Da Vinci Risk Adjustment Implementation Guide
1.0.0 - STU 1
US
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. For a full list of available versions, see the Directory of published versions 
| Active as of 2022-06-16 |
{
"resourceType" : "ValueSet",
"id" : "example-cmshcc",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><ul><li>Include these codes as defined in <a href=\"http://terminology.hl7.org/3.1.0/CodeSystem-cmshcc.html\"><code>http://terminology.hl7.org/CodeSystem/cmshcc</code></a> version <code>24</code><table class=\"none\"><tr><td style=\"white-space:nowrap\"><b>Code</b></td><td><b>Display</b></td></tr><tr><td>1</td><td>HIV/AIDS</td></tr><tr><td>2</td><td>Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock</td></tr><tr><td>6</td><td>Opportunistic Infections</td></tr><tr><td>8</td><td>Metastatic Cancer and Acute Leukemia</td></tr><tr><td>9</td><td>Lung and Other Severe Cancers</td></tr><tr><td>10</td><td>Lymphoma and Other Cancers</td></tr><tr><td>11</td><td>Colorectal, Bladder, and Other Cancers</td></tr><tr><td>12</td><td>Breast, Prostate, and Other Cancers and Tumors</td></tr><tr><td>17</td><td>Diabetes with Acute Complications</td></tr><tr><td>18</td><td>Diabetes with Chronic Complications</td></tr><tr><td>19</td><td>Diabetes without Complication</td></tr><tr><td>21</td><td>Protein-Calorie Malnutrition</td></tr><tr><td>22</td><td>Morbid Obesity</td></tr><tr><td>23</td><td>Other Significant Endocrine and Metabolic Disorders</td></tr><tr><td>27</td><td>End-Stage Liver Disease</td></tr><tr><td>28</td><td>Cirrhosis of Liver</td></tr><tr><td>29</td><td>Chronic Hepatitis</td></tr><tr><td>33</td><td>Intestinal Obstruction/Perforation</td></tr><tr><td>34</td><td>Chronic Pancreatitis</td></tr><tr><td>35</td><td>Inflammatory Bowel Disease</td></tr><tr><td>39</td><td>Bone/Joint/Muscle Infections/Necrosis</td></tr><tr><td>40</td><td>Rheumatoid Arthritis and Inflammatory Connective Tissue Disease</td></tr><tr><td>46</td><td>Severe Hematological Disorders</td></tr><tr><td>47</td><td>Disorders of Immunity</td></tr><tr><td>48</td><td>Coagulation Defects and Other Specified Hematological Disorders</td></tr><tr><td>51</td><td>Dementia With Complications</td></tr><tr><td>52</td><td>Dementia Without Complication</td></tr><tr><td>54</td><td>Substance Use with Psychotic Complications</td></tr><tr><td>55</td><td>Substance Use Disorder, Moderate/Severe, or Substance Use with Complications</td></tr><tr><td>56</td><td>Substance Use Disorder, Mild, Except Alcohol and Cannabis</td></tr><tr><td>57</td><td>Schizophrenia</td></tr><tr><td>58</td><td>Reactive and Unspecified Psychosis</td></tr><tr><td>59</td><td>Major Depressive, Bipolar, and Paranoid Disorders</td></tr><tr><td>60</td><td>Personality Disorders</td></tr><tr><td>70</td><td>Quadriplegia</td></tr><tr><td>71</td><td>Paraplegia</td></tr><tr><td>72</td><td>Spinal Cord Disorders/Injuries</td></tr><tr><td>73</td><td>Amyotrophic Lateral Sclerosis and Other Motor Neuron Disease</td></tr><tr><td>74</td><td>Cerebral Palsy</td></tr><tr><td>75</td><td>Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy</td></tr><tr><td>76</td><td>Muscular Dystrophy</td></tr><tr><td>77</td><td>Multiple Sclerosis</td></tr><tr><td>78</td><td>Parkinson's and Huntington's Diseases</td></tr><tr><td>79</td><td>Seizure Disorders and