Hierarchical Condition Category API
Hierarchical Condition Category (HCC) coding is a risk adjustment payment model mandated by the *Centers for Medicare and Medicaid Services (CMS)*. There are more than 9000 ICD-10 codes that map to more than 70 HCC codes in the model. *CMS* requires documentation of the person’s condition at least once each calendar year to ensure reimbursement.
Note: The supporting and competing fact data and related diagnosis code information retrieved by this API are filtered based on your sensitive data filters for Oracle Health Data Intelligence. Ensure that your implementations of this API are designed with this in mind, and if you integrate data from Health Data Intelligence into a clinical workflow using this API, ensure that your users are informed of your sensitive data filters. See Understand Sensitive Data in Oracle Health Data Intelligence in the Reference Pages on Cerner Wiki for more information.
Hierarchical Condition Category
HCCs in the Health Data Intelligence Hierarchical Condition Categories solution are represented as persistent diagnoses and suspected conditions. A persistent diagnosis is a previously documented condition tied to an HCC not yet documented this calendar year. A suspected condition is a condition not diagnosed or documented for the person, but suspected based on laboratory results, medications, and procedures. Both supporting and possible competing clinical facts are provided to facilitate decisions around a suspected condition.
The HCC object
Example HCC object
{
"diagnosis_code": "E13.9",
"code": "HCC 17, 18, 19 Diabetes",
"diagnosis_code_description": "Other specified diabetes mellitus without complications",
"diagnosis_code_system_id": "2.16.840.1.113883.6.90",
"last_service_date": "2018-03-12T05:00:00.000Z",
"status": "PENDING",
"aliases": [
"HCC_18_DIABETES_WITH_CHRONIC_COMPLICATIONS_CLIN",
"HCC_19_DIABETES_WITHOUT_COMPLICATION_CLIN"
],
"stratification": "Highly Suspected",
"stratification_category": "HIGH",
"supporting_facts": [
{
"name": "insulin_present",
"value": "true",
"last_service_date": "2014-04-22T06:00:00Z"
},
{
"name": "meglitinide_present",
"value": "false"
},
{
"name": "sulfonylurea_present",
"value": "false"
},
{
"name": "thiazolidinedione_present",
"value": "false"
},
{
"name": "incretin_mimetic_present",
"value": "false"
},
{
"name": "metformin_present",
"value": "false"
},
{
"name": "dipeptidyl_peptidase_inhibitor_present",
"value": "false"
},
{
"name": "amylin_analog_present",
"value": "false"
},
{
"name": "alpha_glucosidase_inhibitor_present",
"value": "false"
}
],
"competing_facts": [
{
"name": "gestational_diabetes_present",
"value": "false"
},
{
"name": "pcos_present",
"value": "false"
},
{
"name": "pregnancy_present",
"value": "false"
}
],
"types": ["PERSISTENT", "SUSPECTED"]
}
Name | Type | Description |
---|---|---|
diagnosis_code | string |
The previously documented diagnosis code (ICD-9 or ICD-10). |
code | string |
The HCC code number and description. |
diagnosis_code_description | string |
The description of the previously documented diagnosis code. |
diagnosis_code_system_id | string |
The coding system ID of the diagnosis code. |
last_service_date | string |
The date and time (ISO 8601 format) of the most recent visit or condition. |
status | string |
Indicates the status of the condition. Possible values:
|
aliases | array |
All the HCC code aliases that are relevant for a condition. |
stratification | string |
Indicates the extent to which the condition is suspected based on the supporting and competing facts.Possible values:
Note: This field is being deprecated in favor of stratification_category. |
stratification_category | string |
Indicates the category of suspected HCC for a person based on the supporting and competing facts.Possible values:
Note: This field is only present in the response object if Cerner has implemented a suspected HCC algorithm for the HCC. The suspected HCC algorithms use clinical data to identify potentially undiagnosed or undocumented conditions. |
supporting_facts | array |
The clinical facts supporting a suspected HCC. Note: This field is only present in the response object if Cerner has implemented a suspected HCC algorithm for the HCC. The suspected HCC algorithms use clinical data to identify potentially undiagnosed or undocumented conditions. |
competing_facts | array |
The clinical facts disputing a suspected HCC. Note: This field is only present in the response object if Cerner has implemented a suspected HCC algorithm for the HCC. The suspected HCC algorithms use clinical data to identify potentially undiagnosed or undocumented conditions. |
types | array |
The type of the condition. Possible values:
|
Retrieve HCC
Example Request
curl -H 'Authorization: auth_header' https://cernerdemo.programs.healtheintent.com/api/populations/1424e81d-8cea-4d6b-b140-d6630b684a58/people/53580e0b-3170-42fe-80cf-9cd4685f6d4f/hcc_diagnoses
require 'httparty'
HTTParty.get(
'https://cernerdemo.programs.healtheintent.com/api/populations/1424e81d-8cea-4d6b-b140-d6630b684a58/people/53580e0b-3170-42fe-80cf-9cd4685f6d4f/hcc_diagnoses',
