Da Vinci Risk Adjustment Implementation Guide
2.0.0-ballot - STU2 Ballot

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## ValueSet: Sample CMS Hierarchical Condition Category

Official URL: http://hl7.org/fhir/us/davinci-ra/ValueSet/sample-cmshcc | Version: 2.0.0-ballot
Active as of 2023-03-28 | Computable Name: SampleCMSHCC
Copyright/Legal: Used by permission of HL7 International - Clinical Quality Information Work Group, all rights reserved Creative Commons License

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.

References

- Risk Adjustment Coding Gap MeasureReport

### Logical Definition (CLD)

- Include these codes as defined in `http://terminology.hl7.org/CodeSystem/cmshcc`

  Code | Display
  22 | Morbid Obesity
  88 | Angina Pectoris
  112 | Fibrosis of Lung and Other Chronic Lung Disorders

### Expansion

No Expansion for this valueset (Unknown Code System)

Explanation of the columns that may appear on this page:

Level | A few code lists that FHIR defines are hierarchical - each code is assigned a level. In this scheme, some codes are under other codes, and imply that the code they are under also applies
System | The source of the definition of the code (when the value set draws in codes defined elsewhere)
Code | The code (used as the code in the resource instance)
Display | The display (used in the display element of a Coding). If there is no display, implementers should not simply display the code, but map the concept into their application
Definition | An explanation of the meaning of the concept
Comments | Additional notes about how to use the code