dgx-spark-playbooks/nvidia/station-healthcare-agent/assets/HEALTHCARE-REFERENCE.md

Healthcare Reference Supplement

Clinical code tables, full CMS quality measure specifications, drug classification libraries, FHIR resource reference, and glossary.

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SNOMED CT Condition Codes

Code	Condition	ICD-10	US Prevalence	CMS Measure
44054006	Type 2 Diabetes Mellitus	E11.x	~37M adults	CMS122, CMS134
46635009	Type 1 Diabetes Mellitus	E10.x	~1.6M adults	CMS122, CMS134
38341003	Essential Hypertension	I10	~116M adults	CMS165
84114007	Heart Failure	I50.x	~6.7M adults	CMS135
40055000	Chronic Kidney Disease	N18.x	~37M adults	CMS134
53741008	Coronary Artery Disease	I25.x	~20M adults	—
13645005	COPD	J44.x	~16M adults	—
195967001	Asthma	J45.x	~25M adults	—
49436004	Atrial Fibrillation	I48.x	~6M adults	—
431856006	CKD Stage 2	N18.2	—	—
55822004	Hyperlipidemia	E78.5	—	—

Note: Use bare codes when querying the test server. Do not use system-qualified URIs (e.g., use code=44054006, not code=http://snomed.info/sct|44054006).

LOINC Laboratory and Vitals Codes

Code	Display	Category	Unit	Clinical Context
4548-4	Hemoglobin A1c	Metabolic	%	Diabetes monitoring (CMS122)
2345-7	Glucose	Metabolic	mg/dL	Diabetes screening
2160-0	Creatinine	Renal	mg/dL	Kidney function
33914-3	eGFR (CKD-EPI)	Renal	mL/min/1.73m²	CKD staging
85354-9	Blood Pressure panel	Vital Signs	—	Component observation (CMS165)
8480-6	Systolic Blood Pressure	Vital Signs	mmHg	Component of 85354-9, or standalone
8462-4	Diastolic Blood Pressure	Vital Signs	mmHg	Component of 85354-9, or standalone
2093-3	Total Cholesterol	Lipids	mg/dL	Cardiovascular risk
2571-8	Triglycerides	Lipids	mg/dL	Cardiovascular risk
2085-9	HDL Cholesterol	Lipids	mg/dL	Cardiovascular risk
18262-6	LDL Cholesterol	Lipids	mg/dL	Statin therapy target
42637-9	BNP	Cardiac	pg/mL	Heart failure marker
33762-6	NT-proBNP	Cardiac	pg/mL	Heart failure marker
2823-3	Potassium	Electrolyte	mEq/L	ACEi/ARB/MRA safety
2951-2	Sodium	Electrolyte	mEq/L	HF fluid status
718-7	Hemoglobin	Hematology	g/dL	Anemia (CKD)
1742-6	ALT	Hepatic	U/L	Statin monitoring
14959-1	Urine Albumin/Creatinine Ratio	Renal	mg/g	Nephropathy screening (CMS134)

FHIR Coding Systems

System URI	Code System	Example
http://snomed.info/sct	SNOMED CT	44054006 (Type 2 Diabetes)
http://hl7.org/fhir/sid/icd-10-cm	ICD-10-CM	E11.9 (T2DM, unspecified)
http://loinc.org	LOINC	4548-4 (HbA1c)
http://www.nlm.nih.gov/research/umls/rxnorm	RxNorm	Medication identifiers
http://hl7.org/fhir/sid/ndc	NDC	National Drug Codes

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CMS Quality Measure Specifications

