Object Description
One record per distinct patient-final action diagnosis code-calendar date triple for records that are qualifying for use in calculating HCC/RAF score, either because they meet the claims or billing data standard or because they are associated with an allowed MAO-004 record. Includes patient-code-date triples with disallowed MAO-004 records if there is a diagnosis from a qualifying claim or bill present on that same date; this provides flexibility to downstream logic as to whether to use only allowed MAO-004 records or to cast a wider net (i.e., to include claims and/or billing data).
Metadata
- Table Name: ursa.so_ursa_hcc_cond_001
- Layer: SYNTHETIC_OBJECT
- Object Type: Single Stack
- Temporal Class: Event
- Case ID: Patient ID, Diagnosis Effective Date, Diagnosis ICD-10-CM Code
- Event Date: Diagnosis Effective Date
- Primary Key: Patient ID, Diagnosis Effective Date, Diagnosis ICD-10-CM Code
Published Fields
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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)
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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.
- Earliest Claim Paid Date
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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)
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Module Fields
- CMS-HCC ICD-10-CM Code -- The ICD-10-CM code on a qualifying diagnosis document type record, formatted for use as an input to the CMS-HCC model (i.e., with the decimal point removed).
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Metadata 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.
- Is Claim Diagnosis
- Is Bill Diagnosis
- Is Acceptable CMS MAO-004 Diagnosis
- Is Acceptable Claim Diagnosis
- Is Acceptable Bill Diagnosis
- Is Acceptable Diagnosis Document Type
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Validation Only Fields
- Qualifying Master Document ID