Da Vinci Risk Adjustment Implementation Guide
2.1.0 - STU 2.1

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 2.1.0 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

## Example Bundle: Risk Adjustment MeasureReport Bundle example, MeasureReport01: Patient01

Profile: Risk Adjustment Coding Gap Report Bundle

Bundle ra-bundle01 of type collection

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

Resource MeasureReport:

> Profile: Risk Adjustment Coding Gap MeasureReport

> Measure Report Category: Risk Adjustment

> Clinical Data Collection Deadline Extension: 2022-03-31

> status: Complete

> type: Individual

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

> subject: Eve Everywoman (official) Female, DoB: 1975-01-16 ( Medical record number: 12345 (use: usual, ))

> date: 2021-10-18

> reporter: Organization ABC Payer

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

> > group

> > > id

> > > group-001

> > Condition Category Type Extension: Historic Condition Category Gap

> > Evidence Status Extension: Closed Condition Category Gap

> > Evidence Status Date Extension: 2021-04-01

> > Hierarchical Status Extension: Hierarchies applied and Condition Category is not superseded

> > code: HCC 18: Diabetes with Chronic Complications

> > group

> > > id

> > > group-002

> > Condition Category Type Extension: Historic Condition Category Gap

> > Evidence Status Extension: Pending Condition Category Gap

> > Evidence Status Date Extension: 2021-09-29

> > Hierarchical Status Extension: Hierarchies applied and Condition Category is not superseded

> > code: HCC 111: Chronic Obstructive Pulmonary Disease

> > group

> > > id

> > > group-003

> > Condition Category Type Extension: Historic Condition Category Gap

> > Evidence Status Extension: Open Condition Category Gap

> > Evidence Status Date Extension: 2020-07-15

> > Hierarchical Status Extension: Hierarchies applied and Condition Category is not superseded

> > code: HCC 59: Major Depressive, Bipolar, and Paranoid Disorders

> > group

> > > id

> > > group-004

> > Condition Category Type Extension: Historic Condition Category Gap

> > Evidence Status Extension: Closed Condition Category Gap

> > Evidence Status Date Extension: 2021-04-27

> > Hierarchical Status Extension: Hierarchies applied and Condition Category is superseded

> > code: HCC 112: Fibrosis of lung and other chronic lung disorders

> > group

> > > id

> > > group-005

> > Condition Category Type Extension: Historic Condition Category Gap

> > Evidence Status Extension: Pending Condition Category Gap

> > Evidence Status Date Extension: 2021-09-27

> > Hierarchical Status Extension: Hierarchies applied and Condition Category is superseded

> > code: HCC 19: Diabetes without Complications

> > group

> > > id

> > > group-006

> > Condition Category Type Extension: Historic Condition Category Gap

> > Evidence Status Extension: Open Condition Category Gap

> > Evidence Status Date Extension: 2020-12-15

> > Hierarchical Status Extension: Hierarchies applied and Condition Category is superseded

> > code: HCC 84: Cardio-Respiratory Failure and Shock

> > group

> > > id

> > > group-007

> > Condition Category Type Extension: Suspected Condition Category Gap

> > Evidence Status Extension: Closed Condition Category Gap

> > Evidence Status Date Extension: 2021-03-15

> > Hierarchical Status Extension: Hierarchies applied and Condition Category is not superseded

> > code: HCC 22: Morbid Obesity

> > group

> > > id

> > > group-008

> > Condition Category Type Extension: Suspected Condition Category Gap

> > Evidence Status Extension: Pending Condition Category Gap

> > Evidence Status Date Extension: 2021-09-27

> > Hierarchical Status Extension: Hierarchies applied and Condition Category is not superseded

> > code: HCC 96: Specified Heart Arrhythmias

> > group

> > > id

> > > group-009

> > Condition Category Type Extension: Suspected Condition Category Gap

> > Evidence Status Extension: Open Condition Category Gap

> > Evidence Status Date Extension: 2020-07-15

> > Hierarchical Status Extension: Hierarchies applied and Condition Category is not superseded

> > code: HCC 110: Cystic Fibrosis

> > group

> > > id

> > > group-010

> > Condition Category Type Extension: Net-New Condition Category

> > Evidence Status Extension: Pending Condition Category Gap

> > Evidence Status Date Extension: 2021-09-28

> > Hierarchical Status Extension: Hierarchies applied and Condition Category is not superseded

> > code: HCC 110: Cystic Fibrosis

> evaluatedResource:

> - Condition Diabetes mellitus due to underlying condition with other diabetic kidney complication
> - Condition Chronic obstructive pulmonary disease with (acute) exacerbation
> - Condition Bipolar disorder, current episode mixed, mild
> - Condition Allergic bronchopulmonary aspergillosis
> - Condition Long term (current) use of insulin
> - Condition Acute pulmonary edema
> - Condition Body mass index [BMI] 45.0-49.9, adult
> - Condition Longstanding persistent atrial fibrillation
> - Condition Respiratory arrest
> - Condition Diabetes mellitus due to underlying condition with other diabetic kidney complication
> - Condition Allergic bronchopulmonary aspergillosis
> - 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
> - 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
> - 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
> - 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
> - 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 = 2020-11-02 --> 2020-11-02
> - 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 = 2019-02-10 --> 2019-02-10
> - 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 = 2017-01-18 --> 2017-01-18
> - Observation Trypsin [Mass/volume] in Serum or Plasma

