URSA-PHF-045: Post-Op Clinician Office Visit within 14 Days

  • Published on Apr 23, 2026
  • 23 minute(s) read
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Measure Description

Among surgery encounters for patients with active plan membership where the patient was discharge home or home with home health, the percentage with a clinician office visit within 14 days of discharge

Metadata

  • Measure Identifier: URSA-PHF-045
  • Measure Type: Rate Measure
  • Temporal Structure: Event
  • Component Class: Normal-Form
  • Denominator Case Field: Surgery Encounter ID
  • Target Direction: Up

Denominator Description

Surgery encounters for patients with active plan membership across all settings. Excludes encounters with discharge status indicating the patient; expired, was transferred to inpatient status at another hospital or facility, or had a planned readmission.

Numerator Description

Clinician office visits occurring within 14 days of the surgery encounter end date.

Published Fields

  • Data Model Keys

    • Surgery Encounter ID
    • Surgery Patient ID
    • Surgery Encounter Primary Payor ID
    • Surgery Encounter Primary Plan ID
    • Surgery Facility Provider ID
    • Surgery Attending Provider ID
    • Surgery Primary HCPCS Procedure Provider ID
    • 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 Payor ID -- The internal database identifier (used, e.g., for joins and primary keys) for the Primary Payor. (See also [URSA-CORE] Primary Payor)
    • Primary Plan ID -- The identifier for the health insurance plan product that is the first party responsible for payment.
    • Primary Plan Attributee Provider ID
    • Empirical Attributee Primary Care Individual Provider ID
    • Empirical Attributee Primary Care Provider Group Provider ID

  • Date Fields

    • Surgery Encounter Start Date
    • Surgery Encounter End Date
    • Period Start Date -- The date identifying the start of a period of time. Period Start Date values are inclusive; e.g., a period with Period Start Date = January 1 would begin be considered to begin at 00:00 on January 1.
    • Period End Date -- The date identifying the end of an period of time. Period End Date values are exclusive; e.g., a period with Period End Date = January 1 would begin be considered to end at precisely 00:00 on January 1 (meaning that the period did not include any time on January 1).
    • Current Continuous Primary Payor Membership Episode Start Date -- The start date of the Continuous Primary Payor Membership Episode in effect as of the (potentially historical) period covered by the record. (See also [URSA-CORE] Continuous Primary Payor Membership Episode)
    • Current Continuous Primary Payor Membership Episode End Date -- The end date of the Continuous Primary Payor Membership Episode in effect as of the (potentially historical) period covered by the record. Values follow the standard exclusive convention for Period End Dates. (See also [URSA-CORE] Continuous Primary Payor Membership Episode, [URSA-CORE] Period End Date)
    • 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)

  • Encounter Fields

    • Is Surgery Observation Stay Parent Encounter
    • Surgery Encounter LOS in Elapsed Midnights
    • Is Surgery Same Day Discharge
    • Surgery Surgery Encounter Setting Category
    • Is Surgery Patient Discharged Home or Home with Home Health
    • Is Surgery Hospital Inpatient Admission Encounter
    • Is Surgery Ambulatory Surgical Center Encounter
    • Is Surgery Hospital Outpatient Surgery Encounter
    • Is Surgery Emergency Department Parent Encounter
    • Is Surgery MSK Related Encounter