Convulsions</td></tr><tr><td>80</td><td>Coma, Brain Compression/Anoxic Damage</td></tr><tr><td>82</td><td>Respirator Dependence/Tracheostomy Status</td></tr><tr><td>83</td><td>Respiratory Arrest</td></tr><tr><td>84</td><td>Cardio-Respiratory Failure and Shock</td></tr><tr><td>85</td><td>Congestive Heart Failure</td></tr><tr><td>86</td><td>Acute Myocardial Infarction</td></tr><tr><td>87</td><td>Unstable Angina and Other Acute Ischemic Heart Disease</td></tr><tr><td>88</td><td>Angina Pectoris</td></tr><tr><td>96</td><td>Specified Heart Arrhythmias</td></tr><tr><td>99</td><td>Intracranial Hemorrhage</td></tr><tr><td>100</td><td>Ischemic or Unspecified Stroke</td></tr><tr><td>103</td><td>Hemiplegia/Hemiparesis</td></tr><tr><td>104</td><td>Monoplegia, Other Paralytic Syndromes</td></tr><tr><td>106</td><td>Atherosclerosis of the Extremities with Ulceration or Gangrene</td></tr><tr><td>107</td><td>Vascular Disease with Complications</td></tr><tr><td>108</td><td>Vascular Disease</td></tr><tr><td>110</td><td>Cystic Fibrosis</td></tr><tr><td>111</td><td>Chronic Obstructive Pulmonary Disease</td></tr><tr><td>112</td><td>Fibrosis of Lung and Other Chronic Lung Disorders</td></tr><tr><td>114</td><td>Aspiration and Specified Bacterial Pneumonias</td></tr><tr><td>115</td><td>Pneumococcal Pneumonia, Empyema, Lung Abscess</td></tr><tr><td>122</td><td>Proliferative Diabetic Retinopathy and Vitreous Hemorrhage</td></tr><tr><td>124</td><td>Exudative Macular Degeneration</td></tr><tr><td>134</td><td>Dialysis Status</td></tr><tr><td>135</td><td>Acute Renal Failure</td></tr><tr><td>136</td><td>Chronic Kidney Disease, Stage 5</td></tr><tr><td>137</td><td>Chronic Kidney Disease, Severe (Stage 4)</td></tr><tr><td>138</td><td>Chronic Kidney Disease, Moderate (Stage 3)</td></tr><tr><td>157</td><td>Pressure Ulcer of Skin with Necrosis Through to Muscle, Tendon, or Bone</td></tr><tr><td>158</td><td>Pressure Ulcer of Skin with Full Thickness Skin Loss</td></tr><tr><td>159</td><td>Pressure Ulcer of Skin with Partial Thickness Skin Loss</td></tr><tr><td>161</td><td>Chronic Ulcer of Skin, Except Pressure</td></tr><tr><td>162</td><td>Severe Skin Burn or Condition</td></tr><tr><td>166</td><td>Severe Head Injury</td></tr><tr><td>167</td><td>Major Head Injury</td></tr><tr><td>169</td><td>Vertebral Fractures without Spinal Cord Injury</td></tr><tr><td>170</td><td>Hip Fracture/Dislocation</td></tr><tr><td>173</td><td>Traumatic Amputations and Complications</td></tr><tr><td>176</td><td>Complications of Specified Implanted Device or Graft</td></tr><tr><td>186</td><td>Major Organ Transplant or Replacement Status</td></tr><tr><td>188</td><td>Artificial Openings for Feeding or Elimination</td></tr><tr><td>189</td><td>Amputation Status, Lower Limb/Amputation Complications</td></tr></table></li></ul></div>"
},
"url" : "http://hl7.org/fhir/us/davinci-ra/ValueSet/example-cmshcc",
"version" : "1.0.0",
"name" : "ExampleCMSHCCValueSet",
"title" : "Example CMS Hierarchical Condition Category Value Set",
"status" : "active",
"experimental" : true,
"date" : "2022-06-16T14:25:19+00:00",
"publisher" : "HL7 Clinical Quality Information Work Group",
"contact" : [
{
"name" : "HL7 Clinical Quality Information Work Group",
"telecom" : [
{
"system" : "url",
"value" : "http://www.hl7.org/Special/committees/cqi"
}
]
}
],
