deadline</b>: 2022-03-31</p><p><b>status</b>: Complete</p><p><b>type</b>: Individual</p><p><b>measure</b>: <a href=\"Measure-RAModelExample03.html\">Risk Adjustment Model Version 5 - CMS Prescribing Drug Hierarchical Category Condition (CMS-HCC)</a></p><p><b>subject</b>: <a href=\"Patient-ra-patient01.html\">Eve Everywoman (official) Female, DoB: 1975-01-16 ( Medical record number: 12345\u00a0(use:\u00a0usual,\u00a0))</a></p><p><b>date</b>: 2021-10-18</p><p><b>reporter</b>: <a href=\"Organization-ra-payer01.html\">Organization ABC Payer</a></p><p><b>period</b>: 2021-01-01 --> 2021-09-30</p><blockquote><p><b>group</b></p><blockquote><p><b>id</b></p>group-001</blockquote><p><b>Risk Adjustment Condition Category Type</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-ra/CodeSystem/cc-type historic}\">Historic Condition Category Gap</span></p><p><b>Evidence Status</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status closed-gap}\">Closed Condition Category Gap</span></p><p><b>Risk Adjustment Evidence Status Date</b>: 2021-04-01</p><p><b>Hierarchical Status</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status not-applied}\">Hierarchies not applied</span></p><p><b>code</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/cmsrxhcc 227}\">CMS-RxHCC 227: Pulmonary Fibrosis and Other Chronic Lung Disorders</span></p></blockquote><blockquote><p><b>group</b></p><blockquote><p><b>id</b></p>group-002</blockquote><p><b>Risk Adjustment Condition Category Type</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-ra/CodeSystem/cc-type historic}\">Historic Condition Category Gap</span></p><p><b>Evidence Status</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status open-gap}\">Open Condition Category Gap</span></p><p><b>Risk Adjustment Evidence Status Date</b>: 2020-07-01</p><p><b>Hierarchical Status</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status not-applied}\">Hierarchies not applied</span></p><p><b>code</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/cmsrxhcc 131}\">CMS-RxHCC 131: Bipolar Disorders</span></p></blockquote><blockquote><p><b>group</b></p><blockquote><p><b>id</b></p>group-003</blockquote><p><b>Risk Adjustment Condition Category Type</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-ra/CodeSystem/cc-type suspected}\">Suspected Condition Category Gap</span></p><p><b>Evidence Status</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status closed-gap}\">Closed Condition Category Gap</span></p><p><b>Risk Adjustment Evidence Status Date</b>: 2021-02-15</p><p><b>Hierarchical Status</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status not-applied}\">Hierarchies not applied</span></p><p><b>code</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/cmsrxhcc 30}\">CMS-RxHCC 30: Diabetes with Chronic Complications</span></p></blockquote><blockquote><p><b>group</b></p><blockquote><p><b>id</b></p>group-004</blockquote><p><b>Risk Adjustment Condition Category Type</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-ra/CodeSystem/cc-type suspected}\">Suspected Condition Category Gap</span></p><p><b>Risk Adjustment Evidence Status Date</b>: 2021-04-01</p><p><b>Evidence Status</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status closed-gap}\">Closed Condition Category Gap</span></p><p><b>Hierarchical Status</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status not-applied}\">Hierarchies not applied</span></p><p><b>code</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/cmsrxhcc 43}\">CMS-RxHCC 43: Morbid Obesity</span></p></blockquote><blockquote><p><b>group</b></p><blockquote><p><b>id</b></p>group-005</blockquote><p><b>Risk Adjustment Condition Category Type</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-ra/CodeSystem/cc-type suspected}\">Suspected Condition Category Gap</span></p><p><b>Evidence Status</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status pending}\">Pending Condition Category Gap</span></p><p><b>Risk Adjustment Evidence Status Date</b>: 2021-09-29</p><p><b>Hierarchical Status</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status not-applied}\">Hierarchies not applied</span></p><p><b>code</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/cmsrxhcc 31}\">CMS-RxHCC 31: Diabetes without Complications</span></p></blockquote><blockquote><p><b>group</b></p><blockquote><p><b>id</b></p>group-006</blockquote><p><b>Risk Adjustment Condition Category Type</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-ra/CodeSystem/cc-type net-new}\">Net-New Condition Category</span></p><p><b>Evidence Status</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status pending}\">Pending Condition Category Gap</span></p><p><b>Risk Adjustment Evidence Status Date</b>: 2021-09-29</p><p><b>Hierarchical Status</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status not-applied}\">Hierarchies not applied</span></p><p><b>code</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/cmsrxhcc 226}\">CMS-RxHCC 226: Chronic Obstructive Pulmonary Disease and Asthma</span></p></blockquote><p><b>evaluatedResource</b>: </p><ul><li><a href=\"Condition-ra-condition09pat01.html\">Condition