headers: { 'Authorization' => 'auth_header' }
)
Example Response
{
"conditions":[
{
"diagnosis_code":"E11.9",
"code":"HCC 17, 18, 19 Diabetes",
"diagnosis_code_description":"Type 2 diabetes mellitus without complications",
"diagnosis_code_system_id":"2.16.840.1.113883.6.90",
"last_service_date":"2016-02-01",
"status":"PENDING",
"aliases":[
"HCC_19_DIABETES_WITHOUT_COMPLICATION_CLIN",
"HCC_17_DIABETES_WITH_ACUTE_COMPLICATIONS_CLIN",
"HCC_18_DIABETES_WITH_CHRONIC_COMPLICATIONS_CLIN"
],
"stratification":"Highly Suspected",
"supporting_facts":[
{
"name":"metformin",
"value":"true",
"last_service_date":"2018-06-12T14:00:00.000Z"
},
{
"name":"hba1c",
"value":"6.8",
"last_service_date":"2017-08-15T19:20:00.000Z"
},
{
"name":"hba1c",
"value":"6.5",
"last_service_date":"2017-05-18T03:07:00.000Z"
}
],
"stratification_category":"HIGH",
"types":[
"PERSISTENT",
"SUSPECTED"
]
},
{
"diagnosis_code":"K50.80",
"code":"HCC35 Inflammatory Bowel Disease",
"diagnosis_code_description":"Crohn's disease of both small and large intestine without complication",
"diagnosis_code_system_id":"2.16.840.1.113883.6.90",
"last_service_date":"2017-11-30T16:18:00.000Z",
"status":"PENDING",
"aliases":[
"HCC_35_INFLAMMATORY_BOWEL_DISEASE_CLIN"
],
"types":[
"PERSISTENT"
]
},
{
"diagnosis_code":"L97.529",
"code":"HCC161 Chronic Ulcer of Skin, Except Pressure",
"diagnosis_code_description":"Toe ulcer",
"diagnosis_code_system_id":"2.16.840.1.113883.6.90",
"last_service_date":"2017-05-18T12:24:00.000Z",
"status":"PENDING",
"aliases":[
"HCC_161_CHRONIC_ULCER_OF_SKIN_EXCEPT_PRESSURE_CLIN"
],
"types":[
"PERSISTENT"
]
}
]
}
GET https://{client}.programs.healtheintent.com/api/populations/{population_id}/people/{person_id}/hcc_diagnoses
Retrieves the suspected and persistent HCCs for a person within a population.
Path Parameters
Parameter | Description |
---|---|
population_id | The Health Data Intelligence population ID. |
person_id | The Health Data Intelligence person ID. |
Query Parameters
Parameter | Description |
---|---|
type | OPTIONAL Filters conditions to only those of a certain type for the given person. All conditions are returned if you do not set this parameter. Allowed:
|
status | OPTIONAL The status query parameter is relevant only if type is set to persistent. Filters conditions to only those in a certain status for the given person. Conditions with a status of pending are returned if you do not set this parameter. You can filter only persistent conditions by statuses. If you set the type parameter to suspected, all suspected HCCs are returned regardless of the status parameter you set. Allowed:
|
Responses
Status | Type | Description |
---|---|---|
200 | Hierarchical Condition Categories | Collection of HCC objects |
400 | string |
Bad Request |
401 | string |
Unauthorized |
403 | string |
Forbidden |
404 | string |
Not Found |
500 | string |
Internal Server Error |
The Risk Adjustment Factor (RAF) Score object
Example RAF Scores object
{
"raf_scores": [
{
"type": "ACTUAL_CMS_RAF",
"display": "Actual RAF",
"value": "0.300"
},
{
"type": "POTENTIAL_CMS_RAF",
"display": "Potential RAF",
"value": "1.480"
},
{
"type": "POTENTIAL_CMS_RAF_WITH_SUSPECTED",
"display": "Potential RAF with Suspected",
"value": "1.875"
},
{
"type": "CLINICALLY_VALIDATED_ACTUAL_CMS_RAF",
"display": "Clinically validated RAF",
"value": "0.350"
}
]
}
Name | Type | Description |
---|---|---|
type | string |
The type of RAF score. Possible values are:
|
display | string |
The display text of the type of RAF score. |
value | string |
The RAF score value. |
Retrieve RAF Score
Example Request
curl -H 'Authorization: auth_header' https://cernerdemo.programs.healtheintent.com/api/populations/1424e81d-8cea-4d6b-b140-d6630b684a58/people/53580e0b-3170-42fe-80cf-9cd4685f6d4f/raf_scores
require 'httparty'
HTTParty.get(
'https://cernerdemo.programs.healtheintent.com/api/populations/1424e81d-8cea-4d6b-b140-d6630b684a58/people/53580e0b-3170-42fe-80cf-9cd4685f6d4f/raf_scores',
headers: { 'Authorization' => 'auth_header' }
)
Example Response
{
"raf_scores": [
{
"type": "ACTUAL_CMS_RAF",
"display": "Actual RAF",
"value": "0.300"
},
{
"type": "POTENTIAL_CMS_RAF",
"display": "Potential RAF",
"value": "1.480"
},
{
"type": "POTENTIAL_CMS_RAF_WITH_SUSPECTED",
"display": "Potential RAF with Suspected",
"value": "1.875"
},
{
"type": "CLINICALLY_VALIDATED_ACTUAL_CMS_RAF",
"display": "Clinically validated RAF",
"value": "0.350"
}
]
}
GET https://{client}.programs.healtheintent.com/api/populations/{population_id}/people/{person_id}/raf_scores
Retrieves the RAF score data for a person based on population ID and person ID.
Path Parameters
Parameter | Description |
---|---|
population_id | The Health Data Intelligence population ID. |
person_id | The Health Data Intelligence person ID. |
Responses
Status | Type | Description |
---|---|---|
200 | RAF Scores | Collection of RAF Score objects |
401 | string |
Unauthorized |
403 | string |
Forbidden |
404 | string |
Not Found |
500 | string |
Internal Server Error |