Da Vinci Risk Adjustment Implementation Guide
1.0.0 - STU 1 US

This page is part of the Da Vinci Risk Adjustment FHIR Implementation Guide (v1.0.0: STU 1) based on FHIR R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

Example Bundle: ra-bundle01: Risk Adjustment Bundle

Bundle ra-bundle01 of type collection

Entry 1 - Full URL = https://ra-sandbox.alphora.com/cqf-ruler-r4/fhir/MeasureReport/ra-measurereport01

Resource MeasureReport:

Generated Narrative

Resource "ra-measurereport01"

Profile: Risk Adjustment Coding Gap Report Profile

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: Patient/ra-patient01 " EVERYWOMAN"

date: 2021-10-18

reporter: Organization/ra-payer01 "ABC Payer"

period: 2021-01-01 --> 2021-09-30

group

Risk Adjustment Suspect Type Extension: Historic Condition Category Gap (Risk Adjustment Suspect Type Code System#historic)

Evidence Status Extension: Closed Condition Category Gap (Risk Adjustment Evidence Status Code System#closed-gap)

Risk Adjustment Evidence Status Date Extension: 2021-04-01

Hierarchical Status Extension: Hierarchies applied and Condition Category is not superseded (Risk Adjustment Hierarchical Status Code System#applied-not-superseded)

code: HCC 18: Diabetes with Chronic Complications (CMS Hierarchical Condition Categories[24]#18 "Diabetes with Chronic Complications")

group

Risk Adjustment Suspect Type Extension: Historic Condition Category Gap (Risk Adjustment Suspect Type Code System#historic)

Evidence Status Extension: Pending Condition Category Gap (Risk Adjustment Evidence Status Code System#pending)

Risk Adjustment Evidence Status Date Extension: 2021-09-29

Hierarchical Status Extension: Hierarchies applied and Condition Category is not superseded (Risk Adjustment Hierarchical Status Code System#applied-not-superseded)

code: HCC 111: Chronic Obstructive Pulmonary Disease (CMS Hierarchical Condition Categories[24]#111 "Chronic Obstructive Pulmonary Disease")

group

Risk Adjustment Suspect Type Extension: Historic Condition Category Gap (Risk Adjustment Suspect Type Code System#historic)

Evidence Status Extension: Open Condition Category Gap (Risk Adjustment Evidence Status Code System#open-gap)

Risk Adjustment Evidence Status Date Extension: 2020-07-15

Hierarchical Status Extension: Hierarchies applied and Condition Category is not superseded (Risk Adjustment Hierarchical Status Code System#applied-not-superseded)

code: HCC 59: Major Depressive, Bipolar, and Paranoid Disorders (CMS Hierarchical Condition Categories[24]#59 "Major Depressive, Bipolar, and Paranoid Disorders")

group

Risk Adjustment Suspect Type Extension: Historic Condition Category Gap (Risk Adjustment Suspect Type Code System#historic)

Evidence Status Extension: Closed Condition Category Gap (Risk Adjustment Evidence Status Code System#closed-gap)

Risk Adjustment Evidence Status Date Extension: 2021-04-27

Hierarchical Status Extension: Hierarchies applied and Condition Category is superseded (Risk Adjustment Hierarchical Status Code System#applied-superseded)

code: HCC 112: Fibrosis of lung and other chronic lung disorders (CMS Hierarchical Condition Categories[24]#112 "Fibrosis of lung and other chronic lung disorders")

group

Risk Adjustment Suspect Type Extension: Historic Condition Category Gap (Risk Adjustment Suspect Type Code System#historic)

Evidence Status Extension: Pending Condition Category Gap (Risk Adjustment Evidence Status Code System#pending)

Risk Adjustment Evidence Status Date Extension: 2021-09-27

Hierarchical Status Extension: Hierarchies applied and Condition Category is superseded (Risk Adjustment Hierarchical Status Code System#applied-superseded)

code: HCC 19: Diabetes without Complications (CMS Hierarchical Condition Categories[24]#19 "Diabetes without Complications")

group

Risk Adjustment Suspect Type Extension: Historic Condition Category Gap (Risk Adjustment Suspect Type Code System#historic)

Evidence Status Extension: Open Condition Category Gap (Risk Adjustment Evidence Status Code System#open-gap)