  • Patient Fields

    • Is Patient Alive
    • Is Hospice in Last 12 Months -- Evidence of CMS hospice status or evidence of hospice services in the last 12 months. Typically used as a denominator exclusion.
    • Patient Last Name
    • Patient Date of Birth -- The patient's date of birth. On the Patients Natural Object, this field reflects the "best" known value for the patient available from all data sources; on other Natural Objects, e.g., MMR Member-Months, the value faithfully reflects the date of birth found on that particular type of record in the source data.
    • Patient Age Integer -- Patient age, expressed as an integer, as of a reference date or interval.
    • Patient Age Category Tier 1 -- Non-overlapping ranges of the patient age in years into three categories; [01] Pediatrics < 19, [02] Adults 19 - 64, and [03] Older Adults >= 65. Coarser grain to the Patient Age Category Tier 2. (See also [URSA-CORE] Patient Age Category Tier 2)
    • Patient Age Category Tier 2 -- Non-overlapping ranges of the patient age in years representing finer grain categories than the Patient Age Category Tier 1. This field incorporates findings from publications on defining meaningful age groups in the context of disease. These ranges closely, but not exactly, align with standard age ranges such as those defined by the Medical Subject Headings (MeSH). See results of K-Means simple clustering method at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3825015/ (See also [URSA-CORE] Patient Age Category Tier 1)
    • Patient Sex Category
    • Is Patient Sex Female -- Indicates the patient's sex is female. On the Patients Natural Object, this field reflects the "best" known value for the patient available from all data sources; on other Natural Objects, e.g., MMR Member-Months, the value faithfully reflects the patient sex documented on that particular type of record in the source data.
    • Is Patient Sex Male -- Indicates the patient's sex is male. On the Patients Natural Object, this field reflects the "best" known value for the patient available from all data sources; on other Natural Objects, e.g., MMR Member-Months, the value faithfully reflects the patient sex documented on that particular type of record in the source data.
    • Count Hospital Inpatient Admissions in Last 12 Months
    • Count ED Visits Without Inpatient Admissions in Last 12 Months
    • PCP Attribution Category
    • Primary Care Engagement Category
    • Count Primary Care Visits in Last 36 Months
    • Specialty Care Engagement Category
    • Count Specialty Care Office Visits in Last 36 Months
    • Primary or Specialty Care Engagement Category
    • Count Clinician Office Visits in Last 3 Years
    • Patient ZIP Code 5-Digit

  • Numerator Fields

    • Clinician Visit Encounter ID
    • Clinician Visit Service Provider ID
    • Clinician Visit Provider Group Provider ID
    • Clinician Visit Facility Provider ID
    • Clinician Visit Encounter Date
    • Clinician Visit Qualifying Preventive Primary Care HCPCS Code
    • Elapsed Days from Surgery Discharge to Visit
    • Is Clinician Visit Primary Care Clinician Office Visit
    • Is Clinician Visit Specialist Clinician Office Visit
    • Is Clinician Visit Preventive Care Visit from Non-Primary Care Specialist
    • Is Clinician Visit Urgent Care Visit
    • Clinician Visit Service Provider NPI
    • Clinician Visit Service Provider Description
    • Clinician Visit Service Provider Primary NUCC Provider Taxonomy Description
    • Clinician Visit Ursa Physician Specialty Type Description
    • Clinician Visit Principal Discharge Diagnosis ICD-10-CM Code
    • Clinician Visit Principal Discharge Diagnosis ICD-10-CM Description
    • Clinician Visit Principal Discharge Diagnosis AHRQ CCS Single-Level Diagnosis Category Code
    • Clinician Visit Principal Discharge Diagnosis AHRQ CCS Single-Level Diagnosis Category Description
    • Clinician Visit Principal Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 1 Code
    • Clinician Visit Principal Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 1 Description
    • Clinician Visit Principal Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 2 Code
    • Clinician Visit Principal Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 2 Description
    • Clinician Visit Principal Discharge Diagnosis WHO ICD-10 Chapter Description
    • Clinician Visit Principal Discharge Diagnosis WHO ICD-10 Block Description
    • Clinician Visit Qualifying Preventive Primary Care HCPCS Code Description
    • Clinician Visit CMS Place of Service Code
    • Clinician Visit Primary Plan Allowed Amount
    • Clinician Visit Primary Plan Paid Amount
    • Clinician Visit Total Plan Paid Amount from All Plans
    • Clinician Visit Patient Paid Amount

  • Provider Fields

    • Surgery Facility Provider Description
    • Surgery Facility Provider Primary NUCC Provider Taxonomy Code
    • Surgery Facility Provider Primary NUCC Provider Taxonomy Description
    • Surgery Facility Provider Practice Address State Abbreviation
    • Surgery Facility Provider Practice Address ZIP Code 5-Digit
    • Primary Plan Attributee Provider Description
    • Primary Plan Attributee Primary NUCC Provider Taxonomy Description
    • Empirical Attributee Primary Care Individual Provider Description
    • Empirical Attributee Primary Care Individual Primary NUCC Provider Taxonomy Description
    • Empirical Attributee Primary Care Provider Group Provider Description
    • Empirical Attributee Primary Care Provider Group Primary NUCC Provider Taxonomy Description
    • Count Visits with Attributee Individual Primary Care Provider in Last 36 Months
    • Count Visits with Attributee Primary Care Provider Group in Last 36 Months

