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 MeasureReport: RA Coding Gap MeasureReport Example02 with RA Model CMS-RxHCC V5 for Patient01 Eve Everywoman

Page standards status: Informative

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 5 - CMS Prescribing Drug Hierarchical Category Condition (CMS-RxHCC)

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 not applied

> code: CMS-RxHCC 227: Pulmonary Fibrosis and Other Chronic Lung Disorders

> group

> > id

> > group-002

> Condition Category Type Extension: Historic Condition Category Gap

> Evidence Status Extension: Open Condition Category Gap

> Evidence Status Date Extension: 2020-07-01

> Hierarchical Status Extension: Hierarchies not applied

> code: CMS-RxHCC 131: Bipolar Disorders

> group

> > id

> > group-003

> Condition Category Type Extension: Suspected Condition Category Gap

> Evidence Status Extension: Closed Condition Category Gap

> Evidence Status Date Extension: 2021-02-15

> Hierarchical Status Extension: Hierarchies not applied

> code: CMS-RxHCC 30: Diabetes with Chronic Complications

> group

> > id

> > group-004

> Condition Category Type Extension: Suspected Condition Category Gap

> Evidence Status Date Extension: 2021-04-01

> Evidence Status Extension: Closed Condition Category Gap

> Hierarchical Status Extension: Hierarchies not applied

> code: CMS-RxHCC 43: Morbid Obesity

> group

> > id

> > group-005

> Condition Category Type Extension: Suspected Condition Category Gap

> Evidence Status Extension: Pending Condition Category Gap

> Evidence Status Date Extension: 2021-09-29

> Hierarchical Status Extension: Hierarchies not applied

> code: CMS-RxHCC 31: Diabetes without Complications

> group

> > id

> > group-006

> Condition Category Type Extension: Net-New Condition Category

> Evidence Status Extension: Pending Condition Category Gap

> Evidence Status Date Extension: 2021-09-29

> Hierarchical Status Extension: Hierarchies not applied

> code: CMS-RxHCC 226: Chronic Obstructive Pulmonary Disease and Asthma

evaluatedResource:

- Condition Allergic bronchopulmonary aspergillosis
- Condition Bipolar disorder, current episode mixed, mild
- Condition Diabetes mellitus due to underlying condition with other diabetic kidney complication
- Condition Body mass index [BMI] 45.0-49.9, adult
- Condition Long term (current) use of insulin
- Condition Chronic obstructive pulmonary disease with (acute) exacerbation
- 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 = 2021-03-27 --> 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 = 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 = 2021-01-31 --> 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 = 2018-07-21 --> 2018-07-21