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 MeasureReport with Remark Example (ra-measurereport01-with-remark)

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 Hierarchical Status Extension: Hierarchies applied and Condition Category is not superseded

> > Condition Category Remark Extension

> > - author: United States National Provider Identifier/1234567890
> > - qualifyingDxCode: Disorder of eye due to type 2 diabetes mellitus (disorder)

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 Hierarchical Status Extension: Hierarchies applied and Condition Category is not superseded

> Diagnosis Code Extension: Moderate major depression

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 Hierarchical Status Extension: Hierarchies applied and Condition Category is not superseded

> > Condition Category Remark Extension

> > - author: United States National Provider Identifier/1234567890
> > - text: Diagnosis added
> > - code: Assessed and present
> > - relatedData: `http://example.org/fhir/myclaimno`/CLM23333

> 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

> > Condition Category Remark Extension

> > - author: United States National Provider Identifier/1234567890
> > - authorDatetime: 2021-11-01
> > - text: Continue evaluation
> > - code: Deferred

> 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

> > Condition Category Remark Extension

> > - author: United States National Provider Identifier/1234567890
> > - authorDatetime: 2021-11-01
> > - qualifyingDxList: E66.01, E66.2, E66.813

> 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

> Confidence Scale Extension: Medium

> > Condition Category Remark Extension

> > - author: United States National Provider Identifier/1234567890
> > - authorDatetime: 2021-11-01
> > - text: Not diagnosed
> > - code: Assessed and not present
> > - relatedData: `http://example.org/fhir/mychart`/432203939

> 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 83: Respiratory Arrest

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