PatientHierarchicalConditionCategoryRegistry
DM_CMS_HCC is a data mart table that stores information related to CMS-HCC. This table consolidates data about the applicability of hierarchical conditions categories (HCCs), most recent related diagnosis information, and whether or not the patient requires a calendar year refresh for each applicable HCC. Only patients that meet specific inclusion criteria have information stored in this table.
| Column Name | Type | Description |
|---|---|---|
| CmsHccCongestiveHeartFailureRenalDiseaseInteractionScore | NUMERIC | Returns the CMS-HCC disease interaction score for CHF x RENAL. It will return a score if the patient has HCC 85 satisfied in addition to HCC 134, 135, 136, 137, or 138 being satisfied. Rule: CMS-HCC Disease Interaction Score (CHF x RENAL) (98107) |
| MajorOrganTransplantDiagnosisSourceIdentifier | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 186: MAJOR ORGAN TRANSPLANT OR REPLACEMENT STATUS (98084) |
| MuscularDystrophyHccRiskStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| LastSevereSkinBurnDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 162: SEVERE SKIN BURN OR CONDITION (98077) |
| LastVertebralFractureDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 169: VERTEBRAL FRACTURES WITHOUT SPINAL CORD INJURY (98080) |
| LastOtherSignificantEndocrineMetabolicDisorderDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 23: OTHER SIGNIFICANT ENDOCRINE AND METABOLIC DISORDERS (98014) |
| TotalChronicConditionScore | NUMERIC | Returns the total score for CMS-HCC chronic/mixed categories, including the roll up of all applicable and satisfied categories, the sex/age factor, total CMS-HCC count factor, and disease interaction scores. Rule: CMS-HCC Chronic/Mixed Total Score (98126) |
| CmsHccChronicPotentialScore | NUMERIC | Returns the total potential score for CMS-HCC, including the roll up of all applicable categories, the sex/age factor, total CMS-HCC count factor, and disease interaction scores. Rule: CMS-HCC Chronic/Mixed Potential Score (98127) |
| LastParaplegiaDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 71: PARAPLEGIA (98036) |
| LastDiabetesWithoutComplicationDiagnosisIdentifier | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 19: DIABETES WITHOUT COMPLICATION (98011) |
| RegistryDataRecordIdentifier | NUMERIC | The unique identifier (.1 item) for the registry data record. |
| AspirationBacterialPneumoniaDiagnosisIdentification | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 114: ASPIRATION AND SPECIFIED BACTERIAL PNEUMONIAS (98064) |
| CmsHcc170HipFractureStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| UpcomingDiagnosisRiskAdjustmentAppointmentDateTime | DATETIME | Returns the date of a patient's upcoming diagnosis-based risk adjustment eligible appointment. Rule: DM Has Upcoming Diagnosis-Based Risk Adjustment Eligible Appointment (98128) |
| HccPersonalityDisorderStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| RecordOwnerCommunityIdentification | VARCHAR | The Community ID (CID) of the instance that owns this record or line. This is only populated if you use IntraConnect. |
| LastDiabetesWithoutComplicationDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 19: DIABETES WITHOUT COMPLICATION (98011) |
| CmsHcc80ComaAnoxicBrainDamageStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| RegistryDataStatus | INTEGER | Status of the registry data. |
| LastHccMetastaticCancerAndAcuteLeukemiaSourceItemNumber | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 8: METASTATIC CANCER AND ACUTE LEUKEMIA (98004) |
| LastProteinCalorieMalnutritionDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 21: PROTEIN-CALORIE MALNUTRITION (98012) |
| CmsHcc9LungAndOtherSevereCancersLastDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 9: LUNG AND OTHER SEVERE CANCERS (98005) |
| HccDisorderOfImmuneSystemStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| LastPersonalityDisorderDiagnosisSourceIdentification | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 60: PERSONALITY DISORDERS (98034) |
| LastRiskAdjustmentEncounterDate | DATETIME | Returns the last date the patient had a diagnosis-based risk adjustment eligible encounter. Rule: DM Last Diagnosis-Based Risk Adjustment Eligible Encounter Date (98105) |
| CmsHccReactiveUnstablePsychiatricStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| LastChronicKidneyDiseaseStage3DiagnosisIdentifier | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 138: CHRONIC KIDNEY DISEASE, MODERATE (STAGE 3) (98072) |
| CmsHcc12BreastProstateCancerSourceIni | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 12: BREAST, PROSTATE, AND OTHER CANCERS AND TUMORS (98008) |
| LastParaplegiaDiagnosisSourceIni | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 71: PARAPLEGIA (98036) |
| LastChronicKidneyDiseaseStage5SourceRecordIdentifier | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 136: CHRONIC KIDNEY DISEASE (STAGE 5) (98070) |
| LastPressureUlcerPartialThicknessDiagnosisSourceIni | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 159: PRESSURE ULCER OF SKIN WITH PARTIAL THICKNESS SKIN LOSS (98075) |
| CmsHccProteinCalorieMalnutritionSourceIdentifier | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 21: PROTEIN-CALORIE MALNUTRITION (98012) |
| LastUnstableAnginaDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 87: UNSTABLE ANGINA AND OTHER ACUTE ISCHEMIC HEART DISEASE (98051) |
| ParkinsonsAndHuntingtonsDiseaseStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| LastRespiratoryArrestDiagnosisSourceIni | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 83: RESPIRATORY ARREST (98047) |
| LastRespiratoryDependenceSourceIni | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 82: RESPIRATOR DEPENDENCE/TRACHEOSTOMY STATUS (98046) |
| LastBoneInfectionDiagnosisIdentification | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 39: BONE/JOINT/MUSCLE INFECTIONS/NECROSIS (98021) |
| LastSeizureConvulsionSourceIni | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 79: SEIZURE DISORDERS AND CONVULSIONS (98044) |
| LastDiabetesWithChronicComplicationsDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 18: DIABETES WITH CHRONIC COMPLICATIONS (98010) |
| LastDialysisDiagnosisSourceIdentifier | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 134: DIALYSIS STATUS (98068) |
| CmsHccInflammatoryBowelDiseaseStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| LastMetastaticCancerAndAcuteLeukemiaDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 8: METASTATIC CANCER AND ACUTE LEUKEMIA (98004) |
| LastDiabetesWithAcuteComplicationsDiagnosisSourceInitializationFile | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 17: DIABETES WITH ACUTE COMPLICATIONS (98009) |
| LastMultipleSclerosisDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 77: MULTIPLE SCLEROSIS (98042) |
| HccMajorHeadInjuryStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| HccCirrhosisOfLiverStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| LastAtherosclerosisWithUlcerationGangreneDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 106: ATHEROSCLEROSIS OF THE EXTREMITIES WITH ULCERATION OR GANGRENE (98058) |
| LastChronicUlcerDiagnosisSourceInitialization | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 161: CHRONIC ULCER OF SKIN, EXCEPT PRESSURE (98076) |
| LastSchizophreniaDiagnosisSourceIdentifier | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 57: SCHIZOPHRENIA (98031) |
| LastQuadriplegiaDiagnosisSourceIdentifier | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 70: QUADRIPLEGIA (98035) |