  • Location Fields

    • Patient State Abbreviation
    • Patient County Description
    • UW HIP ADI Quintile Category -- The UW HIP Area Deprivation Index National Percentile grouped into 5 levels, each spanning 20 percentile points (ADI 1 is percentile scores from 1 to 20 while ADI 5 is scores from 81 to 100). Higher scores indicate more deprivation, so ADI 1 is the least deprived while ADI 5 is the most deprived. Quintiles are frequently used in health research. They give larger sample sizes per group and are easier to plot and interpret. Quintiles also carry less information and group more dissimilar patients. Quintiles are good for descriptive analyses while the original percentile measure is preferable for predictive modeling. (See also [URSA-CORE] UW HIP Area Deprivation Index National Percentile)
    • CDC SVI Overall Quintile Category -- The CDC SVI Overall National Percentile grouped into 5 levels, each spanning 20 percentile points (the first quintile is percentile scores from 1 to 20 while the fifth is scores from 81 to 100). Higher scores indicate more vulnerability, so the first quintile is the least vulnerable while the fifth is the most vulnerable. Quintiles are frequently used in health research. They give larger sample sizes per group and are easier to plot and interpret. Quintiles also carry less information and group more dissimilar patients. Quintiles are good for descriptive analyses while the original percentile measure is preferable for predictive modeling.
    • CDC SVI Socioeconomic Quintile Category -- The CDC SVI Socioeconomic Theme National Percentile grouped into 5 levels, each spanning 20 percentile points (the first quintile is percentile scores from 1 to 20 while the fifth is scores from 81 to 100). Higher scores indicate more vulnerability, so the first quintile is the least vulnerable while the fifth is the most vulnerable. (See also [URSA-CORE] CDC SVI Socioeconomic Theme National Percentile )
    • CDC SVI Household / Disability Quintile Category -- The CDC SVI Household/Disability Theme National Percentile grouped into 5 levels, each spanning 20 percentile points (the first quintile is percentile scores from 1 to 20 while the fifth is scores from 81 to 100). Higher scores indicate more vulnerability, so the first quintile is the least vulnerable while the fifth is the most vulnerable. (See also [URSA-CORE] CDC SVI Household / Disability Theme National Percentile )
    • CDC SVI Minority / Language Quintile Category -- The CDC SVI Minority/Language Theme National Percentile grouped into 5 levels, each spanning 20 percentile points (the first quintile is percentile scores from 1 to 20 while the fifth is scores from 81 to 100). Higher scores indicate more vulnerability, so the first quintile is the least vulnerable while the fifth is the most vulnerable. (See also [URSA-CORE] CDC SVI Minority / Language Theme National Percentile)
    • CDC SVI Housing / Transportation Quintile Category -- The CDC SVI Housing/Transportation Theme National Percentile grouped into 5 levels, each spanning 20 percentile points (the first quintile is percentile scores from 1 to 20 while the fifth is scores from 81 to 100). Higher scores indicate more vulnerability, so the first quintile is the least vulnerable while the fifth is the most vulnerable. (See also [URSA-CORE] CDC SVI Housing / Transportation Theme National Percentile)

  • Insurance Fields

    • Surgery Encounter Primary Payor Description
    • Surgery Encounter Primary Plan Description
    • Surgery Encounter Primary Plan Financial Class Description
    • Primary Payor Description
    • Primary Plan Description

