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URSA-HCC-R02: Qualifying CMS-HCC Diagnoses

  • Published on Nov 4, 2026
  • 3 minute(s) read
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Measure Description

Registry of distinct qualifying CMS-HCC ICD-10-CM diagnosis codes. Each record is a distinct patient-code-date triple; that is, multiple instances of the same diagnosis code documented on the same day for the same patient are captured as a single record in the registry.

Metadata

  • Measure Identifier: URSA-HCC-R02
  • Measure Type: Registry
  • Temporal Structure: Event
  • Component Class: Normal-Form
  • Case Fields: Patient ID, Diagnosis Effective Date, Diagnosis ICD-10-CM Code
  • Observation Fields: Patient ID, Diagnosis Effective Date, Diagnosis ICD-10-CM Code
  • Target Direction: None

Published Fields

  • Data Model Keys

    • Patient ID -- The internal database identifier (used, e.g., for joins and primary keys) for the patient. This value is typically mastered, i.e., all records for the same patient, regardless of the source data system from which that record originated, should have the same Patient ID value. (Note that while the mastered Patient ID value might resemble a local identifier used in one of the upstream data sources, this does not indicate any special priority of that source system in determining the characteristics of the patient.) (See also [URSA-CORE] Patient)
    • Primary Diagnosis Document ID -- The Document ID for the qualifying claim or billing diagnosis record, or qualifying MAO-004 diagnosis record, supplying the diagnosis code for the given patient-calendar date (potentially among multiple qualifying records). (See also [URSA-CORE] Document ID)
    • Primary Encounter ID
    • Primary Encounter Facility Provider ID
    • Primary Encounter Attending Provider ID
    • Primary Encounter Service Provider ID
    • Primary Encounter Provider Group ID

  • Date Fields

    • Diagnosis Effective Date -- The date of the diagnosis is considered to have been assigned to the patient for CMS-HCC model calculation purposes; may be different than the date the diagnosis record was submitted to CMS.
    • Segment Start Date -- The start date of the reporting segment. (See also [URSA-CORE] Reporting Segment)
    • Segment End Date -- The end date of the reporting segment. (See also [URSA-CORE] Reporting Segment)

  • Diagnosis Fields

    • Diagnosis ICD-10-CM Code -- The standard ICD-10-CM diagnosis code; e.g., A00 = Cholera. ICD-10-CM diagnosis codes longer than 3 digits must include a decimal point after the 3rd digit.
    • Diagnosis ICD-10-CM Description -- The natural language description of a ICD-10-CM diagnosis code. (See also [URSA-CORE] Diagnosis ICD-10-CM Code)

  • Module Fields

    • Is CMS MAO-004 Diagnosis -- Indicates that at least one qualifying MAO-004 diagnosis code record was present for the given patient-date-diagnosis code triple. Useful for applying restrictions to use only certain types of diagnosis codes to generate HCC/RAF scores.

  • Encounter Fields

    • Is Diagnoses within URSA-CORE Encounter
    • Is Clinician Office Visit
    • Is Primary Care Clinician Office Visit -- A Clinician Office Visit encounter with a primary care provider or in which primary care services were delivered; operationally defined by the presence of one or more of the following: (1) a service provider or attending provider identified as a primary care provider or with a qualifying primary NUCC taxonomy code; or (2) a qualifying HCPCS code for preventive and/or primary care services. (See also [URSA-CORE] Clinician Office Visit)
    • Ursa Encounter Type Tier 1 Category -- The numbered, sort-friendly label for the broad encounter type represented by Ursa Encounter Type Tier 1 Code (e.g., "[01] Hospital Inpatient Admission Encounter", "[03] Emergency Department Visit Only"). Resolved via a lookup table keyed on Ursa Encounter Type Tier 1 Code. Use this variant when building visualizations or reports where consistent sort order matters. (See also [URSA-CORE] Ursa Encounter Type Tier 1 Code)
    • Ursa Encounter Type Tier 2 Category -- The numbered, sort-friendly label for the detailed encounter type represented by Ursa Encounter Type Tier 2 Code (e.g., "[01] Direct Acute Care Hospital Inpatient Admission", "[09] Urgent Care Visit"). Resolved via a lookup table keyed on Ursa Encounter Type Tier 2 Code. Use this variant when building visualizations or reports where consistent sort order matters within the more granular encounter classification. (See also [URSA-CORE] Ursa Encounter Type Tier 2 Code)

  • Provider Fields

    • Primary Encounter Facility Provider Description
    • Primary Encounter Facility Provider Taxonomy Description
    • Primary Encounter Attending Provider Description
    • Primary Encounter Service Provider Description
    • Primary Encounter Service Provider Taxonomy Description
    • Primary Encounter Provider Group Description

  • Metadata Fields

    • Is Claim Diagnosis
    • Is Bill Diagnosis
    • Is Acceptable Diagnosis Document Type

  • Measure Fields