minimal Common Oncology Data Elements (mCODE) Implementation Guide
4.0.0-ballot - STU4 Release United States of America flag

minimal Common Oncology Data Elements (mCODE) Implementation Guide, published by HL7 International / Clinical Interoperability Council. This guide is not an authorized publication; it is the continuous build for version 4.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-mCODE-ig/ and changes regularly. See the Directory of published versions

Artifacts Summary

This page provides a list of the FHIR artifacts defined as part of this implementation guide.

Behavior: Capability Statements

The following artifacts define the specific capabilities that different types of systems are expected to have in order to comply with this implementation guide. Systems conforming to this implementation guide are expected to declare conformance to one or more of the following capability statements.

mCODE Data Receiver CapabilityStatement: Get in-scope patients (and associated Conditions) using _include

Uses _include to retrieve a Bundle of Condition resources with a code in mCODE’s cancer condition value set, along with the associated Patient resources. Use ONLY when reverse chaining is not available on the system.

mCODE Data Receiver CapabilityStatement: Get in-scope patients using reverse chaining

Uses reverse chaining to retrieve a Bundle of Patient resources with a condition code in mCODE’s cancer condition value set.

mCODE Data Receiver: Get Bundle for a Patient

Gets an mCODE Patient Bundle for a specific patient that contains all of that patient’s resources that conform to mCODE Profiles.

mCODE Data Receiver: Get Conditions then Patients

Retrieves a Bundle of Condition resources with a code in mCODE’s cancer condition value set, and allows for associated Patient resources to be retrieved in a subsequent request. Use ONLY when reverse chaining AND _include are not available on the system.

mCODE Data Receiver: Get Patients in Group

Capabilities for an mCODE Data Receiver where not all cancer patients conform to mCODE. Retrieves a Group of references to Patient resources that conform to mCODE, and allows for the full Patient resources to be retrieved in a subsequent request.

mCODE Data Sender CapabilityStatement: Get in-scope patients (and associated Conditions) using _include

Uses _include to retrieve a Bundle of Condition resources with a code in mCODE’s cancer condition value set, along with the associated Patient resources. Use ONLY when reverse chaining is not available on the system.

mCODE Data Sender CapabilityStatement: Get in-scope patients using reverse chaining

Uses reverse chaining to retrieve a Bundle of Patient resources with a condition code in mCODE’s cancer condition value set.

mCODE Data Sender: Get Bundle for a Patient

Retrieves a Bundle of Condition resources with a code in mCODE’s cancer condition value set, and allows for associated Patient resources to be retrieved in a subsequent request. Use ONLY when reverse chaining AND _include are not available on the system.

mCODE Data Sender: Get Conditions then Patients

Retrieves a Bundle of Condition resources with a code in mCODE’s cancer condition value set, and allows for associated Patient resources to be retrieved in a subsequent request. Use ONLY when reverse chaining AND _include are not available on the system.

mCODE Data Sender: Get Patients in Group

Capabilities for an mCODE Data Sender where not all cancer patients conform to mCODE. Retrieves a Group of references to Patient resources that conform to mCODE, and allows for the full Patient resources to be retrieved in a subsequent request.

Behavior: Operation Definitions

These are custom operations that can be supported by and/or invoked by systems conforming to this implementation guide.

Fetch mCODE Patient Bundle for a given Patient

Gets an mCODE Patient Bundle for a specific patient that contains all of that patient’s resources that conform to mCODE Profiles.

Behavior: Search Parameters

These define the properties by which a RESTful server can be searched. They can also be used for sorting and including related resources.

Search by code:in in Conditions

This SearchParameter enables query of conditions by code with the in modifier.

Structures: Abstract Profiles

These are profiles on resources or data types that describe patterns used by other profiles, but cannot be instantiated directly. I.e. instances can conform to profiles based on these abstract profiles, but do not declare conformance to the abstract profiles themselves.

Cancer Risk Assessment Profile

Parent profile for observations regarding cancer risk assessment. Risk assessment is a process used to estimate the risk that a certain event will happen. In medicine, this may include a person’s risk of having a child with a certain condition or disease, such as cancer. It may also be used to estimate the risk of carrying a certain gene mutation (change), or of having an adverse event (unexpected medical problem) in response to certain types of drugs or other substances. A risk assessment may be done by collecting information about a person’s age, sex, personal and family medical history, ethnic background, lifestyle, and other factors and using statistics tools to calculate risk (Definition from: NCI Dictionary of Cancer Terms).