"description" : "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.",
"jurisdiction" : [
{
"coding" : [
{
"system" : "urn:iso:std:iso:3166",
"code" : "US",
"display" : "United States of America"
}
]
}
],
"copyright" : "Used by permission of HL7 International - Clinical Quality Information Work Group, all rights reserved Creative Commons License",
"compose" : {
"include" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/cmshcc",
"version" : "24",
"concept" : [
{
"code" : "1",
"display" : "HIV/AIDS"
},
{
"code" : "2",
"display" : "Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock"
},
{
"code" : "6",
"display" : "Opportunistic Infections"
},
{
"code" : "8",
"display" : "Metastatic Cancer and Acute Leukemia"
},
{
"code" : "9",
"display" : "Lung and Other Severe Cancers"
},
{
"code" : "10",
"display" : "Lymphoma and Other Cancers"
},
{
"code" : "11",
"display" : "Colorectal, Bladder, and Other Cancers"
},
{
"code" : "12",
"display" : "Breast, Prostate, and Other Cancers and Tumors"
},
{
"code" : "17",
"display" : "Diabetes with Acute Complications"
},
{
"code" : "18",
"display" : "Diabetes with Chronic Complications"
},
{
"code" : "19",
"display" : "Diabetes without Complication"
},
{
"code" : "21",
"display" : "Protein-Calorie Malnutrition"
},
{
"code" : "22",
"display" : "Morbid Obesity"
},
{
"code" : "23",
"display" : "Other Significant Endocrine and Metabolic Disorders"
},
{
"code" : "27",
"display" : "End-Stage Liver Disease"
},
{
"code" : "28",
"display" : "Cirrhosis of Liver"
},
{
"code" : "29",
"display" : "Chronic Hepatitis"
},
{
"code" : "33",
"display" : "Intestinal Obstruction/Perforation"
},
{
"code" : "34",
"display" : "Chronic Pancreatitis"
},
{
"code" : "35",
"display" : "Inflammatory Bowel Disease"
},
{
"code" : "39",
"display" : "Bone/Joint/Muscle Infections/Necrosis"
},
{
"code" : "40",
"display" : "Rheumatoid Arthritis and Inflammatory Connective Tissue Disease"
},
{
"code" : "46",
"display" : "Severe Hematological Disorders"
},
{
"code" : "47",
"display" : "Disorders of Immunity"
},
{
"code" : "48",
"display" : "Coagulation Defects and Other Specified Hematological Disorders"
},
{
"code" : "51",
"display" : "Dementia With Complications"
},
{
"code" : "52",
"display" : "Dementia Without Complication"
},
{
"code" : "54",
"display" : "Substance Use with Psychotic Complications"
},
{
"code" : "55",
"display" : "Substance Use Disorder, Moderate/Severe, or Substance Use with Complications"
},
{
"code" : "56",
"display" : "Substance Use Disorder, Mild, Except Alcohol and Cannabis"
},
{
"code" : "57",
"display" : "Schizophrenia"
},
{
"code" : "58",
"display" : "Reactive and Unspecified Psychosis"
},
{
"code" : "59",
"display" : "Major Depressive, Bipolar, and Paranoid Disorders"
},
{
"code" : "60",
"display" : "Personality Disorders"
},
{
"code" : "70",
"display" : "Quadriplegia"
},
{
"code" : "71",
"display" : "Paraplegia"
},
{
"code" : "72",
"display" : "Spinal Cord Disorders/Injuries"
},
{
"code" : "73",
"display" : "Amyotrophic Lateral Sclerosis and Other Motor Neuron Disease"
},
{
"code" : "74",
"display" : "Cerebral Palsy"
},
{
"code" : "75",
"display" : "Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy"
},
{
"code" : "76",
"display" : "Muscular Dystrophy"
},
{
"code" : "77",
"display" : "Multiple Sclerosis"
},
{
"code" : "78",
