Da Vinci Risk Adjustment Implementation Guide
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CodeSystem: Risk Adjustment Suspect Type CodeSystem

Official URL: http://hl7.org/fhir/us/davinci-ra/CodeSystem/suspect-type Version: 2.0.0-ballot
Active as of 2023-03-28 Computable Name: RiskAdjustmentSuspectType

Copyright/Legal: Used by permission of HL7 International - Clinical Quality Information Work Group, all rights reserved Creative Commons License

Risk Adjustment suspect type indicates whether it is a suspected Condition Category (CC) gap, a historic Condition Category (CC) gap, or an unsuspected Condition Category (CC). Historic, suspected, and net-new are mutually exclusive.

This Code system is referenced in the content logical definition of the following value sets:

This code system http://hl7.org/fhir/us/davinci-ra/CodeSystem/suspect-type defines the following codes:

CodeDisplayDefinition
historic Historic Condition Category GapHistoric Condition Category (CC) Gap. Historic Condition Category (CC) is based on data from a prior clinical evaluation period.
suspected Suspected Condition Category GapSuspected Condition Category (CC) Gap. A member never has Condition Category (CC) before, but when a Server runs a suspecting algorithm, suspected Condition Categories (CCs) are identified for the member.
net-new Net-New Condition CategoryNet-New Condition Category (CC). New Condition Category (CC), not from suspected process or historic. A Net-New Condition Category (CC) is documented for the first time during the clinical evaluation period for the risk adjustment model. Any Condition Categories (CCs) that are net new must be either closed-gap or pending, and can not be open-gap.