CMS122v12 — Simplified vs. Full eCQM

Component	This System (Simplified)	Full eCQM Specification
Denominator	Patients 18–75 with diabetes (SNOMED 44054006 or 46635009)	+ at least 2 outpatient encounters during measurement year; specific encounter value sets (CPT 99201-99215, HCPCS G0438-G0439)
Numerator	Most recent HbA1c > 9.0% OR no HbA1c recorded	Same threshold, but HbA1c must be during measurement period; specific LOINC value set (4548-4, 4549-2, 17856-6)
Exclusions	Hospice, palliative care, advanced illness + frailty	+ specific value sets for hospice (SNOMED 385763009+), palliative care (ICD-10 Z51.5), advanced illness (200+ ICD-10 codes), frailty indicators, dementia medications (specific RxNorm codes)
Measurement period	Any recent HbA1c	January 1 – December 31 of the performance year

CMS165v12 — Simplified vs. Full eCQM

Component	This System (Simplified)	Full eCQM Specification
Denominator	Patients 18–85 with hypertension (SNOMED 38341003)	+ diagnosed before or during first 6 months of measurement period; at least 2 outpatient encounters
Numerator	Most recent BP < 140/90	BP measured during an outpatient encounter within measurement period
Exclusions	Hospice, ESRD, pregnancy	+ kidney transplant, palliative care, advanced illness + frailty

CMS135v12 — Simplified vs. Full eCQM

Component	This System (Simplified)	Full eCQM Specification
Denominator	Patients 18+ with HF (SNOMED 84114007) + LVEF < 40%	+ specific HF diagnosis value set (ICD-10 I50.1, I50.20-I50.23, I50.40-I50.43, I50.9)
Numerator	Prescribed ACEi, ARB, or ARNI	+ specific RxNorm medication value sets; at least 1 prescription during measurement period
LVEF source	Not queryable via standard FHIR Observation	Typically in DiagnosticReport or CarePlan

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Drug Classification Tables

Diabetes Medications

Class	Generic Names	Brand Names	Matching Strings
Biguanide	metformin	Glucophage, Fortamet, Riomet	metformin
Sulfonylureas	glipizide, glyburide, glimepiride	Glucotrol, DiaBeta, Amaryl	glipizide, glyburide, glimepiride
Insulin	lispro, glargine, aspart, detemir, degludec, NPH	Humalog, Lantus, Novolog, Levemir, Tresiba	insulin
GLP-1 RA	liraglutide, semaglutide, dulaglutide, exenatide, tirzepatide	Victoza, Ozempic, Wegovy, Rybelsus, Trulicity, Byetta, Mounjaro	liraglutide, semaglutide, dulaglutide, exenatide, tirzepatide, victoza, ozempic, trulicity, byetta, mounjaro, rybelsus
SGLT2i	empagliflozin, dapagliflozin, canagliflozin, ertugliflozin	Jardiance, Farxiga, Invokana, Steglatro	empagliflozin, dapagliflozin, canagliflozin, ertugliflozin, jardiance, farxiga, invokana, steglatro
DPP-4i	sitagliptin, saxagliptin, linagliptin, alogliptin	Januvia, Onglyza, Tradjenta, Nesina	sitagliptin, saxagliptin, linagliptin, alogliptin

Antihypertensives

Class	Generic Names	Matching Strings
ACE Inhibitors	lisinopril, enalapril, ramipril, benazepril, fosinopril, quinapril	lisinopril, enalapril, ramipril, benazepril, fosinopril, quinapril
ARBs	losartan, valsartan, irbesartan, olmesartan, telmisartan, candesartan, azilsartan	losartan, valsartan, irbesartan, olmesartan, telmisartan, candesartan, azilsartan
ARNIs	sacubitril/valsartan	entresto, sacubitril
CCBs	amlodipine, nifedipine, diltiazem, verapamil	amlodipine, nifedipine, diltiazem, verapamil
Beta-Blockers	metoprolol, atenolol, carvedilol, bisoprolol, propranolol, nebivolol	metoprolol, atenolol, carvedilol, bisoprolol, propranolol, nebivolol
Thiazides	HCTZ, chlorthalidone, indapamide	hydrochlorothiazide, hctz, chlorthalidone, indapamide
Loop Diuretics	furosemide, bumetanide, torsemide	furosemide, bumetanide, torsemide
Aldosterone Antagonists	spironolactone, eplerenone	spironolactone, eplerenone

