Da Vinci Risk Adjustment Implementation Guide
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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

: ra-measurereport05: Risk Adjustment Measure Report for RxHCC V5 for Patient03 - XML Representation

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<MeasureReport xmlns="http://hl7.org/fhir">
  <id value="ra-measurereport05"/>
  <meta>
    <profile
             value="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-measurereport"/>
  </meta>
  <text>
    <status value="extensions"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: MeasureReport ra-measurereport05</b></p><a name="ra-measurereport05"> </a><a name="hcra-measurereport05"> </a><a name="ra-measurereport05-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-patient03.html">Nelda Nuclear (official) Female, DoB: 1965-07-26 ( Medical record number: 34567 (use: usual, ))</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 --&gt; 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 pending}">Pending 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 226}">CMS-RxHCC 226: Chronic Obstructive Pulmonary Disease and Asthma</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 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>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 Complication</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>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 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>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 261}">CMS-RxHCC 261: Dialysis Status</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 open-gap}">Open 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 262}">CMS-RxHCC 262: Chronic Kidney Disease Stage 5</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 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 216}">CMS-RxHCC 216: Peripheral Vascular Disease</span></p></blockquote><p><b>evaluatedResource</b>: </p><ul><li><a href="Condition-ra-condition04pat03.html">Condition Chronic obstructive pulmonary disease with (acute) exacerbation</a></li><li><a href="Condition-ra-condition21pat03.html">Condition Type 2 diabetes mellitus without complications</a></li><li><a href="Condition-ra-condition15pat03.html">Condition Diabetes mellitus due to underlying condition with diabetic chronic kidney disease</a></li><li><a href="Condition-ra-condition16pat03.html">Condition Dependence on renal dialysis</a></li><li><a href="Condition-ra-condition35pat03.html">Condition Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene</a></li><li><a href="Encounter-ra-encounter04pat03.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 = 2020-12-18 --&gt; 2020-12-18</a></li><li><a href="Encounter-ra-encounter21pat03.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 = 2021-01-30 --&gt; 2021-01-30</a></li><li><a href="Encounter-ra-encounter15pat03.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 = 2021-08-08 --&gt; 2021-08-08</a></li><li><a href="Encounter-ra-encounter16pat03.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 = 2021-07-27 --&gt; 2021-07-27</a></li><li><a href="Encounter-ra-encounter35pat03.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 = 2021-02-12 --&gt; 2021-02-12</a></li><li><a href="Observation-ra-obs01pat03.html">Observation Creat SerPl-mCnc</a></li></ul></div>
  </text>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/measurereport-category">
    <valueCodeableConcept>
      <coding>
        <system
                value="http://hl7.org/fhir/CodeSystem/measurereport-category"/>
        <code value="ra"/>
      </coding>
    </valueCodeableConcept>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-clinicalDataCollectionDeadline">
    <valueDate value="2022-03-31"/>
  </extension>
  <status value="complete"/>
  <type value="individual"/>
  <measure
           value="https://build.fhir.org/ig/HL7/davinci-ra/Measure-RAModelExample03"/>
  <subject>🔗 
    <reference value="Patient/ra-patient03"/>
  </subject>
  <date value="2021-10-18"/>
  <reporter>🔗 
    <reference value="Organization/ra-payer01"/>
  </reporter>
  <period>
    <start value="2021-01-01"/>
    <end value="2021-09-30"/>
  </period>
  <group id="group-001">
    <extension
               url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccType">
      <valueCodeableConcept>
        <coding>
          <system
                  value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/cc-type"/>
          <code value="historic"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <extension
               url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus">
      <valueCodeableConcept>
        <coding>
          <system
                  value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status"/>
          <code value="pending"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <extension
               url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus">
      <valueCodeableConcept>
        <coding>
          <system
                  value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status"/>
          <code value="not-applied"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <code>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/cmsrxhcc"/>
        <version value="5"/>
        <code value="226"/>
        <display value="Chronic Obstructive Pulmonary Disease and Asthma"/>
      </coding>
      <text
            value="CMS-RxHCC 226: Chronic Obstructive Pulmonary Disease and Asthma"/>
    </code>
  </group>
  <group id="group-002">
    <extension
               url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccType">
      <valueCodeableConcept>
        <coding>
          <system
                  value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/cc-type"/>
          <code value="suspected"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <extension
               url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus">
      <valueCodeableConcept>
        <coding>
          <system
                  value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status"/>
          <code value="closed-gap"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <extension
               url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus">
      <valueCodeableConcept>
        <coding>
          <system
                  value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status"/>
          <code value="not-applied"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <code>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/cmsrxhcc"/>
        <version value="5"/>
        <code value="31"/>
        <display value="Diabetes without Complication"/>
      </coding>
      <text value="CMS-RxHCC 31: Diabetes without Complication"/>
    </code>
  </group>
  <group id="group-003">
    <extension
               url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccType">
      <valueCodeableConcept>
        <coding>
          <system
                  value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/cc-type"/>
          <code value="suspected"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <extension
               url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus">
      <valueCodeableConcept>
        <coding>
          <system