The key elements are the code, method, value, and optionally, prognostic factors referenced in the hasMember element.

Cancer Stage Profile

Parent profile for observations regarding cancer stage, grade, or classification. The stage is an assessment of the extent of the cancer in the body, according to a given cancer staging classification system. Profiles for different staging systems (e.g., TNM stage group, Rai stage, FIGO stage, etc.) must derive from this profile.

Despite its name, the CancerStage profile can also be used as a parent for cancer grade or classification. This is because the structure of the profiles are the same or very similar. The key elements are the code, method, value, and optionally, prognostic factors referenced in the hasMember element.

Parent for T, N, and M Categories.

Parent profile for T, N, and M category profiles.

Structures: Resource Profiles

These define constraints on FHIR resources for systems conforming to this implementation guide.

ALL Risk Assessment Profile

Risk assessment for acute lymphoblastic leukemia (ALL).

Body Surface Area

Entire body surface area, either measured or calculated.

CLL Binet Stage Profile

Binet stage for chronic lymphocytic leukemia (CLL)

CLL Rai Stage Profile

Rai stage for chronic lymphocytic leukemia (CLL)

Cancer Disease Status Profile

A clinician’s qualitative judgment on the current trend of the cancer, e.g., whether it is stable, worsening (progressing), or improving (responding). The judgment may be based a single type or multiple kinds of evidence, such as imaging data, assessment of symptoms, tumor markers, laboratory data, etc.

Cancer Patient Profile

A patient who has been diagnosed with or is receiving medical treatment for a malignant growth or tumor. The only difference between CancerPatient and US Core Patient is that Patient.deceased is a must-support element in mCODE. Must-support is an instruction to implementers of FHIR clients and servers, rather than a constraint on data structure. Any Patient resource complying with US Core Patient Profile will also comply with CancerPatient.

Cancer-Related Medication Administration Profile

An episode of medication administration for a patient whose condition is related to a primary or secondary cancer condition. In the context of chemotherapy drugs, the medication administration in most cases is performed and documented by the provider.

Cancer-Related Medication Request Profile

A record of a medication prescription or consumption associated with cancer treatment. The medication may reported by the prescriber, prescribing organization, or patient. It does not have to be directly observed.

Cancer-Related Surgical Procedure Profile

A surgical action addressing a cancer condition. The scope of this profile has been narrowed to cancer-related procedures by constraining the reasonReference and reasonCode to cancer conditions, one of which is required.

Comorbidities Profile

General structure for capturing comorbid conditions with respect to a primary (‘index’) condition. The user can use this profile in three ways: (1) free-form, listing any conditions they wish to highlight as significant comorbidities, (2) following a formal paradigm such as the Charlson Comorbidity Index or the NCI Comorbidity Index, or (3) use disease categories defined for registry reporting purposes, such as those defined by Center for International Blood and Marrow Transplant Research (CIBMTR).

Deauville Scale Profile

Profile for Deauville Scale. A 5 point scale devised to assess the response to treatment of Hodgkin and aggressive Non-Hodgkin lymphoma.

ECOG Performance Status Profile

The Eastern Cooperative Oncology Group (ECOG) Performance Status represents the patient’s functional status and is used to determine their ability to tolerate therapies in serious illness, specifically for chemotherapy. (Definition from: LOINC)

Genomic Region Studied Profile

A subset of genes or genomic regions of interest in a targeted resequencing study.

Genomic Variant Profile

Details about a set of changes in the tested sample compared to a reference sequence. The term variant can be used to describe an alteration that may be benign, pathogenic, or of unknown significance. The term variant is increasingly being used in place of the term mutation. Variants can be computed relative to reference sequence assembly from which it was identified.

Genomics Report Profile

Genomic analysis summary report. The report may include one or more tests, with two distinct test types. The first type is a targeted mutation test, where a specific mutation on a specific gene is tested for. The result is either positive or negative for that mutation. The second type is a more general test for variants. This type of test returns the identity of variants found in a certain region of the genome.

Gynecologic Tumor FIGO Stage Profile

Gynecologic tumor stage by International Federation of Gynecology and Obstetrics (FIGO) Staging System

Histologic Behavior and Type

Histologic behavior and type determined from examination of tumor sample. ICD-O-3 morphology codes are referenced in the logical definition but not expanded in the value set for intellectual property reasons. For primary cancers, the ICD-O-3 behavior suffix should be /1, /2, or /3. For secondary cancers, the ICD-O-3 behavior suffix should be /6.

Histologic Grade

Histologic grade determined from examination of tumor sample.

