Details
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Change Request
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Resolution: Persuasive
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Medium
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US Da Vinci Risk Adjustment (FHIR)
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current
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Clinical Quality Information
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Example CMS Hierarchical Condition Category Value Set [deprecated]
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Linda Michaelsen/Yan Heras: 16-0-0
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Correction
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Non-substantive
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Yes
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current
Description
Per the discussion completed on 2022-11-02 with Yan and Linda:
The value set can be bound EXAMPLE but the value set so bound should not be a full value set you are not committed to maintain. Therefore change the following in the value set:
- change the name to "Sample CMS Hierarchical Condition Categories"
- Change the CLD to only contain 3 random codes that you have pulled from the CMS pdf used as the source for the code system.
- Remove the experimental flag
- The Definition can stay as detailed as it is but I'd make the following minor change:
- This is a sample of the concepts that can be found in the CMS Hierarchical Condition Categories (CMS-HCC) code system version 24. The source of the codes included in this example was published at 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.