| LastDementiaWithoutComplicationsSourceIni | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 52: DEMENTIA WITHOUT COMPLICATIONS (98027) |
| LastAtherosclerosisDiagnosisSourceIni | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 106: ATHEROSCLEROSIS OF THE EXTREMITIES WITH ULCERATION OR GANGRENE (98058) |
| LastSevereSkinBurnDiagnosisSourceIdentifier | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 162: SEVERE SKIN BURN OR CONDITION (98077) |
| LastCysticFibrosisDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 110: CYSTIC FIBROSIS (98061) |
| VertebralFractureWithoutSpinalCordInjuryLastDiagnosisIdentification | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 169: VERTEBRAL FRACTURES WITHOUT SPINAL CORD INJURY (98080) |
| LastCmsHccSpecifiedHeartArrhythmiasSourceIni | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 96: SPECIFIED HEART ARRHYTHMIAS (98053) |
| IschemicStrokeHccStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| LastMonoplegiaOtherParalyticSyndromesDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 104: MONOPLEGIA, OTHER PARALYTIC SYNDROMES (98057) |
| HccAmyotrophicLateralSclerosisStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| LastSubstanceUseWithPsychoticComplicationsSourceInitialization | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 54: SUBSTANCE USE WITH PSYCHOTIC COMPLICATIONS (98028) |
| LastInflammatoryBowelDiseaseDiagnosisSourceIdentifier | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 35: INFLAMMATORY BOWEL DISEASE (98020) |
| LastPressureUlcerPartialThicknessDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 159: PRESSURE ULCER OF SKIN WITH PARTIAL THICKNESS SKIN LOSS (98075) |
| LastMultipleSclerosisDiagnosisIdentification | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 77: MULTIPLE SCLEROSIS (98042) |
| LastPersonalityDisorderDiagnosisIdentifier | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 60: PERSONALITY DISORDERS (98034) |
| LastRespiratoryArrestDiagnosisIdentification | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 83: RESPIRATORY ARREST (98047) |
| LastLungCancerSourceRecordIdentifier | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 9: LUNG AND OTHER SEVERE CANCERS (98005) |
| LastComplicationSpecifiedImplantedDeviceDiagnosisIdentification | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 176: COMPLICATIONS OF SPECIFIED IMPLANTED DEVICE OR GRAFT (98083) |
| LastDiabetesWithChronicComplicationsDiagnosisSourceIdentifier | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 18: DIABETES WITH CHRONIC COMPLICATIONS (98010) |
| LastPneumococcalPneumoniaSourceINI | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 115: PNEUMOCOCCAL PNEUMONIA, EMPYEMA, LUNG ABSCESS (98065) |
| CmsHcc75MyastheniaGravisDisorderLastDiagnosisIdentification | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 75: MYASTHENIA GRAVIS/MYONEURAL DISORDERS AND GUILLAIN-BARRE SYNDROME/INFLAMMATORY AND TOXIC NEUROPATHY (98040) |
| ProliferativeDiabeticRetinopathyCategoryStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| CmsHccTotalRiskAdjustmentScore | NUMERIC | Returns the total score for CMS-HCC, including the roll up of all applicable and satisfied categories, the sex/age factor, total CMS-HCC count factor, and disease interaction scores. Rule: CMS-HCC Total Score (98121) |
| SubstanceUseWithComplicationsStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| CmsHccCirrhosisOfLiverLastDiagnosisIdentification | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 28: CIRRHOSIS OF LIVER (98016) |
| HccVascularDiseaseStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| LastDiabetesDiagnosisSourceIdentifier | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 19: DIABETES WITHOUT COMPLICATION (98011) |
| LastArtificialOpeningDiagnosisSourceIdentification | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 188: ARTIFICIAL OPENINGS FOR FEEDING OR ELIMINATION (98085) |
| LastChronicKidneyDiseaseStage5DiagnosisSourceIni | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 136: CHRONIC KIDNEY DISEASE (STAGE 5) (98070) |
| SpecifiedHeartArrhythmiaDiagnosisSourceIdentification | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 96: SPECIFIED HEART ARRHYTHMIAS (98053) |
| LastBreastProstateCancerDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 12: BREAST, PROSTATE, AND OTHER CANCERS AND TUMORS (98008) |
| LastSpinalCordDisorderDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 72: SPINAL CORD DISORDERS/INJURIES (98037) |
| LastOtherEndocrineDiagnosisIdentification | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 23: OTHER SIGNIFICANT ENDOCRINE AND METABOLIC DISORDERS (98014) |
| LastMorbidObesityDiagnosisSourceIdentification | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 22: MORBID OBESITY (98013) |
| LastMonoplegiaDiagnosisIdentification | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 104: MONOPLEGIA, OTHER PARALYTIC SYNDROMES (98057) |
| LastParkinsonsHuntingtonsDiseaseDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 78: PARKINSON'S AND HUNTINGTON'S DISEASES (98043) |
| LastMonoplegiaParalysisDiagnosisSourceIdentification | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 104: MONOPLEGIA, OTHER PARALYTIC SYNDROMES (98057) |
| HccVascularDiseaseWithComplicationsStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| LastMyastheniaGravisSourceIni | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 75: MYASTHENIA GRAVIS/MYONEURAL DISORDERS AND GUILLAIN-BARRE SYNDROME/INFLAMMATORY AND TOXIC NEUROPATHY (98040) |
| LastDiabetesWithChronicComplicationSourceIdentifier | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 18: DIABETES WITH CHRONIC COMPLICATIONS (98010) |
| Hcc189LastLowerLimbAmputationDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 189: AMPUTATION STATUS, LOWER LIMB/AMPUTATION COMPLICATIONS (98086) |
| HccFibrosisOfLungStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| MultipleSclerosisRiskStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| CmsHcc110CysticFibrosisDiagnosisNumber | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 110: CYSTIC FIBROSIS (98061) |
| LastPartialThicknessPressureUlcerDiagnosisIdentifier | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 159: PRESSURE ULCER OF SKIN WITH PARTIAL THICKNESS SKIN LOSS (98075) |
| LastCmsHccAspirationBacterialPneumoniasDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 114: ASPIRATION AND SPECIFIED BACTERIAL PNEUMONIAS (98064) |
| LastPneumococcalPneumoniaDiagnosisSourceIdentification | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 115: PNEUMOCOCCAL PNEUMONIA, EMPYEMA, LUNG ABSCESS (98065) |
| CmsHccBoneInfectionStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| CmsHccMyastheniaGravisStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| LastIntracranialHemorrhageDiagnosisSourceIni | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 99: INTRACRANIAL HEMORRHAGE (98054) |
| CmsHccLastMalnutritionDiagnosisIdentification | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 21: PROTEIN-CALORIE MALNUTRITION (98012) |
| LastMyastheniaGravisDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 75: MYASTHENIA GRAVIS/MYONEURAL DISORDERS AND GUILLAIN-BARRE SYNDROME/INFLAMMATORY AND TOXIC NEUROPATHY (98040) |
| LastEndStageLiverDiseaseDiagnosisSourceIdentification | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 27: END-STAGE LIVER DISEASE (98015) |
| LastCardioRespiratoryFailureDataSourceIni | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 84: CARDIO-RESPIRATORY FAILURE AND SHOCK (98048) |
| CmsHccDementiaWithComplicationsStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| LastAcuteRenalFailureDiagnosisSourceIdentifier | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 135: ACUTE RENAL FAILURE (98069) |
| LastRheumatoidArthritisDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 40: RHEUMATOID ARTHRITIS AND INFLAMMATORY CONNECTIVE TISSUE DISEASE (98022) |
| HivAidsHccRiskAdjustmentStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| CmsHcc86AcuteMyocardialInfarctionDiagnosisIdentification | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 86: ACUTE MYOCARDIAL INFARCTION (98050) |
| ColorectalCancerLastDiagnosisIdentifier | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 11: COLORECTAL, BLADDER, AND OTHER CANCERS (98007) |
| HccMalnutritionRiskStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| CmsHcc54SubstanceUsePsychoticComplicationsLastDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 54: SUBSTANCE USE WITH PSYCHOTIC COMPLICATIONS (98028) |
| CmsHccLastProliferativeDiabeticRetinopathyDiagnosisId | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 122: PROLIFERATIVE DIABETIC RETINOPATHY AND VITREOUS HEMORRHAGE (98066) |
| OtherEndocrineDisorderStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| CmsHccSpecifiedHeartArrhythmiaChfInteractionScore | NUMERIC | Returns the CMS-HCC disease interaction score for SPECIFIED HEART ARRHYTHMIA X CHF. It will return a score if the patient has HCC 96 satisfied in addition to HCC 85 being satisfied. Rule: CMS-HCC Disease Interaction Score (SPECIFIED HEART ARRHYTHMIA X CHF) (98110) |
| LastAmyotrophicLateralSclerosisDiagnosisSourceINI | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 73: AMYOTROPHIC LATERAL SCLEROSIS AND OTHER MOTOR NEURON DISEASE (98038) |
| LastChronicKidneyDiseaseStage4DiagnosisSourceIdentifier | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 137: CHRONIC KIDNEY DISEASE, SEVERE (STAGE 4) (98071) |
| LastPressureUlcerFullThicknessDiagnosisSourceIdentification | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 158: PRESSURE ULCER OF SKIN WITH FULL THICKNESS SKIN LOSS (98074) |
| CmsHccChronicPancreatitisStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| LastProliferativeDiabeticRetinopathyDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 122: PROLIFERATIVE DIABETIC RETINOPATHY AND VITREOUS HEMORRHAGE (98066) |
| LastSepsisDiagnosisSourceIdentifier | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 2: SEPTICEMIA, SEPSIS, SYSTEMIC INFLAMMATORY RESPONSE SYNDROME/SHOCK (98002) |
| LastExudativeMacularDegenerationDiagnosisIdentification | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 124: EXUDATIVE MACULAR DEGENERATION (98067) |
| CmsHccMajorHeadInjuryDiagnosisNumber | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 167: MAJOR HEAD INJURY (98079) |
| LastBacterialPneumoniaDiagnosisSourceId | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 114: ASPIRATION AND SPECIFIED BACTERIAL PNEUMONIAS (98064) |
| DiabetesChronicComplicationHccStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| LastPressureUlcerWithNecrosisDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 157: PRESSURE ULCER OF SKIN WITH NECROSIS THROUGH TO MUSCLE, TENDON, OR BONE (98073) |
| LastSpecifiedHeartArrhythmiasDiagnosisIdentification | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 96: SPECIFIED HEART ARRHYTHMIAS (98053) |
| CmsHcc86AcuteMyocardialInfarctionStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| CmsHccQuadriplegiaStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| LastSeizureConvulsionDiagnosisIdentification | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 79: SEIZURE DISORDERS AND CONVULSIONS (98044) |
| CmsHcc56SubstanceUseDisorderDiagnosisIdentification | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 56: SUBSTANCE USE DISORDER,MILD,EXCEPT ALCOHOL AND CANNABIS (98030) |
| LastReactiveUnspecifiedPsychosisDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 58: REACTIVE AND UNSPECIFIED PSYCHOSIS (98032) |
| LastIschemicStrokeDiagnosisSourceInitiator | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 100: ISCHEMIC OR UNSPECIFIED STROKE (98055) |
| LastChronicKidneyDiseaseStage3DiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 138: CHRONIC KIDNEY DISEASE, MODERATE (STAGE 3) (98072) |
| LastPressureUlcerWithNecrosisDiagnosisSourceIdentifier | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 157: PRESSURE ULCER OF SKIN WITH NECROSIS THROUGH TO MUSCLE, TENDON, OR BONE (98073) |
| LastLungFibrosisDiagnosisSourceIni | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 112: FIBROSIS OF LUNG AND OTHER CHRONIC LUNG DISORDERS (98063) |
| SepsisHierarchicalConditionCategoryStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| LastAcuteRenalFailureDiagnosisSourceIni | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 135: ACUTE RENAL FAILURE (98069) |
| LastSepsisDiagnosisSourceIni | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 2: SEPTICEMIA, SEPSIS, SYSTEMIC INFLAMMATORY RESPONSE SYNDROME/SHOCK (98002) |
| TotalCmsHccAppliesCount | NUMERIC | The total number of CMS-HCCs that apply to the patient. Rule: CMS-HCC Total Applies Count (98100) |
| LastReactiveUnspecifiedPsychosisDiagnosisSourceIni | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 58: REACTIVE AND UNSPECIFIED PSYCHOSIS (98032) |
| LastAcuteRenalFailureDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 135: ACUTE RENAL FAILURE (98069) |
| LastTraumaticAmputationAndComplicationsDiagnosisSourceInitialization | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 173: TRAUMATIC AMPUTATIONS AND COMPLICATIONS (98082) |
| LastParaplegiaDiagnosisIdentification | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 71: PARAPLEGIA (98036) |
| LastImmunityDisorderDiagnosisSourceId | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 47: DISORDERS OF IMMUNITY (98024) |
| TotalHierarchicalConditionCategoriesNeedingRefreshCount | NUMERIC | This rule returns the total number of CMS-HCCs that need refreshed for the patient. Rule: CMS-HCC Total Needs Refresh Count (98101) |
| LastSubstanceUseWithComplicationsDiagnosisSourceIdentifier | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 55: SUBSTANCE USE DISORDER,MODERATE/SEVERE,OR SUBSTANCE USE WITH COMPLICATIONS (98029) |
| LastSubstanceUseDisorderDiagnosisSourceIni | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 56: SUBSTANCE USE DISORDER,MILD,EXCEPT ALCOHOL AND CANNABIS (98030) |
| LastHccSubstanceUseWithComplicationsDiagnosisIdentifier | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 55: SUBSTANCE USE DISORDER,MODERATE/SEVERE,OR SUBSTANCE USE WITH COMPLICATIONS (98029) |
| LastImmunityDisorderDiagnosisSourceIni | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 47: DISORDERS OF IMMUNITY (98024) |
| LastDementiaDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 52: DEMENTIA WITHOUT COMPLICATIONS (98027) |
| LastDementiaWithComplicationsDiagnosisSourceIdentification | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 51: DEMENTIA WITH COMPLICATIONS (98026) |
| LastMajorHeadInjurySourceIni | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 167: MAJOR HEAD INJURY (98079) |
| CmsMorbidObesityStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| LastEndStageLiverDiseaseDiagnosisIdentifier | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 27: END-STAGE LIVER DISEASE (98015) |
| LastAcuteMyocardialInfarctionSourceINI | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 86: ACUTE MYOCARDIAL INFARCTION (98050) |