Risk Adjustment Evidence Status Date Extension: 2020-12-15

Hierarchical Status Extension: Hierarchies applied and Condition Category is superseded (Risk Adjustment Hierarchical Status Code System#applied-superseded)

code: HCC 84: Cardio-Respiratory Failure and Shock (CMS Hierarchical Condition Categories[24]#84 "Cardio-Respiratory Failure and Shock")

group

Risk Adjustment Suspect Type Extension: Suspected Condtion Category Gap (Risk Adjustment Suspect Type Code System#suspected)

Evidence Status Extension: Closed Condition Category Gap (Risk Adjustment Evidence Status Code System#closed-gap)

Risk Adjustment Evidence Status Date Extension: 2021-03-15

Hierarchical Status Extension: Hierarchies applied and Condition Category is not superseded (Risk Adjustment Hierarchical Status Code System#applied-not-superseded)

code: HCC 22: Morbid Obesity (CMS Hierarchical Condition Categories[24]#22 "Morbid Obesity")

group

Risk Adjustment Suspect Type Extension: Suspected Condtion Category Gap (Risk Adjustment Suspect Type Code System#suspected)

Evidence Status Extension: Pending Condition Category Gap (Risk Adjustment Evidence Status Code System#pending)

Risk Adjustment Evidence Status Date Extension: 2021-09-27

Hierarchical Status Extension: Hierarchies applied and Condition Category is not superseded (Risk Adjustment Hierarchical Status Code System#applied-not-superseded)

code: HCC 96: Specified Heart Arrhythmias (CMS Hierarchical Condition Categories[24]#96 "Specified Heart Arrhythmias")

group

Risk Adjustment Suspect Type Extension: Suspected Condtion Category Gap (Risk Adjustment Suspect Type Code System#suspected)

Evidence Status Extension: Open Condition Category Gap (Risk Adjustment Evidence Status Code System#open-gap)

Risk Adjustment Evidence Status Date Extension: 2020-07-15

Hierarchical Status Extension: Hierarchies applied and Condition Category is not superseded (Risk Adjustment Hierarchical Status Code System#applied-not-superseded)

code: HCC 110: Cystic Fibrosis (CMS Hierarchical Condition Categories[24]#110 "Cystic Fibrosis")

group

Risk Adjustment Suspect Type Extension: Net-New Condition Category (Risk Adjustment Suspect Type Code System#net-new)

Evidence Status Extension: Pending Condition Category Gap (Risk Adjustment Evidence Status Code System#pending)

Risk Adjustment Evidence Status Date Extension: 2021-09-28

Hierarchical Status Extension: Hierarchies applied and Condition Category is not superseded (Risk Adjustment Hierarchical Status Code System#applied-not-superseded)

code: HCC 110: Cystic Fibrosis (CMS Hierarchical Condition Categories[24]#83 "Respiratory Arrest")

evaluatedResource:

Entry 2 - Full URL = https://ra-sandbox.alphora.com/cqf-ruler-r4/fhir/Condition/ra-condition33pat01

Resource Condition:

Generated Narrative

Resource "ra-condition33pat01"

Profile: US Core Condition Profile

clinicalStatus: Active (Condition Clinical Status Codes#active)

verificationStatus: Confirmed (ConditionVerificationStatus#confirmed)

category: Problem (Condition Category Codes#encounter-diagnosis "Encounter Diagnosis")

code: R09.2: Respiratory arrest (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)#R09.2 "Respiratory arrest")

subject: Patient/ra-patient01 " EVERYWOMAN"

onset: 2021-09-26

Entry 3 - Full URL = https://ra-sandbox.alphora.com/cqf-ruler-r4/fhir/Patient/ra-patient01

Resource Patient:

Eve EVERYWOMAN
Identifier12345
Address2222 Home Street
Ann Arbor MI USA
Date of birth16 January 1975

Entry 4 - Full URL = https://ra-sandbox.alphora.com/cqf-ruler-r4/fhir/Condition/ra-condition10pat01

Resource Condition:

Generated Narrative

Resource "ra-condition10pat01"

Profile: US Core Condition Profile

clinicalStatus: Active (Condition Clinical Status Codes#active)

verificationStatus: Confirmed (ConditionVerificationStatus#confirmed)

category: Problem (Condition Category Codes#encounter-diagnosis "Encounter Diagnosis")

code: J44.1: Chronic obstructive pulmonary disease with (acute) exacerbation (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)#J44.1 "Chronic obstructive pulmonary disease with (acute) exacerbation")

subject: Patient/ra-patient01 " EVERYWOMAN"

onset: 2021-09-26

Entry 5 - Full URL = https://ra-sandbox.alphora.com/cqf-ruler-r4/fhir/Encounter/ra-encounter03pat01

