Da Vinci Risk Adjustment Implementation Guide
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Da Vinci Risk Adjustment Implementation Guide, published by HL7 International / Clinical Quality Information. This guide is not an authorized publication; it is the continuous build for version 3.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-ra/ and changes regularly. See the Directory of published versions

Extension: QualifyingDxCode Extension - Detailed Descriptions

Page standards status: Trial-use Maturity Level: 2

Definitions for the ra-qualifyingDxCode extension

Guidance on how to interpret the contents of this table can be foundhere

0. Extension
Definition

Diagnosis codes classified under a Condition Category as defined by the risk adjustment model. This usually comes into play in the scenario where proprietary risk models are used and the mappings of ICD-10 codes to Condition Categories are not readily available. Note that whether qualifying codes may be included in a report depending may depend on individual Risk Adjustment model licensing agreement.


Optional Extension Element - found in all resources.

ShortQualifying diagnosis code(s)Optional Extensions Element
Comments

This extension represents evidence status of a Condition Category (CC) coding gap, whether there is evidence that supports a Condition Category (CC) coding gap is closed-gap, open-gap, invalid-gap, or pending.

Control0..*
This element is affected by the following invariants: ele-1
Is Modifierfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
2. Extension.url
Definition

Source of the definition for the extension code - a logical name or a URL.

Shortidentifies the meaning of the extension
Comments

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Control1..1
Typeuri
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
XML FormatIn the XML format, this property is represented as an attribute.
Summaryfalse
Fixed Valuehttp://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-qualifyingDxCode
4. Extension.value[x]
Definition

Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

ShortValue of extension
Control0..1
TypeCodeableConcept, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
[x] NoteSeeChoice of Data Typesfor further information about how to use [x]
Is Modifierfalse
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
SlicingThis element introduces a set of slices on Extension.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
  • type @ $this
  • 6. Extension.value[x]:valueCodeableConcept
    Slice NamevalueCodeableConcept
    Definition

    Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

    ShortDiagnosis codes classified under a Condition Category as defined by the risk adjustment modelValue of extension
    Control0..1
    BindingUnless not suitable, these codes SHALL be taken from For codes, see USCoreConditionCodes (7.0.0)
    (extensible to http://hl7.org/fhir/us/core/ValueSet/us-core-condition-code|7.0.0)
    TypeCodeableConcept, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
    Is Modifierfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    8. Extension.value[x]:valueCodeableConcept.extension:codeOptions
    Slice NamecodeOptions
    Definition

    A logical reference (i.e. a reference to ValueSet.url) to a value set (and optionally a version) that identifies a set of possible coded values for the element. This extension is used to convey a list of candidate codes when there is no formal code in the code system already defined that captures the intended set. For example, the concept of COVID preventative medications can be expressed as a value set because there is no specific code representing that concept.

    ShortQualifying diagnosis codes provided as a value set
    Comments

    This extension SHALL NOT be used when an appropriate higher level concept code exists. This extension cannot be used on an element with a required binding. When this extension is used on an element with an extensible binding, the set of possible coded values in the referenced value set SHALL be present in the bound value set unless none of the codes in the bound value set apply to the concept being communicated (based on human review). When this extension appears on a CodeableConcept, the CodeableConcept SHALL have no codings, and the text of the CodeableConcept SHOULD include the title of the referenced value set.

    Control0..1
    TypeExtension(Code Options) (Extension Type: canonical(ValueSet))
    Is Modifierfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())

    Guidance on how to interpret the contents of this table can be foundhere

    0. Extension
    Definition

    Diagnosis codes classified under a Condition Category as defined by the risk adjustment model. This usually comes into play in the scenario where proprietary risk models are used and the mappings of ICD-10 codes to Condition Categories are not readily available. Note that whether qualifying codes may be included in a report depending may depend on individual Risk Adjustment model licensing agreement.

    ShortQualifying diagnosis code(s)
    Comments

    This extension represents evidence status of a Condition Category (CC) coding gap, whether there is evidence that supports a Condition Category (CC) coding gap is closed-gap, open-gap, invalid-gap, or pending.

    Control0..*
    2. Extension.url
    Typeuri
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Fixed Valuehttp://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-qualifyingDxCode
    4. Extension.valueCodeableConcept
    ShortDiagnosis codes classified under a Condition Category as defined by the risk adjustment model
    BindingUnless not suitable, these codes SHALL be taken from USCoreConditionCodes (7.0.0)
    (extensible to http://hl7.org/fhir/us/core/ValueSet/us-core-condition-code|7.0.0)
    TypeCodeableConcept
    6. Extension.valueCodeableConcept.extension:codeOptions
    Slice NamecodeOptions
    ShortQualifying diagnosis codes provided as a value set
    Control0..1
    TypeExtension(Code Options) (Extension Type: canonical(ValueSet))

    Guidance on how to interpret the contents of this table can be foundhere

    0. Extension
    Definition

    Diagnosis codes classified under a Condition Category as defined by the risk adjustment model. This usually comes into play in the scenario where proprietary risk models are used and the mappings of ICD-10 codes to Condition Categories are not readily available. Note that whether qualifying codes may be included in a report depending may depend on individual Risk Adjustment model licensing agreement.