Heart Failure GDMT (Four Pillars)

Pillar	Drug Class	Specific Agents	Evidence
1	ACEi/ARB/ARNI	Sacubitril/valsartan preferred; lisinopril, enalapril, losartan, valsartan alternatives	ACC/AHA 2022 Class I
2	Beta-Blocker	Carvedilol, metoprolol succinate, bisoprolol ONLY	ACC/AHA 2022 Class I
3	Aldosterone Antagonist	Spironolactone, eplerenone (if eGFR > 30, K+ < 5.0)	ACC/AHA 2022 Class I
4	SGLT2 Inhibitor	Dapagliflozin, empagliflozin (regardless of diabetes)	ACC/AHA 2022 Class I

Statins

Intensity	Drugs
High	atorvastatin 40-80mg, rosuvastatin 20-40mg
Moderate	atorvastatin 10-20mg, rosuvastatin 5-10mg, simvastatin 20-40mg, pravastatin 40-80mg
Low	simvastatin 10mg, pravastatin 10-20mg, lovastatin 20mg

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FHIR Resource Quick Reference

Endpoints and Search Parameters

Resource	Endpoint	Common Search Parameters	Key JSON Paths
Patient	GET /Patient	name, birthdate, gender, _id, _count	.name[0].given[0], .name[0].family, .birthDate, .gender
Condition	GET /Condition	patient, code (SNOMED), clinical-status, _count	.code.coding[].code, .clinicalStatus.coding[0].code, .onsetDateTime
Observation	GET /Observation	patient, code (LOINC), category, _sort, _count, date	.valueQuantity.value, .effectiveDateTime, .component[]
MedicationRequest	GET /MedicationRequest	patient, status, _count	.medicationCodeableConcept.text, .status
Encounter	GET /Encounter	patient, _sort, _count, type	.type[0].text, .period.start, .class.code

Bundle Navigation

import subprocess, json
r = subprocess.run(["curl", "-sf", "--max-time", "30", url],
                   capture_output=True, text=True, timeout=35)
bundle = json.loads(r.stdout) if r.returncode == 0 else {"entry": []}
entries = bundle.get('entry', [])
total = bundle.get('total', len(entries))

for link in bundle.get('link', []):
    if link.get('relation') == 'next':
        next_url = link['url']

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Glossary

Term	Definition
FHIR	Fast Healthcare Interoperability Resources. HL7 standard for exchanging healthcare data via REST APIs. R4 is the current normative version.
SNOMED CT	Systematized Nomenclature of Medicine. Standardized clinical terminology (~350K concepts). Used for diagnosis coding.
LOINC	Logical Observation Identifiers Names and Codes. Standard for identifying lab tests and vital signs.
ICD-10-CM	International Classification of Diseases, 10th Revision. Used for billing and reimbursement.
RxNorm	Standardized nomenclature for clinical drugs.
eCQM	Electronic Clinical Quality Measure. Machine-readable quality measure specs published by CMS.
CMS	Centers for Medicare & Medicaid Services. Administers Medicare, Medicaid, and quality programs.
MIPS	Merit-based Incentive Payment System. Adjusts Medicare payments based on quality measure performance (up to ±9%).
PHI	Protected Health Information. Any individually identifiable health information covered by HIPAA.
HIPAA	Health Insurance Portability and Accountability Act (1996). Governs privacy/security of health information.
BAA	Business Associate Agreement. HIPAA-required contract when sharing PHI with a third party.
HCC	Hierarchical Condition Category. Risk adjustment model for Medicare Advantage payments.
GDMT	Guideline-Directed Medical Therapy. Evidence-based treatment per clinical practice guidelines.
SaMD	Software as a Medical Device. FDA classification for software meeting medical device definition.
Bulk FHIR	FHIR Bulk Data Access spec. Async API ($export) for large-volume patient data extraction as NDJSON.
Synthea	Open-source synthetic patient data generator. Creates realistic fictional records in FHIR format.