Da Vinci Risk Adjustment Implementation Guide
2.0.0-ballot - STU2 Ballot
Da Vinci Risk Adjustment Implementation Guide
2.0.0-ballot - STU2 Ballot
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 
{
"resourceType" : "MeasureReport",
"id" : "ra-measurereport05",
"meta" : {
"profile" : [
"http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-measurereport"
]
},
"text" : {
"status" : "extensions",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: MeasureReport</b><a name=\"ra-measurereport05\"> </a></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource MeasureReport "ra-measurereport05" </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-ra-measurereport.html\">Risk Adjustment Coding Gap MeasureReport</a></p></div><p><b>Risk Adjustment Clinical Data Collection Deadline</b>: 2022-03-31</p><p><b>status</b>: complete</p><p><b>type</b>: individual</p><p><b>measure</b>: <a href=\"Measure-RAModelExample03.html\">Risk Adjustment Model Version 5 - CMS Prescribing Drug Hierarchical Category Condition (CMS-HCC)</a></p><p><b>subject</b>: <a href=\"Patient-ra-patient03.html\">Patient/ra-patient03</a> " NUCLEAR"</p><p><b>date</b>: 2021-10-18</p><p><b>reporter</b>: <a href=\"Organization-ra-payer01.html\">Organization/ra-payer01</a> "ABC Payer"</p><p><b>period</b>: 2021-01-01 --> 2021-09-30</p><blockquote><p><b>group</b></p><blockquote><p><b>id</b></p>group-001</blockquote><p><b>Risk Adjustment Suspect Type</b>: Historic Condition Category Gap <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-suspect-type.html\">Risk Adjustment Suspect Type CodeSystem</a>#historic)</span></p><p><b>Evidence Status</b>: Pending Condition Category Gap <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-evidence-status.html\">Risk Adjustment Evidence Status CodeSystem</a>#pending)</span></p><p><b>Hierarchical Status</b>: Hierarchies not applied <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-hierarchical-status.html\">Risk Adjustment Hierarchical Status CodeSystem</a>#not-applied)</span></p><p><b>code</b>: CMS-RxHCC 226: Chronic Obstructive Pulmonary Disease and Asthma <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (CMS Prescription Drug Hierarchical Condition Categories[5]#226 "Chronic Obstructive Pulmonary Disease and Asthma")</span></p></blockquote><blockquote><p><b>group</b></p><blockquote><p><b>id</b></p>group-002</blockquote><p><b>Risk Adjustment Suspect Type</b>: Suspected Condition Category Gap <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-suspect-type.html\">Risk Adjustment Suspect Type CodeSystem</a>#suspected)</span></p><p><b>Evidence Status</b>: Closed Condition Category Gap <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-evidence-status.html\">Risk Adjustment Evidence Status CodeSystem</a>#closed-gap)</span></p><p><b>Hierarchical Status</b>: Hierarchies not applied <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-hierarchical-status.html\">Risk Adjustment Hierarchical Status CodeSystem</a>#not-applied)</span></p><p><b>code</b>: CMS-RxHCC 31: Diabetes without Complication <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (CMS Prescription Drug Hierarchical Condition Categories[5]#31 "Diabetes without Complication")</span></p></blockquote><blockquote><p><b>group</b></p><blockquote><p><b>id</b></p>group-003</blockquote><p><b>Risk Adjustment Suspect Type</b>: Suspected Condition Category Gap <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-suspect-type.html\">Risk Adjustment Suspect Type CodeSystem</a>#suspected)</span></p><p><b>Evidence Status</b>: Closed Condition Category Gap <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-evidence-status.html\">Risk Adjustment Evidence Status CodeSystem</a>#closed-gap)</span></p><p><b>Hierarchical Status</b>: Hierarchies not applied <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-hierarchical-status.html\">Risk Adjustment Hierarchical Status CodeSystem</a>#not-applied)</span></p><p><b>code</b>: CMS-RxHCC 30: Diabetes with Complications <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (CMS Prescription Drug Hierarchical Condition Categories[5]#30 "Diabetes with Complications")</span></p></blockquote><blockquote><p><b>group</b></p><blockquote><p><b>id</b></p>group-004</blockquote><p><b>Risk Adjustment Suspect Type</b>: Suspected Condition Category Gap <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-suspect-type.html\">Risk Adjustment Suspect Type CodeSystem</a>#suspected)</span></p><p><b>Evidence Status</b>: Closed Condition Category Gap <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-evidence-status.html\">Risk Adjustment Evidence Status CodeSystem</a>#closed-gap)</span></p><p><b>Hierarchical Status</b>: Hierarchies not applied <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-hierarchical-status.html\">Risk Adjustment Hierarchical Status CodeSystem</a>#not-applied)</span></p><p><b>code</b>: CMS-RxHCC 261: Dialysis Status <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (CMS Prescription Drug Hierarchical Condition Categories[5]#261 "Dialysis Status")</span></p></blockquote><blockquote><p><b>group</b></p><blockquote><p><b>id</b></p>group-005</blockquote><p><b>Risk Adjustment Suspect Type</b>: Suspected Condition Category Gap <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-suspect-type.html\">Risk Adjustment Suspect Type CodeSystem</a>#suspected)</span></p><p><b>Evidence Status</b>: Open Condition Category Gap <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-evidence-status.html\">Risk Adjustment Evidence Status CodeSystem</a>#open-gap)</span></p><p><b>Hierarchical Status</b>: Hierarchies not applied <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-hierarchical-status.html\">Risk Adjustment Hierarchical Status CodeSystem</a>#not-applied)</span></p><p><b>code</b>: CMS-RxHCC 262: Chronic Kidney Disease Stage 5 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (CMS Prescription Drug Hierarchical Condition Categories[5]#262 "Chronic Kidney Disease Stage 5")</span></p></blockquote><blockquote><p><b>group</b></p><blockquote><p><b>id</b></p>group-006</blockquote><p><b>Risk Adjustment Suspect Type</b>: Net-New Condition Category <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-suspect-type.html\">Risk Adjustment Suspect Type CodeSystem</a>#net-new)</span></p><p><b>Evidence Status</b>: Closed Condition Category Gap <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-evidence-status.html\">Risk Adjustment Evidence Status CodeSystem</a>#closed-gap)</span></p><p><b>Hierarchical Status</b>: Hierarchies not applied <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-hierarchical-status.html\">Risk Adjustment Hierarchical Status CodeSystem</a>#not-applied)</span></p><p><b>code</b>: CMS-RxHCC 216: Peripheral Vascular Disease <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (CMS Prescription Drug Hierarchical Condition Categories[5]#216 "Peripheral Vascular Disease")</span></p></blockquote><p><b>evaluatedResource</b>: </p><ul><li><a href=\"Condition-ra-condition04pat03.html\">Condition/ra-condition04pat03</a></li><li><a href=\"Condition-ra-condition21pat03.html\">Condition/ra-condition21pat03</a></li><li><a href=\"Condition-ra-condition15pat03.html\">Condition/ra-condition15pat03</a></li><li><a href=\"Condition-ra-condition16pat03.html\">Condition/ra-condition16pat03</a></li><li><a href=\"Condition-ra-condition35pat03.html\">Condition/ra-condition35pat03</a></li><li><a href=\"Encounter-ra-encounter04pat03.html\">Encounter/ra-encounter04pat03</a></li><li><a href=\"Encounter-ra-encounter21pat03.html\">Encounter/ra-encounter21pat03</a></li><li><a href=\"Encounter-ra-encounter15pat03.html\">Encounter/ra-encounter15pat03</a></li><li><a href=\"Encounter-ra-encounter16pat03.html\">Encounter/ra-encounter16pat03</a></li><li><a href=\"Encounter-ra-encounter35pat03.html\">Encounter/ra-encounter35pat03</a></li><li><a href=\"Observation-ra-obs01pat03.html\">Observation/ra-obs01pat03</a></li></ul></div>"
},
"extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-clinicalDataCollectionDeadline",
"valueDate" : "2022-03-31"
}
],
"status" : "complete",
"type" : "individual",
"measure" : "https://build.fhir.org/ig/HL7/davinci-ra/Measure-RAModelExample03",
"subject" : {
"reference" : "Patient/ra-patient03"
},
"date" : "2021-10-18",
"reporter" : {
"reference" : "Organization/ra-payer01"
},
"period" : {
"start" : "2021-01-01",
"end" : "2021-09-30"
},
"group" : [
{
"id" : "group-001",
"extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-suspectType",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/suspect-type",
"code" : "historic"
}
]
}
},
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status",
"code" : "pending"
}
]
}
},
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status",
"code" : "not-applied"
}
]
}
}
],
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/cmsrxhcc",
"version" : "5",
"code" : "226",
"display" : "Chronic Obstructive Pulmonary Disease and Asthma"
}
],
"text" : "CMS-RxHCC 226: Chronic Obstructive Pulmonary Disease and Asthma"
}
},
{
"id" : "group-002",
"extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-suspectType",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/suspect-type",
"code" : "suspected"
}
]
}
},
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status",
"code" : "closed-gap"
}
]
}
},
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status",
"code" : "not-applied"
}
]
}
}
],
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/cmsrxhcc",
"version" : "5",
"code" : "31",
"display" : "Diabetes without Complication"
}
],
"text" : "CMS-RxHCC 31: Diabetes without Complication"
}
},
{
"id" : "group-003",
"extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-suspectType",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/suspect-type",
"code" : "suspected"
}
]
}
},
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status",
"code" : "closed-gap"
}
]
}
},
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status",
"code" : "not-applied"
}
]
}
}
],
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/cmsrxhcc",
"version" : "5",
"code" : "30",
"display" : "Diabetes with Complications"
}
],
"text" : "CMS-RxHCC 30: Diabetes with Complications"
}
},
{
"id" : "group-004",
"extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-suspectType",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/suspect-type",
"code" : "suspected"
}
]
}
},
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status",
"code" : "closed-gap"
}
]
}
},
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status",
"code" : "not-applied"
}
]
}
}
],
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/cmsrxhcc",
"version" : "5",
"code" : "261",
"display" : "Dialysis Status"
}
],
"text" : "CMS-RxHCC 261: Dialysis Status"
}
},
{
"id" : "group-005",
"extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-suspectType",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/suspect-type",
"code" : "suspected"
}
]
}
},
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status",
"code" : "open-gap"
}
]
}
},
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status",
"code" : "not-applied"
}
]
}
}
],
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/cmsrxhcc",
"version" : "5",
"code" : "262",
"display" : "Chronic Kidney Disease Stage 5"
}
],
"text" : "CMS-RxHCC 262: Chronic Kidney Disease Stage 5"
}
},
{
"id" : "group-006",
"extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-suspectType",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/suspect-type",
"code" : "net-new"
}
]
}
},
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status",
"code" : "closed-gap"
}
]
}
},
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status",
"code" : "not-applied"
}
]
}
}
],
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/cmsrxhcc",
"version" : "5",
"code" : "216",
"display" : "Peripheral Vascular Disease"
}
],
"text" : "CMS-RxHCC 216: Peripheral Vascular Disease"
}
}
],
"evaluatedResource" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
"valueString" : "group-001"
}
],
"reference" : "Condition/ra-condition04pat03"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
"valueString" : "group-002"
}
],
"reference" : "Condition/ra-condition21pat03"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
"valueString" : "group-003"
}
],
"reference" : "Condition/ra-condition15pat03"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
"valueString" : "group-004"
}
],
"reference" : "Condition/ra-condition16pat03"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
"valueString" : "group-006"
}
],
"reference" : "Condition/ra-condition35pat03"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
"valueString" : "group-001"
}
],
"reference" : "Encounter/ra-encounter04pat03"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
"valueString" : "group-002"
}
],
"reference" : "Encounter/ra-encounter21pat03"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
"valueString" : "group-003"
}
],
"reference" : "Encounter/ra-encounter15pat03"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
"valueString" : "group-004"
}
],
"reference" : "Encounter/ra-encounter16pat03"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
"valueString" : "group-006"
}
],
"reference" : "Encounter/ra-encounter35pat03"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
"valueString" : "group-005"
}
],
"reference" : "Observation/ra-obs01pat03"
}
]
}
IG © 2021+ HL7 Clinical Quality Information Work Group. Package hl7.fhir.us.davinci-ra#2.0.0-ballot based on FHIR 4.0.1. Generated 2023-03-28
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