History of Metastatic Cancer

Records the existence of a past episode of metastatic cancer, for the purpose of long term management and tracking.

Human Specimen Profile

A specimen taken from a Patient for the purpose of oncology-related testing. The profile includes extensions to specify a more precise body site and an identifier of source body structure at that site (for example, a tumor identifier).

Karnofsky Performance Status Profile

The Karnofsky Performance Status (KPS) is a tool used to measure a patient’s functional status. It can be used to compare the effectiveness of different therapies and to help assess the prognosis of certain patients, such as those with certain cancers. The KPS score ranges from 0 to 100 in intervals of 10. Higher scores are associated with better functional status, with 100 representing no symptoms or evidence of disease, and 0 representing death.

Lansky Play Performance Status Profile

The Lansky Play-Performance Status for children is a parent-rated instrument which records usual play activity as the index of performance. It is similar to the Karnofsky Performance Scale for adults (Definition from: NCI Thesaurus).

Lymphoma Stage Profile

Staging of lymphoma (both Hodgkins and Non-Hodgkins) by Ann Arbor, Cotswold, or Lugano staging systems. The method (required) indicates which of these related staging systems was used.

Melanoma Breslow Depth Stage Profile

Breslow depth stage for melanoma of the skin

Melanoma Clark Level Profile

Clark level for melanoma

Myeloma ISS Stage Profile

Myeloma Stage by International Staging System (ISS)

Myeloma RISS Stage Profile

Myeloma Stage by Revised International Staging System (RISS)

Neuroblastoma INRGSS Stage Profile

International Neuroblastoma Risk Group Staging System (INRGSS) for neuroblastoma.

Neuroblastoma INSS Stage Profile

The International Neuroblastoma Staging System (INSS) stage for neuroblastoma.

Primary Cancer Condition Profile

Records the the primary cancer condition, the original or first neoplasm in the body (Definition from: NCI Dictionary of Cancer Terms). Cancers that are not clearly secondary (i.e., of uncertain origin or behavior) should be documented as primary.

Prostate Gleason Grade Group Profile

Gleason Grade Group for prostatic cancer

Radiotherapy Course Summary Profile

A summary of a course of radiotherapy delivered to a patient. It records the treatment intent, termination reason, modalities, techniques, number of sessions, and doses delivered to one or more body volumes. Whether the course has been fully delivered or stopped is indicated in the status element.

Radiotherapy Volume Profile

A volume of the body used in radiotherapy planning or treatment delivery.

Rhabdomyocaroma Clinical Group Stage Profile

Clinical stage group for rhabdomyocaroma.

Rhabdomyocaroma Risk Assessment Profile

Risk assessment for rhabdomyocaroma. The assessment is based on three things - TNM stage, clinical group, and whether cancer cells have a PAX/FOX01 fusion gene.

Secondary Cancer Condition Profile

Records the history of secondary neoplasms, including location(s) and the date of onset of metastases. A secondary cancer results from the spread (metastasization) of cancer from its original site (Definition from: NCI Dictionary of Cancer Terms).

TNM Distant Metastases Category Profile

Category describing the extent of a tumor metastasis in remote anatomical locations, based on evidence such as physical examination, imaging, and/or biopsy.

TNM Primary Tumor Category Profile

Category of the primary tumor, based on its size and extent, based on evidence such as physical examination, imaging, and/or biopsy.

TNM Regional Nodes Category Profile

Category of the presence or absence of metastases in regional lymph nodes, based on evidence such as physical examination, imaging, and/or biopsy.

TNM Stage Group Profile

Reporting of the stage group representing the overall extent of a cancer, based on AJCC staging guidelines.

Tumor Marker Test Profile

The result of a tumor marker test. Tumor marker tests are generally used to guide cancer treatment decisions and monitor treatment, as well as to predict the chance of recovery and cancer recurrence.

Tumor Morphology Report

ICD-O-3 morphology determined from examination of tumor sample, composed of three parts: histologic type, the malignant potential of the tumor (behavior) and the tumor grade (degree of differentiation).

Tumor Profile

Identifies a tumor that has not been removed from the body. Whenever possible, a single resource conforming to this profile will be used to track a tumor over time (as opposed to creating new Tumor-conforming BodyStructure resources each time that tumor is measured). Use HumanSpecimen to represent the tumor after removal from the body. Note that the required code for morphology used in STU2 is now inactive. A new code has been specified and SHOULD be used, but the old code remains conformant.