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

Resource Condition:

> Profile: US Core Condition Encounter Diagnosis Profileversion: null7.0.0)

> clinicalStatus: Active

> verificationStatus: Confirmed

> category: Problem

> code: R09.2: Respiratory arrest

> subject: Eve Everywoman (official) Female, DoB: 1975-01-16 ( Medical record number: 12345 (use: usual, ))

> onset: 2021-09-26

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

Resource Patient:

> Eve EVERYWOMAN

> Identifier | 12345
> Address | 2222 Home Street Ann Arbor MI USA
> Date of birth | 16 January 1975

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

Resource Condition:

> Profile: US Core Condition Encounter Diagnosis Profileversion: null7.0.0)

> clinicalStatus: Active

> verificationStatus: Confirmed

> category: Problem

> code: J44.1: Chronic obstructive pulmonary disease with (acute) exacerbation

> subject: Eve Everywoman (official) Female, DoB: 1975-01-16 ( Medical record number: 12345 (use: usual, ))

> onset: 2021-09-26

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

Resource Encounter:

> Profile: US Core Encounter Profileversion: null7.0.0)

> status: completed

> class: ambulatory

> type: Office Visit, High Complexity

> subject: Eve Everywoman (official) Female, DoB: 1975-01-16 ( Medical record number: 12345 (use: usual, ))

> serviceProvider: Organization Community Urgent Care

> > participant

> > diagnosis

> > condition: No display for Encounter.diagnosis.condition (reference: ->Condition Chronic obstructive pulmonary disease with (acute) exacerbation)

> > diagnosis

> > condition: No display for Encounter.diagnosis.condition (reference: ->Condition Long term (current) use of insulin)

> > diagnosis

> > condition: No display for Encounter.diagnosis.condition (reference: ->Condition Longstanding persistent atrial fibrillation)

> > diagnosis

> > condition: No display for Encounter.diagnosis.condition (reference: ->Condition Respiratory arrest)

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

Resource Condition:

> Profile: US Core Condition Encounter Diagnosis Profileversion: null7.0.0)

> clinicalStatus: Active

> verificationStatus: Confirmed

> category: Problem

> code: B44.81: Allergic bronchopulmonary aspergillosis

> subject: Eve Everywoman (official) Female, DoB: 1975-01-16 ( Medical record number: 12345 (use: usual, ))

> onset: 2021-03-27

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

Resource Condition:

> Profile: US Core Condition Encounter Diagnosis Profileversion: null7.0.0)

> clinicalStatus: Active

> verificationStatus: Confirmed

> category: Problem

> code: E08.29: Diabetes mellitus due to underlying condition with other diabetic kidney complication

> subject: Eve Everywoman (official) Female, DoB: 1975-01-16 ( Medical record number: 12345 (use: usual, ))

> onset: 2021-01-31

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

Resource Encounter:

> Profile: US Core Encounter Profileversion: null7.0.0)

> status: completed

> class: ambulatory

> type: Office Visit, High Complexity

> subject: Eve Everywoman (official) Female, DoB: 1975-01-16 ( Medical record number: 12345 (use: usual, ))

> serviceProvider: Organization Community Urgent Care

> > participant

> ### Diagnoses

> - | Condition
> * | No display for Encounter.diagnosis.condition (reference: ->Condition Acute pulmonary edema)

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

Resource Observation:

> Profile: US Core Laboratory Result Observation Profileversion: null7.0.0)

> status: Final

> category: Laboratory

> code: Trypsin [Mass/volume] in Serum or Plasma

> subject: Eve Everywoman

> effective: 2019-06-17

> performer: XYZ Laboratory

> value: 770 ng/mL

> ### ReferenceRanges

> - | Low | High | Type
> * | 169 ng/mL (Details: UCUM codeng/mL = 'ng/mL') | 773 ng/mL (Details: UCUM codemg/dL = 'mg/dL') | Normal Range

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

Resource Condition:

> Profile: US Core Condition Encounter Diagnosis Profileversion: null7.0.0)

> clinicalStatus: Active

> verificationStatus: Confirmed

> category: Problem

> code: I48.11: Longstanding persistent atrial fibrillation

> subject: Eve Everywoman (official) Female, DoB: 1975-01-16 ( Medical record number: 12345 (use: usual, ))

> onset: 2021-09-26

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

Resource Encounter:

> Profile: US Core Encounter Profileversion: null7.0.0)

> status: completed

> class: ambulatory

> type: Office Visit, High Complexity

> subject: Eve Everywoman (official) Female, DoB: 1975-01-16 ( Medical record number: 12345 (use: usual, ))