Allergic bronchopulmonary aspergillosis</a></li><li><a href=\"Condition-ra-condition08pat01.html\">Condition Bipolar disorder, current episode mixed, mild</a></li><li><a href=\"Condition-ra-condition02pat01.html\">Condition Diabetes mellitus due to underlying condition with other diabetic kidney complication</a></li><li><a href=\"Condition-ra-condition17pat01.html\">Condition Body mass index [BMI] 45.0-49.9, adult</a></li><li><a href=\"Condition-ra-condition10pat01.html\">Condition Long term (current) use of insulin</a></li><li><a href=\"Condition-ra-condition03pat01.html\">Condition Chronic obstructive pulmonary disease with (acute) exacerbation</a></li><li><a href=\"Condition-ra-condition44pat01.html\">Condition Allergic bronchopulmonary aspergillosis</a></li><li><a href=\"Encounter-ra-encounter09pat01.html\">Encounter: status = finished; class = ambulatory (ActCode#AMB); type = Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter.; period = 2021-03-27 --> 2021-03-27</a></li><li><a href=\"Encounter-ra-encounter08pat01.html\">Encounter: status = finished; class = ambulatory (ActCode#AMB); type = Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter.; period = 2017-02-03 --> 2017-02-03</a></li><li><a href=\"Encounter-ra-encounter02pat01.html\">Encounter: status = finished; class = ambulatory (ActCode#AMB); type = Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter.; period = 2021-01-31 --> 2021-01-31</a></li><li><a href=\"Encounter-ra-encounter03pat01.html\">Encounter: status = finished; class = ambulatory (ActCode#AMB); type = Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter.; period = 2021-09-26 --> 2021-09-26</a></li><li><a href=\"Encounter-ra-encounter45pat01.html\">Encounter: status = finished; class = ambulatory (ActCode#AMB); type = Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter.; period = 2018-07-21 --> 2018-07-21</a></li></ul></div>"
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🔗 "reference" : "Patient/ra-patient01"
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🔗 "reference" : "Organization/ra-payer01"
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"period" : {
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"end" : "2021-09-30"
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"group" : [
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"id" : "group-001",
"extension" : [
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"valueCodeableConcept" : {
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"code" : "historic"
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{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus",
"valueCodeableConcept" : {
"coding" : [
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"valueDate" : "2021-04-01"
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"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus",
"valueCodeableConcept" : {
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],
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/cmsrxhcc",
"version" : "5",
"code" : "227",
"display" : "Pulmonary Fibrosis and Other Chronic Lung Disorders"
}
],
"text" : "CMS-RxHCC 227: Pulmonary Fibrosis and Other Chronic Lung Disorders"
}
},
{
"id" : "group-002",
"extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccType",
"valueCodeableConcept" : {
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"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus",
"valueCodeableConcept" : {
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{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate",
"valueDate" : "2020-07-01"
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"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus",
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"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/cmsrxhcc",
"version" : "5",
"code" : "131",
"display" : "Bipolar Disorders"
}
],
"text" : "CMS-RxHCC 131: Bipolar Disorders"
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},
{
"id" : "group-003",
"extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccType",
"valueCodeableConcept" : {
"coding" : [
{
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"code" : "suspected"
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},
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status",
"code" : "closed-gap"
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}
},
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate",
"valueDate" : "2021-02-15"
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{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status",
"code" : "not-applied"
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],
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/cmsrxhcc",
"version" : "5",
"code" : "30",
"display" : "Diabetes with Chronic Complications"
}
],
"text" : "CMS-RxHCC 30: Diabetes with Chronic Complications"
}
},
{
"id" : "group-004",
"extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccType",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/cc-type",
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}
},