Resource Encounter:

Not done yet

Entry 6 - Full URL = https://ra-sandbox.alphora.com/cqf-ruler-r4/fhir/Condition/ra-condition09pat01

Resource Condition:

Generated Narrative

Resource "ra-condition09pat01"

Profile: US Core Condition Profile

clinicalStatus: Active (Condition Clinical Status Codes#active)

verificationStatus: Confirmed (ConditionVerificationStatus#confirmed)

category: Problem (Condition Category Codes#encounter-diagnosis "Encounter Diagnosis")

code: B44.81: Allergic bronchopulmonary aspergillosis (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)#B44.81 "Allergic bronchopulmonary aspergillosis")

subject: Patient/ra-patient01 " EVERYWOMAN"

onset: 2021-03-27

Entry 7 - Full URL = https://ra-sandbox.alphora.com/cqf-ruler-r4/fhir/Condition/ra-condition02pat01

Resource Condition:

Generated Narrative

Resource "ra-condition02pat01"

Profile: US Core Condition Profile

clinicalStatus: Active (Condition Clinical Status Codes#active)

verificationStatus: Confirmed (ConditionVerificationStatus#confirmed)

category: Problem (Condition Category Codes#encounter-diagnosis "Encounter Diagnosis")

code: E08.29: Diabetes mellitus due to underlying condition with other diabetic kidney complication (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)#E08.29 "Diabetes mellitus due to underlying condition with other diabetic kidney complication")

subject: Patient/ra-patient01 " EVERYWOMAN"

onset: 2021-01-31

Entry 8 - Full URL = https://ra-sandbox.alphora.com/cqf-ruler-r4/fhir/Encounter/ra-encounter11pat01

Resource Encounter:

Not done yet

Entry 9 - Full URL = https://ra-sandbox.alphora.com/cqf-ruler-r4/fhir/Observation/ra-obs21pat01

Resource Observation:

Generated Narrative

Resource "ra-obs21pat01"

Profile: US Core Laboratory Result Observation Profile

status: FINAL

category: Laboratory (Observation Category Codes#laboratory)

code: Trypsin [Mass/volume] in Serum or Plasma (LOINC#33325-2)

subject: Patient/ra-patient01: Eve Everywoman " EVERYWOMAN"

effective: 2019-06-17

value: 770 ng/mL

ReferenceRanges

-LowHighType
*169 ng/mL (Details: UCUM code ng/mL = 'ng/mL')773 ng/mL (Details: UCUM code mg/dL = 'mg/dL')Normal Range (Observation Reference Range Meaning Codes#normal)

Entry 10 - Full URL = https://ra-sandbox.alphora.com/cqf-ruler-r4/fhir/Condition/ra-condition18pat01

Resource Condition:

Generated Narrative

Resource "ra-condition18pat01"

Profile: US Core Condition Profile

clinicalStatus: Active (Condition Clinical Status Codes#active)

verificationStatus: Confirmed (ConditionVerificationStatus#confirmed)

category: Problem (Condition Category Codes#encounter-diagnosis "Encounter Diagnosis")

code: I48.11: Longstanding persistent atrial fibrillation (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)#I48.11 "Longstanding persistent atrial fibrillation")

subject: Patient/ra-patient01 " EVERYWOMAN"

onset: 2021-09-26

Entry 11 - Full URL = https://ra-sandbox.alphora.com/cqf-ruler-r4/fhir/Encounter/ra-encounter08pat01

Resource Encounter:

Not done yet

Entry 12 - Full URL = https://ra-sandbox.alphora.com/cqf-ruler-r4/fhir/Condition/ra-condition44pat01

Resource Condition:

Generated Narrative

Resource "ra-condition44pat01"

Profile: US Core Condition Profile

clinicalStatus: Active (Condition Clinical Status Codes#active)

verificationStatus: Confirmed (ConditionVerificationStatus#confirmed)

category: Problem (Condition Category Codes#encounter-diagnosis "Encounter Diagnosis")

code: B44.81: Allergic bronchopulmonary aspergillosis (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)#B44.81 "Allergic bronchopulmonary aspergillosis")

subject: Patient/ra-patient01 " EVERYWOMAN"

onset: 2017-01-18

Entry 13 - Full URL = https://ra-sandbox.alphora.com/cqf-ruler-r4/fhir/Encounter/ra-encounter02pat01