  • Diagnosis Fields

    • Surgery Principal Discharge Diagnosis ICD-10-CM Code
    • Surgery Principal Discharge Diagnosis ICD-10-CM Description
    • Surgery Principal Discharge Diagnosis AHRQ CCS Single-Level Diagnosis Category Code
    • Surgery Principal Discharge Diagnosis AHRQ CCS Single-Level Diagnosis Category Description
    • Surgery Principal Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 1 Code
    • Surgery Principal Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 1 Description
    • CCW Count Category
    • Count CCW Conditions -- The total of both Chronic Conditions and Potentially Disabling Events included in the CMS Chronic Condition Warehouse (CCW) library. (See also [URSA-CORE] CCW Comorbidity Category, [URSA-CORE] Count Potentially Disabling Events, [URSA-CORE] CMS Chronic Condition Warehouse (CCW), [URSA-CORE] Count Chronic Conditions)
    • Is CCW Acquired Hypothyroidism -- At least 1 inpatient, SNF, HHA OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.
    • Is CCW Acute Myocardial Infarction -- At least 1 inpatient claim with one or more of the DX codes from the corresponding CCW value set as the first or second diagnosis position in the prior 1 year.
    • Is CCW ADHD, Conduct Disorders, and Hyperkinetic Syndrome -- At least 1 inpatient claim OR 2 other non-drug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Alzheimers Disease -- At least 1 inpatient, SNF, HHA, HOP, or Carrier claim with one or more of the DX codes from the corresponding CCW value set in the prior 3 years.
    • Is CCW Alzheimers Disease and Related Disorders or Senile Dementia -- At least 1 inpatient, SNF, HHA, HOP, or Carrier claim with one or more of the DX codes from the corresponding CCW value set in the prior 3 years.
    • Is CCW Anemia -- At least 1 inpatient, SNF, HHA, HOP, or Carrier claim with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.
    • Is CCW Anxiety Disorders -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Asthma -- At least 1 inpatient, SNF, HHA OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.
    • Is CCW Atrial Fibrillation -- At least 1 inpatient OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set as the first or second diagnosis position in the prior 1 year.
    • Is CCW Autism Spectrum Disorder -- At least 1 inpatient claim OR 2 other non-drug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Benign Prostatic Hyperplasia -- At least 1 inpatient, SNF, HHA OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 1 year. Exclusion: If any of the qualifying claims also have an ICD-10 DX of D29.1, then it is excluded.
    • Is CCW Bipolar Disorder -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Blindness and Visual Impairment -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Breast Cancer -- At least 1 inpatient, SNF OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in prior 1 year.
    • Is CCW Cataract -- At least 1 HOP or Carrier claim with one or more of the DX codes from the corresponding CCW value set as the principal diagnosis position in the prior 1 year.
    • Is CCW Cerebral Palsy -- At least 1 inpatient claim OR 2 other non-drug claims of any service type with DX codes over the last 2 years (See also [URSA-CORE] CMS Chronic Condition Warehouse (CCW))
    • Is CCW CKD -- Indicates that the patient meets the CMS Chronic Condition Warehouse criteria for chronic kidney disease; i.e., 2 or more qualifying outpatient or professional ICD codes in the prior 2 years, or 1 or more non-outpatient institutional claim ICD codes in the prior 2 years.
    • Is CCW Colorectal Cancer -- At least 1 inpatient, SNF OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.
    • Is CCW COPD and Bronchiectasis -- At least 1 inpatient, SNF, HHA OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.
    • Is CCW Cystic Fibrosis and Other Metabolic Disorder -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Deafness and Hearing Impairment -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Depression -- At least 1 inpatient, SNF, HHA, HOP, or Carrier claim with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.
    • Is CCW Depressive Disorders -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Diabetes -- At least 1 inpatient, SNF, HHA OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Endometrial Cancer -- At least 1 inpatient, SNF OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.
    • Is CCW Epilepsy -- At least 1 inpatient claim OR 2 other non-drug claims of any service type during the two-year period (See also [URSA-CORE] CMS Chronic Condition Warehouse (CCW))
    • Is CCW Fibromyalgia and Chronic Pain and Fatigue -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Glaucoma -- At least 1 Carrier claim with one or more of the DX codes from the corresponding CCW value set as the principal diagnosis position in the prior 1 year.
    • Is CCW Heart Failure -- At least 1 inpatient, HOP, or Carrier claim with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Hip or Pelvic Fracture -- At least 1 inpatient or SNF claim with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.
    • Is CCW Hyperlipidemia -- At least 1 inpatient, SNF, HHA OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.
    • Is CCW Hypertension -- At least 1 inpatient, SNF, HHA OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.