> serviceProvider: Organization Community Urgent Care

> > participant

> ### Diagnoses

> - | Condition
> * | No display for Encounter.diagnosis.condition (reference: ->Condition Bipolar disorder, current episode mixed, mild)

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

Resource Condition:

> Profile: US Core Condition Encounter Diagnosis Profileversion: null7.0.0)

> clinicalStatus: Active

> verificationStatus: Confirmed

> category: Problem

> code: B44.81: Allergic bronchopulmonary aspergillosis

> subject: Eve Everywoman (official) Female, DoB: 1975-01-16 ( Medical record number: 12345 (use: usual, ))

> onset: 2017-01-18

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

Resource Encounter:

> Profile: US Core Encounter Profileversion: null7.0.0)

> status: completed

> class: ambulatory

> type: Office Visit, High Complexity

> subject: Eve Everywoman (official) Female, DoB: 1975-01-16 ( Medical record number: 12345 (use: usual, ))

> serviceProvider: Organization Community Urgent Care

> > participant

> > diagnosis

> > condition: No display for Encounter.diagnosis.condition (reference: ->Condition Diabetes mellitus due to underlying condition with other diabetic kidney complication)

> > diagnosis

> > condition: No display for Encounter.diagnosis.condition (reference: ->Condition Body mass index [BMI] 45.0-49.9, adult)

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

Resource Encounter:

> Profile: US Core Encounter Profileversion: null7.0.0)

> status: completed

> class: ambulatory

> type: Office Visit, High Complexity

> subject: Eve Everywoman (official) Female, DoB: 1975-01-16 ( Medical record number: 12345 (use: usual, ))

> serviceProvider: Organization Community Urgent Care

> > participant

> ### Diagnoses

> - | Condition
> * | No display for Encounter.diagnosis.condition (reference: ->Condition Allergic bronchopulmonary aspergillosis)

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

Resource Condition:

> Profile: US Core Condition Encounter Diagnosis Profileversion: null7.0.0)

> clinicalStatus: Active

> verificationStatus: Confirmed

> category: Problem

> code: Bipolar disorder, current episode mixed, mild

> subject: Eve Everywoman (official) Female, DoB: 1975-01-16 ( Medical record number: 12345 (use: usual, ))

> onset: 2017-02-03

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

Resource Condition:

> Profile: US Core Condition Encounter Diagnosis Profileversion: null7.0.0)

> clinicalStatus: Active

> verificationStatus: Confirmed

> category: Problem

> code: E08.29: Diabetes mellitus due to underlying condition with other diabetic kidney complication

> subject: Eve Everywoman (official) Female, DoB: 1975-01-16 ( Medical record number: 12345 (use: usual, ))

> onset: 2019-02-10

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

Resource Condition:

> Profile: US Core Condition Encounter Diagnosis Profileversion: null7.0.0)

> clinicalStatus: Active

> verificationStatus: Confirmed

> category: Problem

> code: J44.1: Chronic obstructive pulmonary disease with (acute) exacerbation

> subject: Eve Everywoman (official) Female, DoB: 1975-01-16 ( Medical record number: 12345 (use: usual, ))

> onset: 2021-09-26

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

Resource Condition:

> Profile: US Core Condition Encounter Diagnosis Profileversion: null7.0.0)

> clinicalStatus: Active

> verificationStatus: Confirmed

> category: Problem

> code: J81.0: Acute pulmonary edema

> subject: Eve Everywoman (official) Female, DoB: 1975-01-16 ( Medical record number: 12345 (use: usual, ))

> onset: 2020-11-02

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

Resource Encounter:

> Profile: US Core Encounter Profileversion: null7.0.0)

> status: completed

> class: ambulatory

> type: Office Visit, High Complexity

> subject: Eve Everywoman (official) Female, DoB: 1975-01-16 ( Medical record number: 12345 (use: usual, ))

> serviceProvider: Organization Community Urgent Care

> > participant

> ### Diagnoses

> - | Condition
> * | No display for Encounter.diagnosis.condition (reference: ->Condition Diabetes mellitus due to underlying condition with other diabetic kidney complication)

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

Resource Encounter:

> Profile: US Core Encounter Profileversion: null7.0.0)

> status: completed

> class: ambulatory

> type: Office Visit, High Complexity

> subject: Eve Everywoman (official) Female, DoB: 1975-01-16 ( Medical record number: 12345 (use: usual, ))

> serviceProvider: Organization Community Urgent Care

> > participant

> ### Diagnoses

> - | Condition
> * | No display for Encounter.diagnosis.condition (reference: ->Condition Allergic bronchopulmonary aspergillosis)

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

Resource Condition:

> Profile: US Core Condition Encounter Diagnosis Profileversion: null7.0.0)

> clinicalStatus: Active

> verificationStatus: Confirmed

> category: Problem

> code: Z68.42: Body mass index [BMI] 45.0-49.9, adult

> subject: Eve Everywoman (official) Female, DoB: 1975-01-16 ( Medical record number: 12345 (use: usual, ))

> onset: 2021-01-31