Da Vinci - Coverage Requirements Discovery
2.2.0-snapshot - STU 2.2 Peer Review

Da Vinci - Coverage Requirements Discovery, published by HL7 International / Financial Management. This guide is not an authorized publication; it is the continuous build for version 2.2.0-snapshot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-crd/ and changes regularly. See the Directory of published versions

## ValueSet: CRD Coverage Information Documentation Reason Value Set

Official URL: http://hl7.org/fhir/us/davinci-crd/ValueSet/DocReason | Version: 2.2.0-snapshot | Highlight text changes?
Standards status: Trial-use Active as of 2026-02-19 | Maturity Level: 1 | Computable Name: CRDDocReason
Other Identifiers: OID:2.16.840.1.113883.4.642.40.18.48.3

List of reasons for additional documentation

References

- Coverage Information

### Logical Definition (CLD)

This value set includes codes based on the following rules:

- Include these codes as defined in `http://hl7.org/fhir/us/davinci-crd/CodeSystem/coverage-information-codes` version 📦2.2.0-snapshot

  Code | Display | Definition
  withpa | Include in prior authorization | The information in this QuestionnaireResponse should be packaged into a Bundle and submitted as part of (or in association with) a prior authorization for the associated request resource(s).
  withclaim | Include with claim | The information in this QuestionnaireResponse should be packaged into a Bundle and submitted as part of (or in association with) the insurance claim for the services ordered by the associated request resource(s).
  withorder | Include with order | The information in this QuestionnaireResponse should be packaged into a Bundle and submitted along with (or referenced as supporting information to) the associated request resource(s) when transmitting the order to the fulfilling system.
  retain-doc | Medical necessity | The information in this QuestionnaireResponse should be retained within the EHR as supporting evidence of the medical necessity of the associated request resource(s).

- Include these codes as defined in `http://terminology.hl7.org/CodeSystem/v3-NullFlavor` version 📍3.0.0

  Code | Display | Definition
  OTH | other | **Description:**The actual value is not a member of the set of permitted data values in the constrained value domain of a variable. (e.g., concept not provided by required code system). **Usage Notes**: This flavor and its specializations are most commonly used with the CD datatype and its flavors. However, it may apply to \*any\* datatype where the constraints of the type are tighter than can be conveyed. For example, a PQ that is for a true measured amount whose units are not supported in UCUM, a need to convey a REAL when the type has been constrained to INT, etc. With coded datatypes, this null flavor may only be used if the vocabulary binding has a coding strength of CNE. By definition, all local codes and original text are part of the value set if the coding strength is CWE.

### Expansion

Expansion performed internally based on:

- codesystem Coverage Information Codes v2.2.0-snapshot (CodeSystem)
- codesystem NullFlavor v3.0.0 (CodeSystem)

This value set contains 5 concepts

System | Code | Display (en) | Definition | JSON | XML
`http://hl7.org/fhir/us/davinci-crd/CodeSystem/coverage-information-codes` | withpa | Include in prior authorization | The information in this QuestionnaireResponse should be packaged into a Bundle and submitted as part of (or in association with) a prior authorization for the associated request resource(s). |  |
`http://hl7.org/fhir/us/davinci-crd/CodeSystem/coverage-information-codes` | withclaim | Include with claim | The information in this QuestionnaireResponse should be packaged into a Bundle and submitted as part of (or in association with) the insurance claim for the services ordered by the associated request resource(s). |  |
`http://hl7.org/fhir/us/davinci-crd/CodeSystem/coverage-information-codes` | withorder | Include with order | The information in this QuestionnaireResponse should be packaged into a Bundle and submitted along with (or referenced as supporting information to) the associated request resource(s) when transmitting the order to the fulfilling system. |  |
`http://hl7.org/fhir/us/davinci-crd/CodeSystem/coverage-information-codes` | retain-doc | Medical necessity | The information in this QuestionnaireResponse should be retained within the EHR as supporting evidence of the medical necessity of the associated request resource(s). |  |
`http://terminology.hl7.org/CodeSystem/v3-NullFlavor` | OTH | other | **Description:**The actual value is not a member of the set of permitted data values in the constrained value domain of a variable. (e.g., concept not provided by required code system). Usage Notes: This flavor and its specializations are most commonly used with the CD datatype and its flavors. However, it may apply to *any* datatype where the constraints of the type are tighter than can be conveyed. For example, a PQ that is for a true measured amount whose units are not supported in UCUM, a need to convey a REAL when the type has been constrained to INT, etc. With coded datatypes, this null flavor may only be used if the vocabulary binding has a coding strength of CNE. By definition, all local codes and original text are part of the value set if the coding strength is CWE. |  |

Description of the above table(s).