    • Is CCW Intellectual Disability -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Ischemic Heart Disease -- At least 1 inpatient, SNF, HHA, HOP, or Carrier claim with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Learning Disability -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Leukemia -- At least 1 inpatient OR 2 non-inpatient claims with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Lung Cancer -- At least 1 inpatient, SNF OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.
    • Is CCW Migraine and Chronic Headache -- At least 1 inpatient claim OR 2 non-inpatient claims with DX codes within a 2 year period. (See also [URSA-CORE] CMS Chronic Condition Warehouse (CCW))
    • Is CCW Mobility Impairment -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Multiple Sclerosis -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Muscular Dystrophy -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Obesity -- At least 1 inpatient OR 2 non-inpatient claims with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Osteoporosis -- At least 1 inpatient, SNF, HHA OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.
    • Is CCW Other Developmental Delay -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Personality Disorder -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Pressure or Chronic Ulcer -- At least 1 inpatient OR 2 non-inpatient claims with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Prostate Cancer -- At least 1 inpatient, SNF OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.
    • Is CCW PTSD -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW PVD -- At least 1 inpatient OR 2 non-inpatient claims with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Rheumatoid Arthritis or Osteoarthritis -- At least 2 inpatient, SNF, HHA, HOP, or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Schizophrenia -- At least 1 inpatient claim OR 2 other non-drug claims of any service type with DX codes at least one day apart in the prior within the 2 year reference period. Qualifying codes can also be found as a subset of those in the CCW "Schizophrenia or Other Psychotic Disorders". (See also [URSA-CORE] Is CCW Schizophrenia or Other Psychotic Disorders)
    • Is CCW Schizophrenia or Other Psychotic Disorders -- At least 1 inpatient OR 2 other nondrug claims of any service type with one ore more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Stroke or Transient Ischemic Attack -- At least 1 inpatient OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.
      EXCLUSIONS: If any of the qualifying claims have : 800 <= DX Code <=
      804.9, 850 <= DX Code <= 854.1 in any DX position OR DX V57xx as the principal DX Code, then the claim is excluded.
    • CCW Systems Category
    • Count CCW Systems -- The count of distinct systems of the body with one or more active CCW Condition. CCW Systems are as a parent category to the individual CCW Conditions grouping them based primarily on the human body system they impact such as; Behavioral Health, Cancers, Cardiovascular, Cerebrovascular, Endocrine, Genitourinary, Musculoskeletal, and Pulmonary. (See also [URSA-CORE] CMS Chronic Condition Warehouse (CCW))
    • Is CCW System Behavioral Health -- Indicates the patient has one or more of the following CCW conditions; ADHD, Conduct Disorders, and Hyperkinetic Syndrome, Anxiety Disorders, Autism Spectrum Disorder, Bipolar Disorder, Depression, Depressive Disorders, Personality Disorders, PTSD, Schizophrenia, or Schizophrenia and Other Psychotic Disorders.
    • Is CCW System Cardiovascular -- Indicates the patient has one or more of the following CCW conditions; Acute Myocardial Infarction (AMI), Atrial Fibrillation, Heart Failure, Hypertension, Ischemic Heart Disease, or Peripheral Vascular Disease (PVD).
    • Is CCW System Congenital -- Indicates the patient has one or more of the following CCW conditions; Cerebral Palsy, Cystic Fibrosis and Other Metabolic Disorder, Intellectual Disability, Learning Disability, Muscular Dystrophy, or Other Developmental Delays.
    • Is CCW System Endocrine/Metabolic -- Indicates the patient has one or more of the following CCW conditions; Diabetes, Acquired Hypothyroidism, Hyperlipidemia, or Obesity.
    • Is CCW System Genitourinary -- Indicates the patient has one or more of the following CCW conditions; Benign Prostatic Hyperplasia or Chronic Kidney Disease (CKD).
    • Is CCW System Hematologic -- Indicates the patient has one or more of the following CCW conditions; Anemia.
    • Is CCW System Musculoskeletal -- Indicates the patient has one or more of the following CCW conditions; Hip or Pelvic Fracture, Rheumatoid Arthritis or Osteoarthritis, or Osteoporosis.
    • Is CCW System Neurological -- Indicates the patient has one or more of the following CCW conditions; Alzheimer's Disease, Alzheimer's Disease and Related Disorders or Senile Dementia, Stroke or Transient Ischemic Attack, Epilepsy, Migraine and Chronic Headache, Mobility Impairment, Multiple Sclerosis, or Deafness and Hearing Impairment.
    • Is CCW System Oncologic -- Indicates the patient has one or more of the following CCW conditions; Breast Cancer, Colorectal Cancer, Endometrial Cancer, Lung Cancer, Prostate Cancer, or Leukemia.
    • Is CCW System Ophthalmologic -- Indicates the patient has one or more of the following CCW conditions; Cataract, Glaucoma, or Blindness and Visual Impairment.
    • Is CCW System Pulmonary -- Indicates the patient has one or more of the following CCW conditions; Asthma, or Chronic Obstructive Pulmonary Disease (COPD) and Bronchiectasis.
    • Is CCW System Other -- Indicates the patient has one or more of the following CCW conditions; Fibromyalgia and Chronic Pain and Fatigue, Pressure or Chronic Ulcer.