| MyastheniaGravisLastDiagnosisSourceIdentification | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 75: MYASTHENIA GRAVIS/MYONEURAL DISORDERS AND GUILLAIN-BARRE SYNDROME/INFLAMMATORY AND TOXIC NEUROPATHY (98040) |
| LastRespiratoryArrestDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 83: RESPIRATORY ARREST (98047) |
| Hcc111CopdRiskAdjustmentStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| LastChronicObstructivePulmonaryDiseaseDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 111: CHRONIC OBSTRUCTIVE PULMONARY DISEASE (98062) |
| CancerImmuneDiseaseInteractionPotentialScore | NUMERIC | Returns the CMS-HCC disease interaction potential score for CANCER X IMMUNE. It will return a score if the patient has HCC 8, 9, 10, 11, or 12 applied in addition to HCC 47 being applied. Rule: CMS-HCC Disease Interaction Potential Score (CANCER X IMMUNE) (98117) |
| LastInflammatoryBowelDiseaseDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 35: INFLAMMATORY BOWEL DISEASE (98020) |
| PatientIdentification | VARCHAR | The unique ID of the record for this row. |
| CommunityIdentifier | VARCHAR | The Community ID (CID) of the instance from which this record or line was extracted. This is only populated if you use IntraConnect. |
| SeizureConvulsionRiskStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| LastColorectalCancerDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 11: COLORECTAL, BLADDER, AND OTHER CANCERS (98007) |
| RheumatoidArthritisHierarchicalConditionCategoryStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| LastColorectalCancerDiagnosisSourceIdentification | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 11: COLORECTAL, BLADDER, AND OTHER CANCERS (98007) |
| LastDementiaWithComplicationsDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 51: DEMENTIA WITH COMPLICATIONS (98026) |
| LastHipFractureDislocationDiagnosisSourceIdentifier | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 170: HIP FRACTURE/DISLOCATION (98081) |
| LastVertebralFractureWithoutSpinalCordInjuryDiagnosisSourceIdentifier | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 169: VERTEBRAL FRACTURES WITHOUT SPINAL CORD INJURY (98080) |
| ReactiveUnspecifiedPsychosisLastDiagnosisSourceId | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 58: REACTIVE AND UNSPECIFIED PSYCHOSIS (98032) |
| LastOtherSignificantEndocrineMetabolicDiagnosisSourceIni | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 23: OTHER SIGNIFICANT ENDOCRINE AND METABOLIC DISORDERS (98014) |
| LastMuscularDystrophyDiagnosisSourceIdentifier | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 76: MUSCULAR DYSTROPHY (98041) |
| HccLastBreastProstateCancerDiagnosisIdentification | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 12: BREAST, PROSTATE, AND OTHER CANCERS AND TUMORS (98008) |
| CmsHccDiagnosisPotentialScore | NUMERIC | Returns the total roll up potential score for CMS-HCC. An HCC will contribute to this potential score when it applies to the patient regardless of if it has been satisfied or not. Rule: CMS-HCC Diagnosis Potential Score (98119) |
| LastSevereHeadInjuryDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 166: SEVERE HEAD INJURY (98078) |
| LastIschemicOrUnspecifiedStrokeDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 100: ISCHEMIC OR UNSPECIFIED STROKE (98055) |
| LastColorectalCancerDiagnosisSourceIni | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 11: COLORECTAL, BLADDER, AND OTHER CANCERS (98007) |
| LastSpecifiedHeartArrhythmiasDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 96: SPECIFIED HEART ARRHYTHMIAS (98053) |
| LastAcuteMyocardialInfarctionDiagnosisSourceIdentifier | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 86: ACUTE MYOCARDIAL INFARCTION (98050) |
| LastBreastProstateCancerDiagnosisSourceIdentifier | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 12: BREAST, PROSTATE, AND OTHER CANCERS AND TUMORS (98008) |
| LastLungFibrosisDiagnosisSourceIdentification | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 112: FIBROSIS OF LUNG AND OTHER CHRONIC LUNG DISORDERS (98063) |
| LastCoagulationDefectDiagnosisSourceIni | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 48: COAGULATION DEFECTS AND OTHER SPECIFIED HEMATOLOGICAL DISORDERS (98025) |
| CmsHccParaplegiaDiagnosisSourceIdentifier | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 71: PARAPLEGIA (98036) |
| LastCardioRespiratoryFailureAndShockDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 84: CARDIO-RESPIRATORY FAILURE AND SHOCK (98048) |
| CmsHccSevereSkinBurnStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| CmsHccColorectalCancerStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| CmsHccLungCancerStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| LastInflammatoryBowelDiseaseDiagnosisSourceIdentifier | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 35: INFLAMMATORY BOWEL DISEASE (98020) |
| LastIntracranialHemorrhageDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 99: INTRACRANIAL HEMORRHAGE (98054) |
| LastAmyotrophicLateralSclerosisDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 73: AMYOTROPHIC LATERAL SCLEROSIS AND OTHER MOTOR NEURON DISEASE (98038) |
| LastProliferativeDiabeticRetinopathyDiagnosisSourceIdentifier | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 122: PROLIFERATIVE DIABETIC RETINOPATHY AND VITREOUS HEMORRHAGE (98066) |
| LastSevereHeadInjurySourceIni | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 166: SEVERE HEAD INJURY (98078) |
| HccSubstanceUseStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| LastDialysisDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 134: DIALYSIS STATUS (98068) |
| CmsHccSpinalCordDisorderDiagnosisIdentification | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 72: SPINAL CORD DISORDERS/INJURIES (98037) |
| HccPressureUlcerFullThicknessStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| ChronicPancreatitisLastDiagnosisSourceIdentifier | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 34: CHRONIC PANCREATITIS (98019) |
| LastHemiplegiaDiagnosisSourceIni | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 103: HEMIPLEGIA/HEMIPARESIS (98056) |
| LastVascularDiseaseDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 108: VASCULAR DISEASE (98060) |
| LastTraumaticAmputationsComplicationsDiagnosisIdentification | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 173: TRAUMATIC AMPUTATIONS AND COMPLICATIONS (98082) |
| LastLowerLimbAmputationStatusDiagnosisIdentifier | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 189: AMPUTATION STATUS, LOWER LIMB/AMPUTATION COMPLICATIONS (98086) |
| LastLymphomaDiagnosisSourceIdentifier | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 10: LYMPHOMA AND OTHER CANCERS (98006) |
| LastMultipleSclerosisDiagnosisSourceIdentification | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 77: MULTIPLE SCLEROSIS (98042) |
| LastCerebralPalsyDiagnosisSourceInitialization | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 74: CEREBRAL PALSY (98039) |
| HccChronicKidneyDiseaseStage3Status | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| LastComaBrainCompressionAnoxicDamageDiagnosisIdentifier | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 80: COMA, BRAIN COMPRESSION/ANOXIC DAMAGE (98045) |
| QuadriplegiaDiagnosisSourceIni | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 70: QUADRIPLEGIA (98035) |
| DeprecatedLastMajorDepressiveBipolarDisorderDiagnosisSourceIni | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 59: MAJOR DEPRESSIVE, BIPOLAR, AND PARANOID DISORDERS (98033) |
| LastFibrosisOfLungDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 112: FIBROSIS OF LUNG AND OTHER CHRONIC LUNG DISORDERS (98063) |
