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
Measure Report Category: Risk Adjustment
Risk Adjustment Clinical Data Collection Deadline: 2022-03-31
status: Complete
type: Individual
measure: Risk Adjustment Model Version 21 - CMS Hierarchical Category Condition (CMS-HCC)
subject: Nelda Nuclear (official) Female, DoB: 1965-07-26 ( Medical record number: 34567 (use: usual, ))
date: 2021-10-18
reporter: Organization ABC Payer
period: 2021-01-01 --> 2021-09-30
group
id
group-001
Risk Adjustment Condition Category Type: Historic Condition Category Gap
Evidence Status: Closed Condition Category Gap
Hierarchical Status: Hierarchies applied and Condition Category is not superseded
code: CMS-HCC 188: Artificial Openings for Feeding or Elimination
group
id
group-002
Risk Adjustment Condition Category Type: Historic Condition Category Gap
Evidence Status: Open Condition Category Gap
Hierarchical Status: Hierarchies applied and Condition Category is not superseded
code: CMS-HCC 111: Chronic Obstructive Pulmonary Disease
group
id
group-003
Risk Adjustment Condition Category Type: Historic Condition Category Gap
Evidence Status: Open Condition Category Gap
Hierarchical Status: Hierarchies applied and Condition Category is not superseded
code: CMS-HCC 21: Protein-Calorie Malnutrition
group
id
group-004
Risk Adjustment Condition Category Type: Historic Condition Category Gap
Evidence Status: Open Condition Category Gap
Hierarchical Status: Hierarchies applied and Condition Category is not superseded
code: CMS-HCC 35: Inflammatory Bowel Disease
group
id
group-005
Risk Adjustment Condition Category Type: Historic Condition Category Gap
Evidence Status: Open Condition Category Gap
Hierarchical Status: Hierarchies applied and Condition Category is not superseded
code: CMS-HCC 96: Specified Heart Arrhythmia
group
id
group-006
Risk Adjustment Condition Category Type: Suspected Condition Category Gap
Evidence Status: Closed Condition Category Gap
Hierarchical Status: Hierarchies applied and Condition Category is not superseded
code: CMS-HCC 18: Diabetes with Chronic Complications
group
id
group-007
Risk Adjustment Condition Category Type: Suspected Condition Category Gap
Evidence Status: Closed Condition Category Gap
Hierarchical Status: Hierarchies applied and Condition Category is not superseded
code: CMS-HCC 134: Dialysis Status
group
id
group-008
Risk Adjustment Condition Category Type: Suspected Condition Category Gap
Evidence Status: Open Condition Category Gap
Hierarchical Status: Hierarchies applied and Condition Category is not superseded
code: CMS-HCC 58: Major Depressive, Bipolar, and Paranoid Disorders
group
id
group-009
Risk Adjustment Condition Category Type: Suspected Condition Category Gap
Evidence Status: Closed Condition Category Gap
Hierarchical Status: Hierarchies applied and Condition Category is superseded
code: CMS-HCC 19: Diabetes without Complication
group
id
group-010
Risk Adjustment Condition Category Type: Suspected Condition Category Gap
Evidence Status: Pending Condition Category Gap
Hierarchical Status: Hierarchies applied and Condition Category is superseded
code: CMS-HCC 135: Acute Renal Failure
group
id
group-011
Risk Adjustment Condition Category Type: Suspected Condition Category Gap
Evidence Status: Open Condition Category Gap
Hierarchical Status: Hierarchies applied and Condition Category is superseded
code: CMS-HCC 136: Chronic Kidney Disease, Stage 5
group
id
group-012
Risk Adjustment Condition Category Type: Net-New Condition Category
Evidence Status: Pending Condition Category Gap
Hierarchical Status: Hierarchies applied and Condition Category is not superseded
code: CMS-HCC 107: Vascular Disease with Complications
group
id
group-013
Risk Adjustment Condition Category Type: Net-New Condition Category
Evidence Status: Closed Condition Category Gap
Hierarchical Status: Hierarchies applied and Condition Category is superseded
code: CMS-HCC 108: Vascular Disease
evaluatedResource:
- Condition Other artificial openings of gastrointestinal tract status
- Condition Chronic obstructive pulmonary disease with (acute) exacerbation
- Condition Unspecified protein-calorie malnutrition
- Condition Crohn's disease of large intestine with unspecified complications
- Condition Other persistent atrial fibrillation
- Condition Diabetes mellitus due to underlying condition with diabetic chronic kidney disease
- Condition Dependence on renal dialysis
- Condition Type 2 diabetes mellitus without complications
- Condition Other acute kidney failure
- Condition Chronic pulmonary embolism
- Condition Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene
- Condition Other artificial openings of gastrointestinal tract status
- 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 = 2021-07-14 --> 2021-07-14
- 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 = 2020-12-18 --> 2020-12-18
- 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 = 2020-03-03 --> 2020-03-03
- 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 = 2020-09-17 --> 2020-09-17
- 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 = 2019-02-07 --> 2019-02-07
- 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 = 2021-08-08 --> 2021-08-08
- 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 = 2021-07-27 --> 2021-07-27
- 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 = 2019-08-23 --> 2019-08-23
- 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 = 2021-01-30 --> 2021-01-30
- 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 = 2021-07-01 --> 2021-07-01
- 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 = 2021-07-14 --> 2021-07-14
- 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 = 2021-02-12 --> 2021-02-12
- 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 = 2020-02-10 --> 2020-02-11
- Observation Creat SerPl-mCnc
- Observation Patient Health Questionnaire 9 item (PHQ-9) total score [Reported]
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