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 Example04 with RA Model CMS-HCC V21 for Patient03 Nelda Nuclear

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 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

> Condition Category Type Extension: Historic Condition Category Gap

> Evidence Status Extension: Closed Condition Category Gap

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 Hierarchical Status Extension: Hierarchies applied and Condition Category is not superseded

> code: CMS-HCC 188: Artificial Openings for Feeding or Elimination

> group

> > id

> > group-002

> Condition Category Type Extension: Historic Condition Category Gap

> Evidence Status Extension: Open Condition Category Gap

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 Hierarchical Status Extension: Hierarchies applied and Condition Category is not superseded

> code: CMS-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

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 Hierarchical Status Extension: Hierarchies applied and Condition Category is not superseded

> code: CMS-HCC 21: Protein-Calorie Malnutrition

> group

> > id

> > group-004

> Condition Category Type Extension: Historic Condition Category Gap

> Evidence Status Extension: Open Condition Category Gap

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 Hierarchical Status Extension: Hierarchies applied and Condition Category is not superseded

> code: CMS-HCC 35: Inflammatory Bowel Disease

> group

> > id

> > group-005

> Condition Category Type Extension: Historic Condition Category Gap

> Evidence Status Extension: Open Condition Category Gap

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 Hierarchical Status Extension: Hierarchies applied and Condition Category is not superseded

> code: CMS-HCC 96: Specified Heart Arrhythmia

> group

> > id

> > group-006

> Condition Category Type Extension: Suspected Condition Category Gap

> Evidence Status Extension: Closed Condition Category Gap

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 Hierarchical Status Extension: Hierarchies applied and Condition Category is not superseded

> code: CMS-HCC 18: Diabetes with Chronic Complications

> group

> > id

> > group-007

> Condition Category Type Extension: Suspected Condition Category Gap

> Evidence Status Extension: Closed Condition Category Gap

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 Hierarchical Status Extension: Hierarchies applied and Condition Category is not superseded

> code: CMS-HCC 134: Dialysis Status

> group

> > id

> > group-008

> Condition Category Type Extension: Suspected Condition Category Gap

> Evidence Status Extension: Open Condition Category Gap

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 Hierarchical Status Extension: Hierarchies applied and Condition Category is not superseded

> code: CMS-HCC 58: Major Depressive, Bipolar, and Paranoid Disorders

> group

> > id

> > group-009

> Condition Category Type Extension: Suspected Condition Category Gap

> Evidence Status Extension: Closed Condition Category Gap

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

> code: CMS-HCC 19: Diabetes without Complication

> group

> > id

> > group-010

> Condition Category Type Extension: Suspected Condition Category Gap

> Evidence Status Extension: Pending Condition Category Gap

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

> code: CMS-HCC 135: Acute Renal Failure

> group

> > id

> > group-011

> Condition Category Type Extension: Suspected Condition Category Gap

> Evidence Status Extension: Open Condition Category Gap

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

> code: CMS-HCC 136: Chronic Kidney Disease, Stage 5

> group

> > id

> > group-012

> Condition Category Type Extension: Net-New Condition Category

> Evidence Status Extension: Pending Condition Category Gap

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

> code: CMS-HCC 107: Vascular Disease with Complications

> group

> > id

> > group-013

> Condition Category Type Extension: Net-New Condition Category

> Evidence Status Extension: Closed Condition Category Gap

> Hierarchical Status Extension: 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 --> 2020-02-10
- Observation Creat SerPl-mCnc
- Observation Patient Health Questionnaire 9 item (PHQ-9) total score [Reported]