| HccSpinalCordDisorderLastDiagnosisSourceIdentification | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 72: SPINAL CORD DISORDERS/INJURIES (98037) |
| DiabetesHccStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| SevereSkinBurnOrConditionLastDiagnosisIdentification | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 162: SEVERE SKIN BURN OR CONDITION (98077) |
| LastMajorHeadInjuryDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 167: MAJOR HEAD INJURY (98079) |
| LastDialysisDiagnosisIdentification | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 134: DIALYSIS STATUS (98068) |
| HccCirrhosisOfLiverLastDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 28: CIRRHOSIS OF LIVER (98016) |
| LastExudativeMacularDegenerationDiagnosisSourceIdentifier | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 124: EXUDATIVE MACULAR DEGENERATION (98067) |
| LastUnstableAnginaAndIschemicHeartDiseaseSourceIni | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 87: UNSTABLE ANGINA AND OTHER ACUTE ISCHEMIC HEART DISEASE (98051) |
| CmsHccLastLymphomaDiagnosisIdentification | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 10: LYMPHOMA AND OTHER CANCERS (98006) |
| LastRheumatoidArthritisInflammatoryConnectiveTissueDiagnosisSourceIni | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 40: RHEUMATOID ARTHRITIS AND INFLAMMATORY CONNECTIVE TISSUE DISEASE (98022) |
| MajorOrganTransplantStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| LastCoagulationDefectDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 48: COAGULATION DEFECTS AND OTHER SPECIFIED HEMATOLOGICAL DISORDERS (98025) |
| LastLowerLimbAmputationStatusSourceIdentification | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 189: AMPUTATION STATUS, LOWER LIMB/AMPUTATION COMPLICATIONS (98086) |
| LastHivAidsDiagnosisSourceIdentifier | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 1: HIV/AIDS (98001) |
| LastChronicKidneyDiseaseStage5DiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 136: CHRONIC KIDNEY DISEASE (STAGE 5) (98070) |
| MajorOrganTransplantLastDiagnosisIdentification | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 186: MAJOR ORGAN TRANSPLANT OR REPLACEMENT STATUS (98084) |
| CmsHccDiabetesCongestiveHeartFailureInteractionPotentialScore | NUMERIC | Returns the CMS-HCC disease interaction potential score for DIABETES X CHF. It will return a score if the patient has HCC 17, 18, or 19 applied in addition to HCC 85 being applied. Rule: CMS-HCC Disease Interaction Potential Score (DIABETES X CHF) (98115) |
| ChronicObstructivePulmonaryDiseaseLastDiagnosisSourceIdentifier | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 111: CHRONIC OBSTRUCTIVE PULMONARY DISEASE (98062) |
| CmsHccChronicAndMixedDiagnosisPotentialScore | NUMERIC | Returns the total roll up potential score for CMS-HCC for chronic and mixed categories. An HCC will contribute to this potential score when it applies to the patient regardless of if it has been satisfied or not. Rule: CMS-HCC Chronic/Mixed Diagnosis Potential Score (98124) |
| CmsHccHemiplegiaDiagnosisSourceIdentifier | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 103: HEMIPLEGIA/HEMIPARESIS (98056) |
| CmsHccChronicKidneyDiseaseStage4Status | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| LastVascularDiseaseWithComplicationsDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 107: VASCULAR DISEASE WITH COMPLICATIONS (98059) |
| CmsExudativeMacularDegenerationDiagnosisSourceIni | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 124: EXUDATIVE MACULAR DEGENERATION (98067) |
| LastVascularDiseaseDiagnosisSourceIdentifier | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 108: VASCULAR DISEASE (98060) |
| CongestiveHeartFailureAndCopdInteractionPotentialScore | NUMERIC | Returns the CMS-HCC disease interaction potential score for CHF x COPD. It will return a score if the patient has HCC 85 applied in addition to HCC 110, 111, or 112 being applied. Rule: CMS-HCC Disease Interaction Potential Score (CHF x COPD/CF) (98112) |
| LastOpportunisticInfectionDiagnosisIdentification | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 6: OPPORTUNISTIC INFECTIONS (98003) |
| LastDiabetesWithAcuteComplicationsDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 17: DIABETES WITH ACUTE COMPLICATIONS (98009) |
| LastChronicKidneyDiseaseStage4DiagnosisIdentification | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 137: CHRONIC KIDNEY DISEASE, SEVERE (STAGE 4) (98071) |
| LastOpportunisticInfectionDiagnosisSourceIni | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 6: OPPORTUNISTIC INFECTIONS (98003) |
| HccRespiratoryArrestStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| LastPressureUlcerFullThicknessDiagnosisSourceIni | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 158: PRESSURE ULCER OF SKIN WITH FULL THICKNESS SKIN LOSS (98074) |
| CmsHcc189LastAmputationStatusLowerLimbDiagnosisSourceInitiation | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 189: AMPUTATION STATUS, LOWER LIMB/AMPUTATION COMPLICATIONS (98086) |
| LastSpecifiedImplantComplicationDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 176: COMPLICATIONS OF SPECIFIED IMPLANTED DEVICE OR GRAFT (98083) |
| LastBoneInfectionDiagnosisSourceIdentifier | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 39: BONE/JOINT/MUSCLE INFECTIONS/NECROSIS (98021) |
| LastSepsisDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 2: SEPTICEMIA, SEPSIS, SYSTEMIC INFLAMMATORY RESPONSE SYNDROME/SHOCK (98002) |
| OpportunisticInfectionStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| CmsHccPressureUlcerNecrosisStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| LastSeizureAndConvulsionsDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 79: SEIZURE DISORDERS AND CONVULSIONS (98044) |
| DialysisCategoryRiskAdjustmentStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| AnginaPectorisHccStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| LastChronicHepatitisDiagnosisSourceIdentifier | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 29: CHRONIC HEPATITIS (98017) |
| LastSevereHematologicalDisorderDiagnosisIdentification | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 46: SEVERE HEMATOLOGICAL DISORDERS (98023) |
| CmsHccPressureUlcerWithNecrosisLastDiagnosisIdentifier | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 157: PRESSURE ULCER OF SKIN WITH NECROSIS THROUGH TO MUSCLE, TENDON, OR BONE (98073) |
| LastAmyotrophicLateralSclerosisDiagnosisNumber | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 73: AMYOTROPHIC LATERAL SCLEROSIS AND OTHER MOTOR NEURON DISEASE (98038) |
| LastPressureUlcerPartialThicknessSourceIdentification | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 159: PRESSURE ULCER OF SKIN WITH PARTIAL THICKNESS SKIN LOSS (98075) |
| LastEndStageLiverDiseaseDiagnosisSourceInitiator | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 27: END-STAGE LIVER DISEASE (98015) |
| LastMetastaticCancerDiagnosisSourceIdentifier | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 8: METASTATIC CANCER AND ACUTE LEUKEMIA (98004) |
| LastEndStageLiverDiseaseDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 27: END-STAGE LIVER DISEASE (98015) |
| DeprecatedLastMajorDepressiveBipolarDisorderDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 59: MAJOR DEPRESSIVE, BIPOLAR, AND PARANOID DISORDERS (98033) |
| LastVascularDiseaseDiagnosisIdentification | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 108: VASCULAR DISEASE (98060) |
