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

## : Risk Adjustment Condition Category Type Codes - JSON Representation

Page standards status: Trial-use | Maturity Level: 2

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    {
      "resourceType" : "CodeSystem",
      "id" : "cc-type",
      "text" : {
        "status" : "generated",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: CodeSystem cc-type</b></p><a name=\"cc-type\"> </a><a name=\"hccc-type\"> </a><p>This case-sensitive code system <code>http://hl7.org/fhir/us/davinci-ra/CodeSystem/cc-type</code> defines the following codes:</p><table class=\"codes\"><tr><td style=\"white-space:nowrap\"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td style=\"white-space:nowrap\">historic<a name=\"cc-type-historic\"> </a></td><td>Historic Condition Category Gap</td><td>Historic Condition Category (CC) Gap. Historic Condition Category (CC) is based on verified data from any clinical evaluation period.</td></tr><tr><td style=\"white-space:nowrap\">suspected<a name=\"cc-type-suspected\"> </a></td><td>Suspected Condition Category Gap</td><td>Suspected Condition Category (CC) Gap. A member has never had this as a verified Condition Category (CC), but when a Server runs a suspecting algorithm, suspected Condition Categories (CCs) are identified.</td></tr><tr><td style=\"white-space:nowrap\">net-new<a name=\"cc-type-net-new\"> </a></td><td>Net-New Condition Category</td><td>Net-New Condition Category (CC). New Condition Category (CC), not from suspected process or historic. A Net-New Condition Category (CC) is documented for the first time during the clinical evaluation period for the risk adjustment model. Any Condition Categories (CCs) that are net new must be either closed-gap or pending and cannot be open-gap.</td></tr></table></div>"
      },
      "extension" : [
        {
          "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
          "valueCode" : "cqi"
        },
        {
          "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
          "valueInteger" : 2,
          "_valueInteger" : {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
                "valueCanonical" : "http://hl7.org/fhir/us/davinci-ra/ImplementationGuide/davinci-ra"
              }
            ]
          }
        },
        {
          "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
          "valueCode" : "trial-use",
          "_valueCode" : {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
                "valueCanonical" : "http://hl7.org/fhir/us/davinci-ra/ImplementationGuide/davinci-ra"
              }
            ]
          }
        }
      ],
      "url" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/cc-type",
      "identifier" : [
        {
          "system" : "urn:ietf:rfc:3986",
          "value" : "urn:oid:2.16.840.1.113883.4.642.40.29.16.1"
        }
      ],
      "version" : "2.1.0",
      "name" : "RiskAdjustmentConditionCategoryType",
      "title" : "Risk Adjustment Condition Category Type Codes",
      "status" : "active",
      "experimental" : false,
      "date" : "2025-11-20T19:49:53+00:00",
      "publisher" : "HL7 International / Clinical Quality Information",
      "contact" : [
        {
          "telecom" : [
            {
              "system" : "url",
              "value" : "http://www.hl7.org/Special/committees/cqi"
            }
          ]
        }
      ],
      "description" : "Code sytstem that indicates whether it is a suspected Condition Category (CC) gap, a historic Condition Category (CC) gap, or a net-new Condition Category (CC). Historic, suspected, and net-new are mutually exclusive.",
      "jurisdiction" : [
        {
          "coding" : [
            {
              "system" : "urn:iso:std:iso:3166",
              "code" : "US",
              "display" : "United States of America"
            }
          ]
        }
      ],
      "copyright" : "Used by permission of HL7 International, all rights reserved Creative Commons License",
      "caseSensitive" : true,
      "content" : "complete",
      "count" : 3,
      "concept" : [
        {
          "code" : "historic",
          "display" : "Historic Condition Category Gap",
          "definition" : "Historic Condition Category (CC) Gap. Historic Condition Category (CC) is based on verified data from any clinical evaluation period."
        },
        {
          "code" : "suspected",
          "display" : "Suspected Condition Category Gap",
          "definition" : "Suspected Condition Category (CC) Gap. A member has never had this as a verified Condition Category (CC), but when a Server runs a suspecting algorithm, suspected Condition Categories (CCs) are identified."
        },
        {
          "code" : "net-new",
          "display" : "Net-New Condition Category",
          "definition" : "Net-New Condition Category (CC). New Condition Category (CC), not from suspected process or historic. A Net-New Condition Category (CC) is documented for the first time during the clinical evaluation period for the risk adjustment model. Any Condition Categories (CCs) that are net new must be either closed-gap or pending and cannot be open-gap."
        }
      ]
    }