                  value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status"/>
          <code value="closed-gap"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <extension
               url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus">
      <valueCodeableConcept>
        <coding>
          <system
                  value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status"/>
          <code value="not-applied"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <code>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/cmsrxhcc"/>
        <version value="5"/>
        <code value="30"/>
        <display value="Diabetes with Complications"/>
      </coding>
      <text value="CMS-RxHCC 30: Diabetes with Complications"/>
    </code>
  </group>
  <group id="group-004">
    <extension
               url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccType">
      <valueCodeableConcept>
        <coding>
          <system
                  value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/cc-type"/>
          <code value="suspected"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <extension
               url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus">
      <valueCodeableConcept>
        <coding>
          <system
                  value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status"/>
          <code value="closed-gap"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <extension
               url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus">
      <valueCodeableConcept>
        <coding>
          <system
                  value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status"/>
          <code value="not-applied"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <code>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/cmsrxhcc"/>
        <version value="5"/>
        <code value="261"/>
        <display value="Dialysis Status"/>
      </coding>
      <text value="CMS-RxHCC 261: Dialysis Status"/>
    </code>
  </group>
  <group id="group-005">
    <extension
               url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccType">
      <valueCodeableConcept>
        <coding>
          <system
                  value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/cc-type"/>
          <code value="suspected"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <extension
               url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus">
      <valueCodeableConcept>
        <coding>
          <system
                  value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status"/>
          <code value="open-gap"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <extension
               url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus">
      <valueCodeableConcept>
        <coding>
          <system
                  value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status"/>
          <code value="not-applied"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <code>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/cmsrxhcc"/>
        <version value="5"/>
        <code value="262"/>
        <display value="Chronic Kidney Disease Stage 5"/>
      </coding>
      <text value="CMS-RxHCC 262: Chronic Kidney Disease Stage 5"/>
    </code>
  </group>
  <group id="group-006">
    <extension
               url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccType">
      <valueCodeableConcept>
        <coding>
          <system
                  value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/cc-type"/>
          <code value="net-new"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <extension
               url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus">
      <valueCodeableConcept>
        <coding>
          <system
                  value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status"/>
          <code value="closed-gap"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <extension
               url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus">
      <valueCodeableConcept>
        <coding>
          <system
                  value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status"/>
          <code value="not-applied"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <code>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/cmsrxhcc"/>
        <version value="5"/>
        <code value="216"/>
        <display value="Peripheral Vascular Disease"/>
      </coding>
      <text value="CMS-RxHCC 216: Peripheral Vascular Disease"/>
    </code>
  </group>
  <evaluatedResource>🔗 
    <extension
               url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference">
      <valueString value="group-001"/>
    </extension>
    <reference value="Condition/ra-condition04pat03"/>
  </evaluatedResource>
  <evaluatedResource>🔗 
    <extension
               url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference">
      <valueString value="group-002"/>
    </extension>
    <reference value="Condition/ra-condition21pat03"/>
  </evaluatedResource>
  <evaluatedResource>🔗 
    <extension
               url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference">
      <valueString value="group-003"/>
    </extension>
    <reference value="Condition/ra-condition15pat03"/>
  </evaluatedResource>
  <evaluatedResource>🔗 
    <extension
               url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference">
      <valueString value="group-004"/>
    </extension>
    <reference value="Condition/ra-condition16pat03"/>
  </evaluatedResource>
  <evaluatedResource>🔗 
    <extension
               url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference">
      <valueString value="group-006"/>
    </extension>
    <reference value="Condition/ra-condition35pat03"/>
  </evaluatedResource>
  <evaluatedResource>🔗 
    <extension
               url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference">
      <valueString value="group-001"/>
    </extension>
    <reference value="Encounter/ra-encounter04pat03"/>
  </evaluatedResource>
  <evaluatedResource>🔗 
    <extension
               url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference">
      <valueString value="group-002"/>
    </extension>
    <reference value="Encounter/ra-encounter21pat03"/>
  </evaluatedResource>
  <evaluatedResource>🔗 
    <extension
               url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference">
      <valueString value="group-003"/>
    </extension>
    <reference value="Encounter/ra-encounter15pat03"/>
  </evaluatedResource>
  <evaluatedResource>🔗 
    <extension
               url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference">
      <valueString value="group-004"/>
    </extension>
    <reference value="Encounter/ra-encounter16pat03"/>
  </evaluatedResource>
  <evaluatedResource>🔗 
    <extension
               url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference">
      <valueString value="group-006"/>
    </extension>
    <reference value="Encounter/ra-encounter35pat03"/>
  </evaluatedResource>
  <evaluatedResource>🔗 
    <extension
               url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference">
      <valueString value="group-005"/>
    </extension>
    <reference value="Observation/ra-obs01pat03"/>
  </evaluatedResource>
</MeasureReport>