| LastChronicHepatitisDiagnosisIdentification | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 29: CHRONIC HEPATITIS (98017) |
| CmsHccMorbidObesityLastDiagnosisIdentifier | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 22: MORBID OBESITY (98013) |
| LastComaBrainCompressionAnoxicDamageDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 80: COMA, BRAIN COMPRESSION/ANOXIC DAMAGE (98045) |
| CerebralPalsyCategoryStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| LastComaAnoxicBrainDamageDiagnosisSourceIdentifier | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 80: COMA, BRAIN COMPRESSION/ANOXIC DAMAGE (98045) |
| LastCardioRespiratoryFailureDiagnosisNumber | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 84: CARDIO-RESPIRATORY FAILURE AND SHOCK (98048) |
| CmsHccHemiplegiaStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| LastChronicObstructivePulmonaryDiseaseDiagnosisIdentification | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 111: CHRONIC OBSTRUCTIVE PULMONARY DISEASE (98062) |
| LastAnginaPectorisDiagnosisIdentification | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 88: ANGINA PECTORIS (98052) |
| LastMorbidObesityDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 22: MORBID OBESITY (98013) |
| HccCancerAndImmuneDisorderInteractionScore | NUMERIC | Returns the CMS-HCC disease interaction score for CANCER X IMMUNE. It will return a score if the patient has HCC 8, 9, 10, 11, or 12 satisfied in addition to HCC 47 being satisfied. Rule: CMS-HCC Disease Interaction Score (CANCER X IMMUNE) (98111) |
| LastRheumatoidArthritisInflammatoryConnectiveTissueDiseaseDiagnosisSourceIdentifier | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 40: RHEUMATOID ARTHRITIS AND INFLAMMATORY CONNECTIVE TISSUE DISEASE (98022) |
| LastIntestinalObstructionPerforationDiagnosisSourceIni | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 33: INTESTINAL OBSTRUCTION/PERFORATION (98018) |
| CmsHcc112LastFibrosisOfLungDiagnosisIdentification | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 112: FIBROSIS OF LUNG AND OTHER CHRONIC LUNG DISORDERS (98063) |
| CmsHccCysticFibrosisCategoryStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| LastSubstanceUseWithPsychoticComplicationsDiagnosisIdentifier | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 54: SUBSTANCE USE WITH PSYCHOTIC COMPLICATIONS (98028) |
| HccArtificialOpeningStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| LastLungCancerDiagnosisIdentification | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 9: LUNG AND OTHER SEVERE CANCERS (98005) |
| LastChronicPancreatitisDiagnosisIdentification | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 34: CHRONIC PANCREATITIS (98019) |
| LastAtherosclerosisExtremitiesDiagnosisSourceIdentifier | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 106: ATHEROSCLEROSIS OF THE EXTREMITIES WITH ULCERATION OR GANGRENE (98058) |
| LastSpinalCordDisorderOrInjurySourceIni | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 72: SPINAL CORD DISORDERS/INJURIES (98037) |
| LastHipFractureDislocationDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 170: HIP FRACTURE/DISLOCATION (98081) |
| LastCirrhosisOfLiverDiagnosisSourceInitiation | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 28: CIRRHOSIS OF LIVER (98016) |
| LastProliferativeDiabeticRetinopathyDiagnosisSourceINI | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 122: PROLIFERATIVE DIABETIC RETINOPATHY AND VITREOUS HEMORRHAGE (98066) |
| CoagulationDeficiencyHierarchicalConditionCategoryStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| CmsHccCongestiveHeartFailureRenalDiseaseInteractionPotentialScore | NUMERIC | Returns the CMS-HCC disease interaction potential score for CHF x RENAL. It will return a score if the patient has HCC 85 applied in addition to HCC 134, 135, 136, 137, or 138 being applied. Rule: CMS-HCC Disease Interaction Potential Score (CHF x RENAL) (98113) |
| LastDialysisDiagnosisSourceIdentifier | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 134: DIALYSIS STATUS (98068) |
| CmsHccDementiaStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| CmsHccInteractionScoreCopdCardiorespiratory | NUMERIC | Returns the CMS-HCC disease interaction score for COPD x CARDIORESP. It will return a score if the patient has HCC 110, 111, or 112 satisfied in addition to HCC 82, 83, or 84 being satisfied. Rule: CMS-HCC Disease Interaction Score (COPD X CARDIORESP) (98108) |
| LastSchizophreniaDiagnosisIdentification | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 57: SCHIZOPHRENIA (98031) |
| CmsHcc46SevereHematologicalDisorderStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| LastChronicKidneyDiseaseStage4DiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 137: CHRONIC KIDNEY DISEASE, SEVERE (STAGE 4) (98071) |
| LastMajorOrganTransplantHccDiagnosisSourceIni | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 186: MAJOR ORGAN TRANSPLANT OR REPLACEMENT STATUS (98084) |
| LastVertebralFractureSourceIdentifier | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 169: VERTEBRAL FRACTURES WITHOUT SPINAL CORD INJURY (98080) |
| HccPressureUlcerPartialThicknessStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| LastMuscularDystrophyDiagnosisSourceIdentifier | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 76: MUSCULAR DYSTROPHY (98041) |
| LastLymphomaDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 10: LYMPHOMA AND OTHER CANCERS (98006) |
| LastAnoxicBrainDamageComaDiagnosisSourceIni | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 80: COMA, BRAIN COMPRESSION/ANOXIC DAMAGE (98045) |
| LastDementiaWithComplicationsDiagnosisSourceIni | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 51: DEMENTIA WITH COMPLICATIONS (98026) |
| LastPressureUlcerWithNecrosisDiagnosisSourceIni | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 157: PRESSURE ULCER OF SKIN WITH NECROSIS THROUGH TO MUSCLE, TENDON, OR BONE (98073) |
| LastDisordersOfImmunityDiagnosisId | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 47: DISORDERS OF IMMUNITY (98024) |
| CmsIntracranialHemorrhageStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| LastSevereSkinBurnDiagnosisSourceIni | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 162: SEVERE SKIN BURN OR CONDITION (98077) |
| LastDementiaDiagnosisSourceIdentifier | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 52: DEMENTIA WITHOUT COMPLICATIONS (98027) |
| CmsHccBreastProstateCancerStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| LastChronicHepatitisDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 29: CHRONIC HEPATITIS (98017) |
| LastSpecifiedImplantComplicationDiagnosisSourceInitializationFile | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 176: COMPLICATIONS OF SPECIFIED IMPLANTED DEVICE OR GRAFT (98083) |
| HccEndStageLiverDiseaseStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| CongestiveHeartFailureCategoryStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| DemographicRiskFactor | NUMERIC | Returns the CMS-HCC base risk factor based on a patient's age and sex. Rule: CMS-HCC Age and Sex Risk Factor (98170) |
| LastVascularDiseaseWithComplicationsDiagnosisIdentification | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 107: VASCULAR DISEASE WITH COMPLICATIONS (98059) |
| ChronicUlcerStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| LastArtificialOpeningsForFeedingOrEliminationDiagnosisIdentifier | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 188: ARTIFICIAL OPENINGS FOR FEEDING OR ELIMINATION (98085) |
