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

## : CRD Coverage Information Documentation Reason Value Set

Page standards status: Trial-use | Maturity Level: 1

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    @prefix fhir: <http://hl7.org/fhir/> .
    @prefix owl: <http://www.w3.org/2002/07/owl#> .
    @prefix rdf: <http://www.w3.org/1999/02/22-rdf-syntax-ns#> .
    @prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
    @prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

    # - resource -------------------------------------------------------------------

     a fhir:ValueSet ;
      fhir:nodeRole fhir:treeRoot ;
      fhir:id [ fhir:v "DocReason"] ; #
      fhir:language [ fhir:v "en"] ; #
      fhir:text [
    fhir:status [ fhir:v "extensions" ] ;
    fhir:div [ fhir:v "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: ValueSet DocReason</b></p><a name=\"DocReason\"> </a><a name=\"hcDocReason\"> </a><p>This value set includes codes based on the following rules:</p><ul><li>Include these codes as defined in <a href=\"CodeSystem-coverage-information-codes.html\"><code>http://hl7.org/fhir/us/davinci-crd/CodeSystem/coverage-information-codes</code></a><span title=\"Version is not explicitly stated, which means it is fixed to the version provided in this specification\"> version ?2.2.0-snapshot</span><table class=\"none\"><tr><td style=\"white-space:nowrap\"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td><a href=\"CodeSystem-coverage-information-codes.html#coverage-information-codes-withpa\">withpa</a></td><td style=\"color: #cccccc\">Include in prior authorization</td><td>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).</td></tr><tr><td><a href=\"CodeSystem-coverage-information-codes.html#coverage-information-codes-withclaim\">withclaim</a></td><td style=\"color: #cccccc\">Include with claim</td><td>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).</td></tr><tr><td><a href=\"CodeSystem-coverage-information-codes.html#coverage-information-codes-withorder\">withorder</a></td><td style=\"color: #cccccc\">Include with order</td><td>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.</td></tr><tr><td><a href=\"CodeSystem-coverage-information-codes.html#coverage-information-codes-retain-doc\">retain-doc</a></td><td style=\"color: #cccccc\">Medical necessity</td><td>The information in this QuestionnaireResponse should be retained within the EHR as supporting evidence of the medical necessity of the associated request resource(s).</td></tr></table></li><li>Include these codes as defined in <a href=\"http://terminology.hl7.org/7.0.1/CodeSystem-v3-NullFlavor.html\"><code>http://terminology.hl7.org/CodeSystem/v3-NullFlavor</code></a><span title=\"Version is explicitly stated to be 3.0.0\"> version ?3.0.0</span><table class=\"none\"><tr><td style=\"white-space:nowrap\"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td><a href=\"http://terminology.hl7.org/7.0.1/CodeSystem-v3-NullFlavor.html#v3-NullFlavor-OTH\">OTH</a></td><td style=\"color: #cccccc\">other</td><td>**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).<br/><br/>**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.<br/><br/>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.</td></tr></table></li></ul></div>"^^rdf:XMLLiteral ]
      ] ; #
      fhir:extension ( [
    fhir:url [
    fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm>     ] ;
    fhir:value [
    a fhir:Integer ;
    fhir:v 1     ]
      ] [
    fhir:url [
    fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/StructureDefinition/structuredefinition-wg>     ] ;
    fhir:value [
    a fhir:Code ;
    fhir:v "fm"     ]
      ] [
    fhir:url [
    fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status>     ] ;
    fhir:value [
    a fhir:Code ;
    fhir:v "trial-use" ;
          ( fhir:extension [
    fhir:url [
    fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom>         ] ;
    fhir:value [
    a fhir:Canonical ;
    fhir:v "http://hl7.org/fhir/us/davinci-crd/ImplementationGuide/davinci-crd"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/us/davinci-crd/ImplementationGuide/davinci-crd>         ]       ] )     ]
      ] ) ; #
      fhir:url [
    fhir:v "http://hl7.org/fhir/us/davinci-crd/ValueSet/DocReason"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/us/davinci-crd/ValueSet/DocReason>
      ] ; #
      fhir:identifier ( [
    fhir:system [
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    fhir:l <urn:ietf:rfc:3986>     ] ;
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      ] ) ; #
      fhir:version [ fhir:v "2.2.0-snapshot"] ; #
      fhir:name [ fhir:v "CRDDocReason"] ; #
      fhir:title [ fhir:v "CRD Coverage Information Documentation Reason Value Set"] ; #
      fhir:status [ fhir:v "active"] ; #
      fhir:experimental [ fhir:v false] ; #
      fhir:date [ fhir:v "2026-02-19T15:54:35+00:00"^^xsd:dateTime] ; #
      fhir:publisher [ fhir:v "HL7 International / Financial Management"] ; #
      fhir:contact ( [
        ( fhir:telecom [
    fhir:system [ fhir:v "url" ] ;
    fhir:value [ fhir:v "http://www.hl7.org/Special/committees/fm" ]     ] )
      ] ) ; #
      fhir:description [ fhir:v "List of reasons for additional documentation"] ; #
      fhir:jurisdiction ( [
        ( fhir:coding [
    fhir:system [
    fhir:v "urn:iso:std:iso:3166"^^xsd:anyURI ;
    fhir:l <urn:iso:std:iso:3166>       ] ;
    fhir:code [ fhir:v "US" ]     ] )
      ] ) ; #
      fhir:compose [
        ( fhir:include [
    fhir:system [
    fhir:v "http://hl7.org/fhir/us/davinci-crd/CodeSystem/coverage-information-codes"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/us/davinci-crd/CodeSystem/coverage-information-codes>       ] ;
          ( fhir:concept [
    fhir:code [ fhir:v "withpa" ]       ] [
    fhir:code [ fhir:v "withclaim" ]       ] [
    fhir:code [ fhir:v "withorder" ]       ] [
    fhir:code [ fhir:v "retain-doc" ]       ] )     ] [
    fhir:system [
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    fhir:l <http://terminology.hl7.org/CodeSystem/v3-NullFlavor>       ] ;
    fhir:version [ fhir:v "3.0.0" ] ;
          ( fhir:concept [
    fhir:code [ fhir:v "OTH" ]       ] )     ] )
      ] . #