Da Vinci Risk Adjustment Implementation Guide
2.0.0-ballot - STU2 Ballot United States of America flag

This page is part of the Da Vinci Risk Adjustment FHIR Implementation Guide (v2.0.0-ballot: STU2 (v2.0.0) Ballot 1) based on FHIR R4. The current version which supercedes this version is 1.0.0. For a full list of available versions, see the Directory of published versions

: Risk Adjustment Suspect Type CodeSystem - XML Representation

Active as of 2023-03-28

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<CodeSystem xmlns="http://hl7.org/fhir">
  <id value="suspect-type"/>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p>This code system <code>http://hl7.org/fhir/us/davinci-ra/CodeSystem/suspect-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="suspect-type-historic"> </a></td><td>Historic Condition Category Gap</td><td>Historic Condition Category (CC) Gap. Historic Condition Category (CC) is based on data from a prior clinical evaluation period.</td></tr><tr><td style="white-space:nowrap">suspected<a name="suspect-type-suspected"> </a></td><td>Suspected Condition Category Gap</td><td>Suspected Condition Category (CC) Gap. A member never has Condition Category (CC) before, but when a Server runs a suspecting algorithm, suspected Condition Categories (CCs) are identified for the member.</td></tr><tr><td style="white-space:nowrap">net-new<a name="suspect-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 can not be open-gap.</td></tr></table></div>
  </text>
  <url value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/suspect-type"/>
  <version value="2.0.0-ballot"/>
  <name value="RiskAdjustmentSuspectType"/>
  <title value="Risk Adjustment Suspect Type CodeSystem"/>
  <status value="active"/>
  <experimental value="false"/>
  <date value="2023-03-28T02:02:49+00:00"/>
  <publisher value="HL7 Clinical Quality Information Work Group"/>
  <contact>
    <name value="HL7 Clinical Quality Information Work Group"/>
    <telecom>
      <system value="url"/>
      <value value="http://www.hl7.org/Special/committees/cqi"/>
    </telecom>
  </contact>
  <description
               value="Risk Adjustment suspect type indicates whether it is a suspected Condition Category (CC) gap, a historic Condition Category (CC) gap, or an unsuspected Condition Category (CC). Historic, suspected, and net-new are mutually exclusive."/>
  <jurisdiction>
    <coding>
      <system value="urn:iso:std:iso:3166"/>
      <code value="US"/>
      <display value="United States of America"/>
    </coding>
  </jurisdiction>
  <copyright
             value="Used by permission of HL7 International - Clinical Quality Information Work Group, all rights reserved Creative Commons License"/>
  <caseSensitive value="true"/>
  <valueSet value="http://hl7.org/fhir/us/davinci-ra/ValueSet/suspect-type"/>
  <content value="complete"/>
  <count value="3"/>
  <concept>
    <code value="historic"/>
    <display value="Historic Condition Category Gap"/>
    <definition
                value="Historic Condition Category (CC) Gap. Historic Condition Category (CC) is based on data from a prior clinical evaluation period."/>
  </concept>
  <concept>
    <code value="suspected"/>
    <display value="Suspected Condition Category Gap"/>
    <definition
                value="Suspected Condition Category (CC) Gap. A member never has Condition Category (CC) before, but when a Server runs a suspecting algorithm, suspected Condition Categories (CCs) are identified for the member."/>
  </concept>
  <concept>
    <code value="net-new"/>
    <display value="Net-New Condition Category"/>
    <definition
                value="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 can not be open-gap."/>
  </concept>
</CodeSystem>