| LastIntracranialHemorrhageDiagnosisSourceId | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 99: INTRACRANIAL HEMORRHAGE (98054) |
| LastRespiratoryDependenceOrTracheostomyStatusDiagnosisIdentification | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 82: RESPIRATOR DEPENDENCE/TRACHEOSTOMY STATUS (98046) |
| LastCmsHccSchizophreniaDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 57: SCHIZOPHRENIA (98031) |
| CmsHccSpecifiedHeartArrhythmiaStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| LastVascularDiseaseWithComplicationsDiagnosisSourceIni | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 107: VASCULAR DISEASE WITH COMPLICATIONS (98059) |
| LastPressureUlcerFullThicknessSkinLossDiagnosisIdentification | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 158: PRESSURE ULCER OF SKIN WITH FULL THICKNESS SKIN LOSS (98074) |
| LastChronicPancreatitisDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 34: CHRONIC PANCREATITIS (98019) |
| LastHivAidsDiagnosisIdentification | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 1: HIV/AIDS (98001) |
| CmsHccUnstableAnginaStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| LastPneumococcalPneumoniaDiagnosisIdentification | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 115: PNEUMOCOCCAL PNEUMONIA, EMPYEMA, LUNG ABSCESS (98065) |
| CmsHccDementiaWithComplicationsLastDiagnosisIdentification | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 51: DEMENTIA WITH COMPLICATIONS (98026) |
| LastHivAidsDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 1: HIV/AIDS (98001) |
| LastAcuteRenalFailureDiagnosisIdentification | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 135: ACUTE RENAL FAILURE (98069) |
| SchizophreniaHccStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| LastTraumaticAmputationDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 173: TRAUMATIC AMPUTATIONS AND COMPLICATIONS (98082) |
| LastSeizureAndConvulsionDiagnosisSourceIdentifier | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 79: SEIZURE DISORDERS AND CONVULSIONS (98044) |
| LastMorbidObesityDiagnosisSourceIni | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 22: MORBID OBESITY (98013) |
| DeprecatedMajorDepressiveBipolarDiagnosisSourceIdentification | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 59: MAJOR DEPRESSIVE, BIPOLAR, AND PARANOID DISORDERS (98033) |
| CmsHcc136ChronicKidneyDiseaseStage5LastDiagnosisIdentification | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 136: CHRONIC KIDNEY DISEASE (STAGE 5) (98070) |
| Hcc136ChronicKidneyDiseaseStage5Status | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| LastUnstableAnginaSourceRecordIdentification | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 87: UNSTABLE ANGINA AND OTHER ACUTE ISCHEMIC HEART DISEASE (98051) |
| CmsHcc103HemiplegiaHemiparesisLastDiagnosisIdentification | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 103: HEMIPLEGIA/HEMIPARESIS (98056) |
| LastHipFractureDiagnosisIdentification | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 170: HIP FRACTURE/DISLOCATION (98081) |
| HccTraumaticAmputationStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| LastChronicObstructivePulmonaryDiseaseDiagnosisSourceIni | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 111: CHRONIC OBSTRUCTIVE PULMONARY DISEASE (98062) |
| CmsHccPotentialScore | NUMERIC | Returns the total potential score for CMS-HCC, including the roll up of all applicable categories, the sex/age factor, total CMS-HCC count factor, and disease interaction scores. Rule: CMS-HCC Potential Score (98122) |
| CmsHccMonoplegiaStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| LastUnstableAnginaDiagnosisIdentification | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 87: UNSTABLE ANGINA AND OTHER ACUTE ISCHEMIC HEART DISEASE (98051) |
| LastCerebralPalsyDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 74: CEREBRAL PALSY (98039) |
| LastDiabetesWithChronicComplicationsDiagnosisIdentification | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 18: DIABETES WITH CHRONIC COMPLICATIONS (98010) |
| CmsHccExudativeMacularDegenerationStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| AtherosclerosisHierarchicalConditionCategoryStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| LastSevereHematologicalDisordersDiagnosisSourceInitiationNumber | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 46: SEVERE HEMATOLOGICAL DISORDERS (98023) |
| LastSevereHeadInjuryDiagnosisIdentification | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 166: SEVERE HEAD INJURY (98078) |
| LastCirrhosisOfLiverDiagnosisSourceIdentifier | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 28: CIRRHOSIS OF LIVER (98016) |
| LastFullThicknessPressureUlcerDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 158: PRESSURE ULCER OF SKIN WITH FULL THICKNESS SKIN LOSS (98074) |
| LastReactiveUnspecifiedPsychosisDiagnosisIdentifier | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 58: REACTIVE AND UNSPECIFIED PSYCHOSIS (98032) |
| LastSevereHematologicalDisorderSourceIdentification | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 46: SEVERE HEMATOLOGICAL DISORDERS (98023) |
| SepsisDiagnosisIdentification | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 2: SEPTICEMIA, SEPSIS, SYSTEMIC INFLAMMATORY RESPONSE SYNDROME/SHOCK (98002) |
| CmsHccAcuteRenalFailureStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| LastHemiplegiaDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 103: HEMIPLEGIA/HEMIPARESIS (98056) |
| CmsHccBacterialPneumoniaStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| LastHipFractureDislocationDiagnosisSourceInitial | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 170: HIP FRACTURE/DISLOCATION (98081) |
| LastDiabetesWithAcuteComplicationsDiagnosisIdentification | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 17: DIABETES WITH ACUTE COMPLICATIONS (98009) |
| LastOpportunisticInfectionDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 6: OPPORTUNISTIC INFECTIONS (98003) |
| LastOtherEndocrineDiagnosisSourceIdentifier | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 23: OTHER SIGNIFICANT ENDOCRINE AND METABOLIC DISORDERS (98014) |
| HccRespiratorDependenceStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| CmsHcc166SevereHeadInjuryStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| LastQuadriplegiaDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 70: QUADRIPLEGIA (98035) |
| LastRespiratorDependenceDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 82: RESPIRATOR DEPENDENCE/TRACHEOSTOMY STATUS (98046) |
| CmsHcc33IntestinalObstructionPerforationLastDiagnosisIdentification | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 33: INTESTINAL OBSTRUCTION/PERFORATION (98018) |
| LastVascularDiseaseDiagnosisSourceIni | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 108: VASCULAR DISEASE (98060) |
| CmsHccChronicAndMixedScoreGap | NUMERIC | Returns the total roll up score gap for CMS-HCC for chronic and mixed categories. It substracts the total score from the total potential score to calculate the score gap. Rule: CMS-HCC Chronic/Mixed Score Gap (98125) |
| LastSubstanceUseWithComplicationsDiagnosisSourceIni | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 55: SUBSTANCE USE DISORDER,MODERATE/SEVERE,OR SUBSTANCE USE WITH COMPLICATIONS (98029) |
| LastChronicKidneyDiseaseStage4DiagnosisSourceIni | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 137: CHRONIC KIDNEY DISEASE, SEVERE (STAGE 4) (98071) |