Resource Encounter:

Not done yet

Entry 14 - Full URL = https://ra-sandbox.alphora.com/cqf-ruler-r4/fhir/Encounter/ra-encounter44pat01

Resource Encounter:

Not done yet

Entry 15 - Full URL = https://ra-sandbox.alphora.com/cqf-ruler-r4/fhir/Condition/ra-condition08pat01

Resource Condition:

Generated Narrative

Resource "ra-condition08pat01"

Profile: US Core Condition Profile

clinicalStatus: Active (Condition Clinical Status Codes#active)

verificationStatus: Confirmed (ConditionVerificationStatus#confirmed)

category: Problem (Condition Category Codes#encounter-diagnosis "Encounter Diagnosis")

code: Bipolar disorder, current episode mixed, mild (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)#F31.61)

subject: Patient/ra-patient01 " EVERYWOMAN"

onset: 2017-02-03

Entry 16 - Full URL = https://ra-sandbox.alphora.com/cqf-ruler-r4/fhir/Condition/ra-condition43pat01

Resource Condition:

Generated Narrative

Resource "ra-condition43pat01"

Profile: US Core Condition Profile

clinicalStatus: Active (Condition Clinical Status Codes#active)

verificationStatus: Confirmed (ConditionVerificationStatus#confirmed)

category: Problem (Condition Category Codes#encounter-diagnosis "Encounter Diagnosis")

code: E08.29: Diabetes mellitus due to underlying condition with other diabetic kidney complication (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)#E08.29 "Diabetes mellitus due to underlying condition with other diabetic kidney complication")

subject: Patient/ra-patient01 " EVERYWOMAN"

onset: 2019-02-10

Entry 17 - Full URL = https://ra-sandbox.alphora.com/cqf-ruler-r4/fhir/Condition/ra-condition03pat01

Resource Condition:

Generated Narrative

Resource "ra-condition03pat01"

Profile: US Core Condition Profile

clinicalStatus: Active (Condition Clinical Status Codes#active)

verificationStatus: Confirmed (ConditionVerificationStatus#confirmed)

category: Problem (Condition Category Codes#encounter-diagnosis "Encounter Diagnosis")

code: J44.1: Chronic obstructive pulmonary disease with (acute) exacerbation (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)#J44.1 "Chronic obstructive pulmonary disease with (acute) exacerbation")

subject: Patient/ra-patient01 " EVERYWOMAN"

onset: 2021-09-26

Entry 18 - Full URL = https://ra-sandbox.alphora.com/cqf-ruler-r4/fhir/Condition/ra-condition11pat01

Resource Condition:

Generated Narrative

Resource "ra-condition11pat01"

Profile: US Core Condition Profile

clinicalStatus: Active (Condition Clinical Status Codes#active)

verificationStatus: Confirmed (ConditionVerificationStatus#confirmed)

category: Problem (Condition Category Codes#encounter-diagnosis "Encounter Diagnosis")

code: J81.0: Acute pulmonary edema (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)#J81.0 "Acute pulmonary edema")

subject: Patient/ra-patient01 " EVERYWOMAN"

onset: 2020-11-02

Entry 19 - Full URL = https://ra-sandbox.alphora.com/cqf-ruler-r4/fhir/Encounter/ra-encounter43pat01

Resource Encounter:

Not done yet

Entry 20 - Full URL = https://ra-sandbox.alphora.com/cqf-ruler-r4/fhir/Encounter/ra-encounter09pat01

Resource Encounter:

Not done yet

Entry 21 - Full URL = https://ra-sandbox.alphora.com/cqf-ruler-r4/fhir/Condition/ra-condition17pat01

Resource Condition:

Generated Narrative

Resource "ra-condition17pat01"

Profile: US Core Condition Profile

clinicalStatus: Active (Condition Clinical Status Codes#active)

verificationStatus: Confirmed (ConditionVerificationStatus#confirmed)

category: Problem (Condition Category Codes#encounter-diagnosis "Encounter Diagnosis")

code: Z68.42: Body mass index [BMI] 45.0-49.9, adult (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)#Z68.42 "Body mass index [BMI] 45.0-49.9, adult")

subject: Patient/ra-patient01 " EVERYWOMAN"

onset: 2021-01-31