Tumor Size Profile

Records the dimensions of a tumor

Wilms Tumor Stage Profile

Wilms Tumors (nephroblastoma) Stage by the National Wilms Tumor Study Group.

mCODE Patient Bundle Profile

A collection of data for an mCODE cancer patient.

mCODE Patient Group Profile

A group of patients included in the scope of mCODE, whose cancer-related resources conform to mCODE profiles.

Structures: Data Type Profiles

These define constraints on FHIR data types for systems conforming to this implementation guide.

Body Structure Identifier Profile

An identifier that designates a body structure such as a tumor and can be used for tracking the structure over time.

Structures: Extension Definitions

These define constraints on FHIR data types for systems conforming to this implementation guide.

Body Location Qualifier Extension

Qualifier to refine an body location. These include qualifiers for relative location, directionality, number, and plane, and exclude qualifiers for laterality.

Cancer Disease Status Evidence Type Extension

Categorization of the kind of evidence contributing to a clinical judgment on cancer disease progression.

Histology-Morphology-Behavior Extension

An extension describing the morphologic and behavioral characteristics of the cancer.

Laterality Qualifier Extension

Qualifier to specify laterality.

Normalization Basis Extension

How the drug dosage was normalized.

Procedure Intent Extension

The purpose of a treatment, medication, or procedure.

Radiotherapy Dose Delivered To Volume Extension

Dose delivered to a given radiotherapy volume.

Radiotherapy Modality And Technique Extension

Extension capturing modality and technique of a given radiotherapy procedure. The allowed combinations of modality and technique are constrained by invariants, one per modality.

Radiotherapy Modality Extension

Extension capturing a modality of external beam or brachytherapy radiation procedures.

Radiotherapy Number of Sessions Extension

The number of sessions in a course of radiotherapy.

Radiotherapy Technique Extension

Extension capturing a technique of external beam or brachytherapy radiation procedures.

Related Condition Absent Extension

A condition that is NOT present, related to the resource.

Related Condition Extension

A condition that has a relationship with the resource.

Treatment Termination Reason Extension (deprecated)

A code explaining the unplanned or premature termination, or normal completion, of a plan of treatment, course of medication, or research study. This extension is deprecated since it is redundant with the statusReason field.

Terminology: Value Sets

These define sets of codes used by systems conforming to this implementation guide.

Acute Lymphoblastic Leukemia (ALL) Risk Assessment Value Set

Codes in the ALL risk assessment system.

Benign Neoplasm of Brain and CNS Disorder Value Set

Types of benign neoplasms and neoplasms of uncertain behavior of the brain and central nervous system, coded in SNOMED CT or ICD-10-CM.

Binet Stage Value Set

Codes in the Binet staging system representing Chronic Lymphocytic Leukemia (CLL) stage.

Body Location Qualifier Value Set

Qualifiers to refine a body structure or location including qualifiers for relative location, directionality, number, and plane, and excluding qualifiers for laterality.

Body Location and Laterality Qualifier Value Set

Qualifiers to refine a body structure or location including qualifiers for relative location, directionality, number, plane, and laterality.

Brachytherapy High Dose Rate Electronic Technique Value Set

Allowed techniques for brachytherapy modality High Dose Rate electronic

Brachytherapy High Dose Rate Technique Value Set

Allowed techniques for brachytherapy modality High Dose Rate

Brachytherapy Low Dose Rate Temporary Radation Technique Value Set

Allowed techniques for brachytherapy modality Low Dose Rate using temporary radiation source

Brachytherapy Modality Value Set

Codes describing the modalities of brachytherapy procedures.

Brachytherapy Permanent Seeds Technique Value Set

Allowed techniques for brachytherapy modality internal radiotherapy - permanent seeds

Brachytherapy Pulsed Dose Rate Technique Value Set

Allowed techniques for brachytherapy modality Pulsed Dose Rate

Brachytherapy Radiopharmaceutical Technique Value Set

Allowed techniques for brachytherapy modality radiopharmaceutical

Brachytherapy Technique Value Set

Codes describing the techniques of brachytherapy (internal or surface radiation) procedures.

Breslow Depth Stage Value Set

Codes in the Breslow staging system representing melanoma depth.

Cancer Body Location Value Set

Codes describing the location(s) of primary or secondary cancer. The value set includes all codes from the SNOMED CT body structure hierarchy (codes descending from 123037004 ‘Body Structure’). The cancer body location may also be expressed using ICD-O-3 topography codes, however, those codes are not included here due to intellectual property restrictions. These topography terms have four-character codes that run from C00.0 to C80.9 ref. Only SNOMED CT and ICD-O-3 are considered conformant.