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate",
"valueDate" : "2021-04-01"
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{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus",
"valueCodeableConcept" : {
"coding" : [
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},
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus",
"valueCodeableConcept" : {
"coding" : [
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"system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status",
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}
],
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/cmsrxhcc",
"version" : "5",
"code" : "43",
"display" : "Morbid Obesity"
}
],
"text" : "CMS-RxHCC 43: Morbid Obesity"
}
},
{
"id" : "group-005",
"extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccType",
"valueCodeableConcept" : {
"coding" : [
{
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"code" : "suspected"
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}
},
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus",
"valueCodeableConcept" : {
"coding" : [
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"system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status",
"code" : "pending"
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},
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate",
"valueDate" : "2021-09-29"
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{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus",
"valueCodeableConcept" : {
"coding" : [
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"system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status",
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],
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/cmsrxhcc",
"version" : "5",
"code" : "31",
"display" : "Diabetes without Complications"
}
],
"text" : "CMS-RxHCC 31: Diabetes without Complications"
}
},
{
"id" : "group-006",
"extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccType",
"valueCodeableConcept" : {
"coding" : [
{
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"code" : "net-new"
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}
},
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status",
"code" : "pending"
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}
},
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate",
"valueDate" : "2021-09-29"
},
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status",
"code" : "not-applied"
}
]
}
}
],
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/cmsrxhcc",
"version" : "5",
"code" : "226",
"display" : "Chronic Obstructive Pulmonary Disease and Asthma"
}
],
"text" : "CMS-RxHCC 226: Chronic Obstructive Pulmonary Disease and Asthma"
}
}
],
"evaluatedResource" : [
{
🔗 "extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
"valueString" : "group-001"
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],
"reference" : "Condition/ra-condition09pat01"
},
{
🔗 "extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
"valueString" : "group-002"
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],
"reference" : "Condition/ra-condition08pat01"
},
{
🔗 "extension" : [
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"valueString" : "group-003"
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],
"reference" : "Condition/ra-condition02pat01"
},
{
🔗 "extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
"valueString" : "group-004"
}
],
"reference" : "Condition/ra-condition17pat01"
},
{
🔗 "extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
"valueString" : "group-005"
}
],
"reference" : "Condition/ra-condition10pat01"
},
{
🔗 "extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
"valueString" : "group-006"
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],
"reference" : "Condition/ra-condition03pat01"
},
{
🔗 "extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
"valueString" : "group-001"
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],
"reference" : "Condition/ra-condition44pat01"
},
{
🔗 "extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
"valueString" : "group-001"
}
],
"reference" : "Encounter/ra-encounter09pat01"
},
{
🔗 "extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
"valueString" : "group-002"
}
],
"reference" : "Encounter/ra-encounter08pat01"
},
{
🔗 "extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
"valueString" : "group-003"
},
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
"valueString" : "group-004"
}
],
"reference" : "Encounter/ra-encounter02pat01"
},
{
🔗 "extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
"valueString" : "group-005"
},
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
"valueString" : "group-006"
}
],
"reference" : "Encounter/ra-encounter03pat01"
},
{
🔗 "extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
"valueString" : "group-001"
}
],
"reference" : "Encounter/ra-encounter45pat01"
}
]
}
IG © 2021+ HL7 International / Clinical Quality Information. Package hl7.fhir.us.davinci-ra#2.0.0 based on FHIR 4.0.1. Generated 2024-11-18
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