Measure Report Category: 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: Eve Everywoman (official) Female, DoB: 1975-01-16 ( Medical record number: 12345 (use: usual, ))

date: 2021-10-18

reporter: Organization ABC Payer

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

group

id

group-001

Condition Category Type Extension: Historic Condition Category Gap

Evidence Status Extension: Closed Condition Category Gap

Evidence Status Date Extension: 2021-04-01

Hierarchical Status Extension: Hierarchies applied and Condition Category is not superseded

code: HCC 18: Diabetes with Chronic Complications

group

id

group-002

Condition Category Type Extension: Historic Condition Category Gap

Evidence Status Extension: Pending Condition Category Gap

Evidence Status Date Extension: 2021-09-29

Hierarchical Status Extension: Hierarchies applied and Condition Category is not superseded

code: HCC 111: Chronic Obstructive Pulmonary Disease

group

id

group-003

Condition Category Type Extension: Historic Condition Category Gap

Evidence Status Extension: Open Condition Category Gap

Evidence Status Date Extension: 2020-07-15

Hierarchical Status Extension: Hierarchies applied and Condition Category is not superseded

code: HCC 59: Major Depressive, Bipolar, and Paranoid Disorders

group

id

group-004

Condition Category Type Extension: Historic Condition Category Gap

Evidence Status Extension: Closed Condition Category Gap

Evidence Status Date Extension: 2021-04-27

Hierarchical Status Extension: Hierarchies applied and Condition Category is superseded

code: HCC 112: Fibrosis of lung and other chronic lung disorders

group

id

group-005

Condition Category Type Extension: Historic Condition Category Gap

Evidence Status Extension: Pending Condition Category Gap

Evidence Status Date Extension: 2021-09-27

Hierarchical Status Extension: Hierarchies applied and Condition Category is superseded

code: HCC 19: Diabetes without Complications

group

id

group-006

Condition Category Type Extension: Historic Condition Category Gap

Evidence Status Extension: Open Condition Category Gap

Evidence Status Date Extension: 2020-12-15

Hierarchical Status Extension: Hierarchies applied and Condition Category is superseded

code: HCC 84: Cardio-Respiratory Failure and Shock

group

id

group-007

Condition Category Type Extension: Suspected Condition Category Gap

Evidence Status Extension: Closed Condition Category Gap

Evidence Status Date Extension: 2021-03-15

Hierarchical Status Extension: Hierarchies applied and Condition Category is not superseded

code: HCC 22: Morbid Obesity

group

id

group-008

Condition Category Type Extension: Suspected Condition Category Gap

Evidence Status Extension: Pending Condition Category Gap

Evidence Status Date Extension: 2021-09-27

Hierarchical Status Extension: Hierarchies applied and Condition Category is not superseded

code: HCC 96: Specified Heart Arrhythmias

group

id

group-009

Condition Category Type Extension: Suspected Condition Category Gap

Evidence Status Extension: Open Condition Category Gap

Evidence Status Date Extension: 2020-07-15

Hierarchical Status Extension: Hierarchies applied and Condition Category is not superseded

Confidence Scale Extension: Medium

code: HCC 110: Cystic Fibrosis

group

id

group-010

Condition Category Type Extension: Net-New Condition Category

Evidence Status Extension: Pending Condition Category Gap

Evidence Status Date Extension: 2021-09-28

Hierarchical Status Extension: Hierarchies applied and Condition Category is not superseded

code: HCC 83: Respiratory Arrest

evaluatedResource:

• Condition Diabetes mellitus due to underlying condition with other diabetic kidney complication
• Condition Chronic obstructive pulmonary disease with (acute) exacerbation
• Condition Bipolar disorder, current episode mixed, mild
• Condition Allergic bronchopulmonary aspergillosis
• Condition Long term (current) use of insulin
• Condition Acute pulmonary edema
• Condition Body mass index [BMI] 45.0-49.9, adult
• Condition Longstanding persistent atrial fibrillation
• Condition Respiratory arrest
• Condition Diabetes mellitus due to underlying condition with other diabetic kidney complication
• Condition Allergic bronchopulmonary aspergillosis
• Encounter: status = finished; class = ambulatory (ActCode#AMB); type = Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter.; period = 2021-01-31 --> 2021-01-31
• Encounter: status = finished; class = ambulatory (ActCode#AMB); type = Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter.; period = 2021-09-26 --> 2021-09-26
• Encounter: status = finished; class = ambulatory (ActCode#AMB); type = Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter.; period = 2017-02-03 --> 2017-02-03
• Encounter: status = finished; class = ambulatory (ActCode#AMB); type = Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter.; period = 2021-03-27 --> 2021-03-27
• Encounter: status = finished; class = ambulatory (ActCode#AMB); type = Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter.; period = 2020-11-02 --> 2020-11-02
• Encounter: status = finished; class = ambulatory (ActCode#AMB); type = Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter.; period = 2019-02-10 --> 2019-02-10
• Encounter: status = finished; class = ambulatory (ActCode#AMB); type = Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter.; period = 2017-01-18 --> 2017-01-18
• Observation Trypsin [Mass/volume] in Serum or Plasma