Measure Report Category: Risk Adjustment

Clinical Data Collection Deadline Extension: 2022-03-31

status: Complete

type: Individual

measure: Risk Adjustment Model Version 5 - CMS Prescribing Drug Hierarchical Category Condition (CMS-RxHCC)

subject: Nelda Nuclear (official) Female, DoB: 1965-07-26 ( Medical record number: 34567 (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: Pending Condition Category Gap

Hierarchical Status Extension: Hierarchies not applied

code: CMS-RxHCC 226: Chronic Obstructive Pulmonary Disease and Asthma

group

id

group-002

Condition Category Type Extension: Suspected Condition Category Gap

Evidence Status Extension: Closed Condition Category Gap

Hierarchical Status Extension: Hierarchies not applied

code: CMS-RxHCC 31: Diabetes without Complication

group

id

group-003

Condition Category Type Extension: Suspected Condition Category Gap

Evidence Status Extension: Closed Condition Category Gap

Hierarchical Status Extension: Hierarchies not applied

code: CMS-RxHCC 30: Diabetes with Complications

group

id

group-004

Condition Category Type Extension: Suspected Condition Category Gap

Evidence Status Extension: Closed Condition Category Gap

Hierarchical Status Extension: Hierarchies not applied

code: CMS-RxHCC 261: Dialysis Status

group

id

group-005

Condition Category Type Extension: Suspected Condition Category Gap

Evidence Status Extension: Open Condition Category Gap

Hierarchical Status Extension: Hierarchies not applied

code: CMS-RxHCC 262: Chronic Kidney Disease Stage 5

group

id

group-006

Condition Category Type Extension: Net-New Condition Category

Evidence Status Extension: Closed Condition Category Gap

Hierarchical Status Extension: Hierarchies not applied

code: CMS-RxHCC 216: Peripheral Vascular Disease

evaluatedResource:

• Condition Chronic obstructive pulmonary disease with (acute) exacerbation
• Condition Type 2 diabetes mellitus without complications
• Condition Diabetes mellitus due to underlying condition with diabetic chronic kidney disease
• Condition Dependence on renal dialysis
• Condition Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene
• 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 = 2020-12-18 --> 2020-12-18
• 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 = 2021-01-30 --> 2021-01-30
• 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 = 2021-08-08 --> 2021-08-08
• 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 = 2021-07-27 --> 2021-07-27
• 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 = 2021-02-12 --> 2021-02-12
• Observation Creat SerPl-mCnc