Cancer Disease Status Evidence Type Value Set

The type of evidence backing up the clinical determination of cancer progression.

Cancer Disorder Value Set

A broad cancer-related value set containing both primary and secondary tumor types, with codes from ICD-10 and SNOMED CT, including both diagnosis and histology/morphology/behavior codes. ICD-O-3 morphology codes may also be used and are considered conformant to the specification. For SNOMED, the value set includes all codes descending from 363346000 ‘Malignant neoplastic disease (disorder)’ and 108369006 ‘Neoplasm (morphologic abnormality)’.

Cancer Stage Type Value Set

Codes that identify the kind of stage reported in an Observation, necessary to correctly interpret the value associated with a staging Observation. In terms of the SNOMED CT hierarchy, these codes represent observable entities. If the staging system used to determine the stage is not implicit in this code, the staging system must be separately recorded in Observation.method. More specific staging profiles, if available, should be consulted before determining the correct code.

Cancer Stage Value Set

A non-exhaustive value set containing codes that result from cancer staging, i.e., the stage or category of the cancer.

Cancer Staging Method Value Set

Staging system or method used for staging cancers. The terms in this value set describe staging systems, not specific stages or descriptors used within those systems.

Cancer-Related Surgical Procedure Value Set

Includes surgical procedure codes from SNOMED CT, ICD-10-PCS and CPT. The value set may be a superset of cancer surgery codes, but narrowing the set further risks eliminating potentially useful and relevant codes.

Carbon Ion Beam Technique Value Set

Allowed techniques for carbon ion beam modality

Carcinoma In-Situ Disorder Value Set

Types of carcinoma in-situ, coded in SNOMED CT or ICD-10-CM.

Clark Level Value Set

Levels for Clark staging of melanoma

Clinical or Pathologic Modifier

Stage value modifier indicating if staging was based on clinical or pathologic evidence.

Condition Status Trend Maximum Value Set

Like the ConditionStatusTrendVS, but includes two additional deprecated codes. Codes from the SNOMED CT disorder hierarchy were less than ideal because the value of an Observation should be either a finding or a qualifier (see https://confluence.ihtsdotools.org/display/FHIR/Observation+binding for details).

Condition Status Trend Value Set

How patient’s given disease, condition, or ability is trending.

Cytologic Evidence of Malignancy Value Set

Types of cytological evidence of malignancy, coded in SNOMED CT or ICD-10-CM.

Deauville Scale Value Set

Codes indicating the value of the Deauville assessment.

Electron Beam Technique Value Set

Allowed techniques for electron beam modality

FAB Classification Value

French American British classification for acute myeloid leukemias, acute lymphoblastic leukemias, and myelodysplastic syndromes.

FIGO Stage Value Set

Values for International Federation of Gynecology and Obstetrics (FIGO) Staging System.

FIGO Staging Method Value Set

Staging methods from International Federation of Gynecology and Obstetrics (FIGO).

Gleason Grade Value Set

Gleason grade for prostatic cancer, with values that explicitly reference the Gleason score.

Histologic Behavior and Type Value Set

A description of a tumor based on how abnormal the cancer cells and tissue look under a microscope and how quickly the cancer cells are likely to grow and spread.

Histologic Grade Value Set

A description of a tumor based on how abnormal the cancer cells and tissue look under a microscope.

Histologic Grading System Value Set

A description of a tumor based on how abnormal the cancer cells and tissue look under a microscope and how quickly the cancer cells are likely to grow and spread.

Histology Morphology Behavior Value Set

Codes representing the structure, arrangement, and behavioral characteristics of malignant neoplasms, and cancer cells. Inclusion criteria: in situ neoplasms and malignant neoplasms. Exclusion criteria: benign neoplasms and neoplasms of unspecified behavior. Note: ICD-O-3 morphology codes are referenced in the logical definition but not expanded in the value set for intellectual property reasons. For primary cancers, the ICD-O-3 behavior suffix should be /1, /2, or /3. For secondary cancers, the ICD-O-3 behavior suffix should be /6.

History of Metastatic Malignant Neoplasm Value Set

Values defining history of metastatic cancer.

Human Specimen Type Value Set

Specimen taken from a human subject. The values include the subset of codes in the HL7 Specimen Type code system (https://terminology.hl7.org/CodeSystem-v2-0487.html) representing body sites and body fluids likely to be used in tumor marker or genomic testing. The most specific term available should be used, for example, for arterial blood, use #BLDA not #BLD.

