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

ValueSet: Example CMS Hierarchical Condition Category Value Set (Experimental)

Official URL: http://hl7.org/fhir/us/davinci-ra/ValueSet/example-cmshcc Version: 1.0.0
Active as of 2022-06-16 Computable Name: ExampleCMSHCCValueSet

Copyright/Legal: Used by permission of HL7 International - Clinical Quality Information Work Group, all rights reserved Creative Commons License

This is an example value set with concepts drawn from the CMS Hierarchical Condition Categories (CMS-HCC) code system version 24. The source of the codes included in this example value set is published on https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Downloads/Announcement2020.pdf. The CMS-HCC model uses more than 9,000 ICD-10-CM codes, which are mapped to condition categories (CCs) that predict costs well. The condition categories (CCs) are based on diagnoses clinically related to one another and with similar predicted cost implications. Hierarchies are imposed on the Condition Categories (CCs) to capture the most costly diagnoses. Hierarchy logic is imposed on certain Condition Categories (CCs) to account for different hierarchical costs, thus, the term Hierarchical Condition Category, or HCC.

References

Logical Definition (CLD)

  • Include these codes as defined in http://terminology.hl7.org/CodeSystem/cmshcc version 24
    CodeDisplay
    1HIV/AIDS
    2Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock
    6Opportunistic Infections
    8Metastatic Cancer and Acute Leukemia
    9Lung and Other Severe Cancers
    10Lymphoma and Other Cancers
    11Colorectal, Bladder, and Other Cancers
    12Breast, Prostate, and Other Cancers and Tumors
    17Diabetes with Acute Complications
    18Diabetes with Chronic Complications
    19Diabetes without Complication
    21Protein-Calorie Malnutrition
    22Morbid Obesity
    23Other Significant Endocrine and Metabolic Disorders
    27End-Stage Liver Disease
    28Cirrhosis of Liver
    29Chronic Hepatitis
    33Intestinal Obstruction/Perforation
    34Chronic Pancreatitis
    35Inflammatory Bowel Disease
    39Bone/Joint/Muscle Infections/Necrosis
    40Rheumatoid Arthritis and Inflammatory Connective Tissue Disease
    46Severe Hematological Disorders
    47Disorders of Immunity
    48Coagulation Defects and Other Specified Hematological Disorders
    51Dementia With Complications
    52Dementia Without Complication
    54Substance Use with Psychotic Complications
    55Substance Use Disorder, Moderate/Severe, or Substance Use with Complications
    56Substance Use Disorder, Mild, Except Alcohol and Cannabis
    57Schizophrenia
    58Reactive and Unspecified Psychosis
    59Major Depressive, Bipolar, and Paranoid Disorders
    60Personality Disorders
    70Quadriplegia
    71Paraplegia
    72Spinal Cord Disorders/Injuries
    73Amyotrophic Lateral Sclerosis and Other Motor Neuron Disease
    74Cerebral Palsy
    75Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy
    76Muscular Dystrophy
    77Multiple Sclerosis
    78Parkinson's and Huntington's Diseases
    79Seizure Disorders and Convulsions
    80Coma, Brain Compression/Anoxic Damage
    82Respirator Dependence/Tracheostomy Status
    83Respiratory Arrest
    84Cardio-Respiratory Failure and Shock
    85Congestive Heart Failure
    86Acute Myocardial Infarction
    87Unstable Angina and Other Acute Ischemic Heart Disease
    88Angina Pectoris
    96Specified Heart Arrhythmias
    99Intracranial Hemorrhage
    100Ischemic or Unspecified Stroke
    103Hemiplegia/Hemiparesis
    104Monoplegia, Other Paralytic Syndromes
    106Atherosclerosis of the Extremities with Ulceration or Gangrene
    107Vascular Disease with Complications
    108Vascular Disease
    110Cystic Fibrosis
    111Chronic Obstructive Pulmonary Disease
    112Fibrosis of Lung and Other Chronic Lung Disorders
    114Aspiration and Specified Bacterial Pneumonias
    115Pneumococcal Pneumonia, Empyema, Lung Abscess
    122Proliferative Diabetic Retinopathy and Vitreous Hemorrhage
    124Exudative Macular Degeneration
    134Dialysis Status
    135Acute Renal Failure
    136Chronic Kidney Disease, Stage 5
    137Chronic Kidney Disease, Severe (Stage 4)
    138Chronic Kidney Disease, Moderate (Stage 3)
    157Pressure Ulcer of Skin with Necrosis Through to Muscle, Tendon, or Bone
    158Pressure Ulcer of Skin with Full Thickness Skin Loss
    159Pressure Ulcer of Skin with Partial Thickness Skin Loss
    161Chronic Ulcer of Skin, Except Pressure
    162Severe Skin Burn or Condition
    166Severe Head Injury
    167Major Head Injury
    169Vertebral Fractures without Spinal Cord Injury
    170Hip Fracture/Dislocation
    173Traumatic Amputations and Complications
    176Complications of Specified Implanted Device or Graft
    186Major Organ Transplant or Replacement Status
    188Artificial Openings for Feeding or Elimination
    189Amputation Status, Lower Limb/Amputation Complications

 

Expansion

No Expansion for this valueset (Unknown Code System)

Explanation of the columns that may appear on this page:

Level A few code lists that FHIR defines are hierarchical - each code is assigned a level. In this scheme, some codes are under other codes, and imply that the code they are under also applies
System The source of the definition of the code (when the value set draws in codes defined elsewhere)
Code The code (used as the code in the resource instance)
Display The display (used in the display element of a Coding). If there is no display, implementers should not simply display the code, but map the concept into their application
Definition An explanation of the meaning of the concept
Comments Additional notes about how to use the code