| LastRheumatoidArthritisDiagnosisIdentification | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 40: RHEUMATOID ARTHRITIS AND INFLAMMATORY CONNECTIVE TISSUE DISEASE (98022) |
| LastProteinCalorieMalnutritionDiagnosisSourceIni | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 21: PROTEIN-CALORIE MALNUTRITION (98012) |
| SpinalCordDisorderCategoryStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| LastDiabetesWithoutComplicationDiagnosisSourceIdentification | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 19: DIABETES WITHOUT COMPLICATION (98011) |
| LastIntestinalObstructionPerforationDiagnosisSourceIdentifier | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 33: INTESTINAL OBSTRUCTION/PERFORATION (98018) |
| LastChronicUlcerDiagnosisIdentifier | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 161: CHRONIC ULCER OF SKIN, EXCEPT PRESSURE (98076) |
| TotalCmsHierarchicalConditionCategoryScoreGap | NUMERIC | Returns the total roll up score gap for CMS-HCC. It substracts the total score from the total potential score to calculate the score gap. Rule: CMS-HCC Score Gap (98120) |
| CmsHccLastSubstanceUseDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 56: SUBSTANCE USE DISORDER,MILD,EXCEPT ALCOHOL AND CANNABIS (98030) |
| CmsHccVertebralFractureCategoryStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| LastCmsHccAnginaPectorisDiagnosisSourceIni | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 88: ANGINA PECTORIS (98052) |
| LastPneumococcalPneumoniaDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 115: PNEUMOCOCCAL PNEUMONIA, EMPYEMA, LUNG ABSCESS (98065) |
| ComplicatedSpecifiedImplantStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| LastCysticFibrosisDiagnosisSourceIdentification | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 110: CYSTIC FIBROSIS (98061) |
| HccSubstanceUseDisorderWithPsychosisStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| MetastaticCancerHierarchicalConditionCategoryStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| LastDiabetesWithAcuteComplicationsDiagnosisSourceIdentification | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 17: DIABETES WITH ACUTE COMPLICATIONS (98009) |
| LastMildSubstanceUseExceptAlcoholCannabisDiagnosisSourceIdentifier | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 56: SUBSTANCE USE DISORDER,MILD,EXCEPT ALCOHOL AND CANNABIS (98030) |
| LastTraumaticAmputationAndComplicationsDiagnosisSourceIdentifier | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 173: TRAUMATIC AMPUTATIONS AND COMPLICATIONS (98082) |
| LastMajorHeadInjuryDiagnosisSourceIdentification | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 167: MAJOR HEAD INJURY (98079) |
| LastHccRespiratorDependenceDiagnosisSourceId | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 82: RESPIRATOR DEPENDENCE/TRACHEOSTOMY STATUS (98046) |
| LastCoagulationDefectDiagnosisIdentifier | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 48: COAGULATION DEFECTS AND OTHER SPECIFIED HEMATOLOGICAL DISORDERS (98025) |
| LastCerebralPalsyDiagnosisSourceIdentifier | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 74: CEREBRAL PALSY (98039) |
| HccOpportunisticInfectionSourceIdentifier | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 6: OPPORTUNISTIC INFECTIONS (98003) |
| LastParkinsonsHuntingtonsDiseaseDiagnosisSourceIdentifier | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 78: PARKINSON'S AND HUNTINGTON'S DISEASES (98043) |
| MajorDepressiveBipolarDisorderHccStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| LastChronicSkinUlcerDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 161: CHRONIC ULCER OF SKIN, EXCEPT PRESSURE (98076) |
| LastCongestiveHeartFailureDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 85: CONGESTIVE HEART FAILURE (98049) |
| LastMajorOrganTransplantDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 186: MAJOR ORGAN TRANSPLANT OR REPLACEMENT STATUS (98084) |
| LastBoneOrJointInfectionDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 39: BONE/JOINT/MUSCLE INFECTIONS/NECROSIS (98021) |
| LastSubstanceUseWithComplicationsDiagnosisDate | DATETIME | The date of the last documented CMS-HCC diagnosis. Rule: CMS-HCC 55: SUBSTANCE USE DISORDER,MODERATE/SEVERE,OR SUBSTANCE USE WITH COMPLICATIONS (98029) |
| TotalSuspectedHierarchicalConditionCategoriesCount | NUMERIC | The total number of CMS-HCCs that are suspected for the patient. Rule: CMS-HCC Total Suspected Count (98129) |
| LastParkinsonsAndHuntingtonsDiseasesDiagnosisIdentifier | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 78: PARKINSON'S AND HUNTINGTON'S DISEASES (98043) |
| CmsHccHeartArrhythmiaCongestiveHeartFailureDiseaseInteractionPotentialScore | NUMERIC | Returns the CMS-HCC disease interaction potential score for SPECIFIED HEART ARRHYTHMIA X CHF. It will return a score if the patient has HCC 96 applied in addition to HCC 85 being applied. Rule: CMS-HCC Disease Interaction Potential Score (SPECIFIED HEART ARRHYTHMIA X CHF) (98116) |
| CmsHccInteractionScoreCongestiveHeartFailureCopd | NUMERIC | Returns the CMS-HCC disease interaction score for CHF x COPD. It will return a score if the patient has HCC 85 satisfied in addition to HCC 110, 111, or 112 being satisfied. Rule: CMS-HCC Disease Interaction Score (CHF x COPD/CF) (98106) |
| LastChronicUlcerOfSkinDiagnosisSourceIdentifier | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 161: CHRONIC ULCER OF SKIN, EXCEPT PRESSURE (98076) |
| CmsHcc100IschemicStrokeLastDiagnosisNumber | NUMERIC | The ID of the last documented diagnosis (EDG .1) within this CMS-HCC category. Rule: CMS-HCC 100: ISCHEMIC OR UNSPECIFIED STROKE (98055) |
| DiabetesWithAcuteComplicationsHccStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |
| Hcc84CardioRespiratoryFailureDiagnosisSourceIdentifier | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 84: CARDIO-RESPIRATORY FAILURE AND SHOCK (98048) |
| ChronicHepatitisHccLastDiagnosisSourceIni | VARCHAR | The unique INI of the source of the most recent documented CMS-HCC diagnosis. Rule: CMS-HCC 29: CHRONIC HEPATITIS (98017) |
| CmsHcc48CoagulationDefectDiagnosisSourceIdentifier | NUMERIC | The unique ID of the source of the most recent documented CMS-HCC diagnosis. This column will either correspond to a Patient Contact Serial Number (I EPT 8), the ID of an internal problem (I LPL .1), or the external data Contact Serial Number (I DXR 8). See the corresponding INI column for context. Rule: CMS-HCC 48: COAGULATION DEFECTS AND OTHER SPECIFIED HEMATOLOGICAL DISORDERS (98025) |
| CardiorespiratoryFailureStatus | NUMERIC | The status of the CMS-HCC category. The status of the category will be calculated as follows: 0 - A diagnosis was found within the search period, but the category should not be included for the patient in the current risk adjustment period. 1 - A diagnosis was found, the category should be included, but a higher category already applies to the patient, meaning that this category should not. A category should be included for a patient if: an encounter/invoice was added in the current risk adjustment period, it is an active problem, or the diagnosis date is after any resolved dates for corresponding problems AND it hasn't been marked as Not Applicable (via SDE) since then. 2 - A diagnosis was found, the category should be included and it currently applies to the patient, and a diagnosis has been added to the patient within the current risk adjustment period and therefore does not need to be refreshed. 3 - A diagnosis was found, the category should be included and it currently applies to the patient, but the diagnosis needs to be refreshed for the current risk adjustment period. |