Da Vinci Risk Adjustment Implementation Guide
1.0.0 - STU 1 US

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: Example CMS Hierarchical Condition Category Value Set - XML Representation

Active as of 2022-06-16

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