    ShortQualifying diagnosis code(s)
    Comments

    This extension represents evidence status of a Condition Category (CC) coding gap, whether there is evidence that supports a Condition Category (CC) coding gap is closed-gap, open-gap, invalid-gap, or pending.

    Control0..*
    This element is affected by the following invariants: ele-1
    Is Modifierfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    2. Extension.id
    Definition

    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

    ShortUnique id for inter-element referencing
    Control0..1
    Typestring
    Is Modifierfalse
    XML FormatIn the XML format, this property is represented as an attribute.
    Summaryfalse
    4. Extension.extension
    Definition

    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

    ShortAdditional content defined by implementations
    Comments

    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

    Control0..*
    TypeExtension
    Is Modifierfalse
    Summaryfalse
    Alternate Namesextensions, user content
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    SlicingThis element introduces a set of slices on Extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ url
    • 6. Extension.url
      Definition

      Source of the definition for the extension code - a logical name or a URL.

      Shortidentifies the meaning of the extension
      Comments

      The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

      Control1..1
      Typeuri
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      XML FormatIn the XML format, this property is represented as an attribute.
      Summaryfalse
      Fixed Valuehttp://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-qualifyingDxCode
      8. Extension.value[x]
      Definition

      Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

      ShortValue of extension
      Control0..1
      TypeCodeableConcept
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      Is Modifierfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      SlicingThis element introduces a set of slices on Extension.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
      • type @ $this
      • 10. Extension.value[x]:valueCodeableConcept
        Slice NamevalueCodeableConcept
        Definition

        Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

        ShortDiagnosis codes classified under a Condition Category as defined by the risk adjustment model
        Control0..1
        BindingUnless not suitable, these codes SHALL be taken from USCoreConditionCodes (7.0.0)
        (extensible to http://hl7.org/fhir/us/core/ValueSet/us-core-condition-code|7.0.0)
        TypeCodeableConcept
        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        12. Extension.value[x]:valueCodeableConcept.id
        Definition

        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

        ShortUnique id for inter-element referencing
        Control0..1
        Typestring
        Is Modifierfalse
        XML FormatIn the XML format, this property is represented as an attribute.
        Summaryfalse
        14. Extension.value[x]:valueCodeableConcept.extension
        Definition

        May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

        ShortAdditional content defined by implementations
        Comments

        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

        Control0..*
        TypeExtension
        Is Modifierfalse
        Summaryfalse
        Alternate Namesextensions, user content
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        SlicingThis element introduces a set of slices on Extension.value[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • 16. Extension.value[x]:valueCodeableConcept.extension:codeOptions
          Slice NamecodeOptions
          Definition

          A logical reference (i.e. a reference to ValueSet.url) to a value set (and optionally a version) that identifies a set of possible coded values for the element. This extension is used to convey a list of candidate codes when there is no formal code in the code system already defined that captures the intended set. For example, the concept of COVID preventative medications can be expressed as a value set because there is no specific code representing that concept.

          ShortQualifying diagnosis codes provided as a value set
          Comments

          This extension SHALL NOT be used when an appropriate higher level concept code exists. This extension cannot be used on an element with a required binding. When this extension is used on an element with an extensible binding, the set of possible coded values in the referenced value set SHALL be present in the bound value set unless none of the codes in the bound value set apply to the concept being communicated (based on human review). When this extension appears on a CodeableConcept, the CodeableConcept SHALL have no codings, and the text of the CodeableConcept SHOULD include the title of the referenced value set.

          Control0..1
          TypeExtension(Code Options) (Extension Type: canonical(ValueSet))
          Is Modifierfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          18. Extension.value[x]:valueCodeableConcept.coding
          Definition

          A reference to a code defined by a terminology system.

          ShortCode defined by a terminology system
          Comments

          Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

          Control0..*
          TypeCoding
          Is Modifierfalse
          Summarytrue
          Requirements

          Allows for alternative encodings within a code system, and translations to other code systems.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          20. Extension.value[x]:valueCodeableConcept.text
          Definition

          A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

          ShortPlain text representation of the concept
          Comments

          Very often the text is the same as a displayName of one of the codings.

          Control0..1
          Typestring
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Requirements

          The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))