"display" : "Parkinson's and Huntington's Diseases"
},
{
"code" : "79",
"display" : "Seizure Disorders and Convulsions"
},
{
"code" : "80",
"display" : "Coma, Brain Compression/Anoxic Damage"
},
{
"code" : "82",
"display" : "Respirator Dependence/Tracheostomy Status"
},
{
"code" : "83",
"display" : "Respiratory Arrest"
},
{
"code" : "84",
"display" : "Cardio-Respiratory Failure and Shock"
},
{
"code" : "85",
"display" : "Congestive Heart Failure"
},
{
"code" : "86",
"display" : "Acute Myocardial Infarction"
},
{
"code" : "87",
"display" : "Unstable Angina and Other Acute Ischemic Heart Disease"
},
{
"code" : "88",
"display" : "Angina Pectoris"
},
{
"code" : "96",
"display" : "Specified Heart Arrhythmias"
},
{
"code" : "99",
"display" : "Intracranial Hemorrhage"
},
{
"code" : "100",
"display" : "Ischemic or Unspecified Stroke"
},
{
"code" : "103",
"display" : "Hemiplegia/Hemiparesis"
},
{
"code" : "104",
"display" : "Monoplegia, Other Paralytic Syndromes"
},
{
"code" : "106",
"display" : "Atherosclerosis of the Extremities with Ulceration or Gangrene"
},
{
"code" : "107",
"display" : "Vascular Disease with Complications"
},
{
"code" : "108",
"display" : "Vascular Disease"
},
{
"code" : "110",
"display" : "Cystic Fibrosis"
},
{
"code" : "111",
"display" : "Chronic Obstructive Pulmonary Disease"
},
{
"code" : "112",
"display" : "Fibrosis of Lung and Other Chronic Lung Disorders"
},
{
"code" : "114",
"display" : "Aspiration and Specified Bacterial Pneumonias"
},
{
"code" : "115",
"display" : "Pneumococcal Pneumonia, Empyema, Lung Abscess"
},
{
"code" : "122",
"display" : "Proliferative Diabetic Retinopathy and Vitreous Hemorrhage"
},
{
"code" : "124",
"display" : "Exudative Macular Degeneration"
},
{
"code" : "134",
"display" : "Dialysis Status"
},
{
"code" : "135",
"display" : "Acute Renal Failure"
},
{
"code" : "136",
"display" : "Chronic Kidney Disease, Stage 5"
},
{
"code" : "137",
"display" : "Chronic Kidney Disease, Severe (Stage 4)"
},
{
"code" : "138",
"display" : "Chronic Kidney Disease, Moderate (Stage 3)"
},
{
"code" : "157",
"display" : "Pressure Ulcer of Skin with Necrosis Through to Muscle, Tendon, or Bone"
},
{
"code" : "158",
"display" : "Pressure Ulcer of Skin with Full Thickness Skin Loss"
},
{
"code" : "159",
"display" : "Pressure Ulcer of Skin with Partial Thickness Skin Loss"
},
{
"code" : "161",
"display" : "Chronic Ulcer of Skin, Except Pressure"
},
{
"code" : "162",
"display" : "Severe Skin Burn or Condition"
},
{
"code" : "166",
"display" : "Severe Head Injury"
},
{
"code" : "167",
"display" : "Major Head Injury"
},
{
"code" : "169",
"display" : "Vertebral Fractures without Spinal Cord Injury"
},
{
"code" : "170",
"display" : "Hip Fracture/Dislocation"
},
{
"code" : "173",
"display" : "Traumatic Amputations and Complications"
},
{
"code" : "176",
"display" : "Complications of Specified Implanted Device or Graft"
},
{
"code" : "186",
"display" : "Major Organ Transplant or Replacement Status"
},
{
"code" : "188",
"display" : "Artificial Openings for Feeding or Elimination"
},
{
"code" : "189",
"display" : "Amputation Status, Lower Limb/Amputation Complications"
}
]
}
]
}
}
IG © 2021+ HL7 Clinical Quality Information Work Group. Package hl7.fhir.us.davinci-ra#1.0.0 based on FHIR 4.0.1. Generated 2022-06-16
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