  • Financial Fields

    • Surgery Primary Plan Allowed Amount
    • Surgery Primary Plan Paid Amount
    • Surgery Total Plan Paid Amount from All Plans
    • Surgery Patient Paid Amount

  • Billing and Claims Fields

    • Surgery MS-DRG Code
    • Surgery MS-DRG Description
    • Surgery MS-DRG MDC Code
    • Surgery MS-DRG MDC Description
    • Is Surgery MS-DRG MDC Code Musculoskeletal System
    • Surgery APR-DRG Code
    • Surgery CMS Admit Type Code
    • Surgery CMS Admit Type Description
    • Surgery CMS Admit Source Code
    • Surgery CMS Admit Source Description
    • Surgery CMS Place of Service Description
    • Surgery CMS Place of Service Code
    • Surgery CMS Patient Discharge Status Code
    • Surgery CMS Patient Discharge Status Description
    • Clinician Visit CMS Place of Service Description

  • Clinical Services Fields

    • Surgery Primary HCPCS Procedure HCPCS Code
    • Surgery Primary HCPCS Short Description
    • Is Surgery Primary HCPCS Procedure Surgical
    • Surgery Primary Surgical Procedure HCPCS Category
    • Is Surgery Primary HCPCS Surgical Procedure of Musculoskeletal System
    • Surgery Primary HCPCS MSK Surgical Procedure Category
    • Surgery Primary HCPCS AHRQ CCS Single-Level Procedure Category Code
    • Surgery Primary HCPCS AHRQ CCS Single-Level Procedure Category Description
    • Surgery Principal ICD Procedure ICD-10-PCS Code
    • Surgery Principal ICD Procedure ICD-10-PCS Description
    • Is Surgery Principal ICD-10-PCS Operation of Musculoskeletal System
    • Surgery Principal ICD-10-PCS AHRQ CCS Single-Level Procedure Category Code
    • Surgery Principal ICD-10-PCS AHRQ CCS Single-Level Procedure Category Description
    • Surgery Principal ICD-10-PCS AHRQ CCS Multi-Level Procedure Category Tier 1 Code
    • Surgery Principal ICD-10-PCS AHRQ CCS Multi-Level Procedure Category Tier 1 Description

  • Validation Only Fields

    • Is Surgery Any Total Hip or Knee Replacement
    • Is Surgery MSDRG for Hip or Knee Replacement
    • Is Surgery Principal ICD-10 PCS AHRQ CCS Single Level Category Total Knee
    • Is Surgery Principal ICD-10 PCS AHRQ CCS Single Level Category Total Hip
    • Is Surgery Primary HCPCS AHRQ CCS Single Level Category Total Knee
    • Is Surgery Primary HCPCS AHRQ CCS Single Level Category Total Hip

  • Measure Fields

    • Is Visit Service Provider the Plan Attributed Provider
    • Is Visit Service Provider the Empirical Attributee Individual Provider
    • Denominator