International Neuroblastoma Risk Group Staging System (INRGSS) for Neuroblastoma Risk Assessment Value Set

Codes in the INRGSS system representing neuroblastoma stage.

International Neuroblastoma Staging System (INSS) for Neuroblastoma Stage Value Set

Codes in INSS staging system representing neuroblastoma stage.

International Staging System (ISS) for Myeloma Stage Value Set

Codes in ISS staging system representing plasma cell or multiple myeloma stage.

Lansky Play Performance Status VS

Value set for Lansky Play-Performance performance status.

Laterality Qualifier Value Set

Qualifiers to specify laterality.

Lymphoma Stage Bulky Modifier Value Set

Bulky modifier indicating if the lymphoma has the presence of bulky disease.

Lymphoma Stage Value Modifier Value Set

Staging modifiers indicating symptoms and extent for lymphomas.

Lymphoma Stage Value Set

Stage values used in lymphoma staging systems.

Lymphoma Staging System Value Set

Staging Systems used to stage lymphomas (Hodgkin’s and non-Hodgkin’s).

Melanoma In-Situ Disorder Value Set

Types of melanoma in-situ, coded in SNOMED CT or ICD-10-CM.

Neutron Beam Technique Value Set

Allowed techniques for neutron beam modality

Normalization Basis Value Set

Normalization basis values.

Photon Beam Technique Value Set

Allowed techniques for photon beam modality

Primary Cancer Disorder Value Set

Types of primary malignant neoplastic disease, coded in SNOMED CT or ICD-10-CM.

Primary Malignant Neoplasm Disorder Value Set

Types of primary malignant neoplasms, coded in SNOMED CT or ICD-10-CM.

Procedure Intent Value Set

The purpose of a procedure.

Proton Beam Technique Value Set

Allowed techniques for proton beam modality

Radiotherapy Modality Value Set

Codes describing the modalities of external beam and brachytherapy radiation procedures, for use with radiotherapy summaries. This value set is the union of the teleradiotherapy and brachytherapy modality value sets.

Radiotherapy Technique Value Set

Codes describing the techniques of external beam and brachytherapy radiation procedures, for use with radiotherapy summaries. This is the union of the EBRT and brachytherapy technique value sets.

Radiotherapy Treatment Location Qualifier Value Set

Various modifiers that can be applied to body locations where radiotherapy treatments can be directed.

Radiotherapy Treatment Location Value Set

Codes describing the body locations where radiotherapy treatments can be directed. Based on TG263.

Radiotherapy Volume Type Value Set

Codes describing the types of body volumes used in radiotherapy planning and treatment. The value set includes the most common codes from DICOM CID 9534 Radiotherapy Targets (UID 1.2.840.10008.6.1.1244) and adds a code for Organs at Risk (OAR).

Rai Stage Value Set

Codes in the Rai staging system representing Chronic Lymphocytic Leukemia (CLL) stage.

Rai Staging System Value Set

Rai Staging Systems used to stage chronic lymphocytic leukemia (CLL).

Revised International Staging System (ISS) for Multiple Myeloma Stage Value Set

Codes in RISS staging system representing plasma cell or multiple myeloma stage.

Rhabdomyosarcoma Assessment Value Set

Codes in the Rhabdomyosarcoma risk assessment system.

Rhabdomyosarcoma Clinical Group Value

Intergroup code indicating whether the rhabdomyosarcoma is confined to its primary location or has extended beyond the site of origin.

Risk Assessment Type Value Set

Codes that identify the kind of risk assessment reported in an Observation, necessary to correctly interpret the value associated with a risk assessment Observation. In terms of the SNOMED CT hierarchy, these codes represent observable entities. If the staging system used to determine the stage is not implicit in this code, the staging system must be separately recorded in Observation.method. More specific risk assessment profiles, if available, should be consulted before determining the correct code.

Risk Assessment Value Set

A non-exhaustive value set containing codes that result from risk assessments, i.e., the risk level of the cancer.

Secondary Cancer Disorder Value Set

Types of secondary malignant neoplastic disease, coded in SNOMED CT or ICD-10-CM.

Specific Diagnosis of Cancer Value Set

Types of hypereosinophilic syndrome, coded in SNOMED CT or ICD-10-CM.

TNM Distant Metastases Category Value Set

Result values for AJCC M category. This value set contains SNOMED-CT equivalents of AJCC codes for the M category, according to TNM staging rules.

TNM Distant Metastases Maximum Value Set

Values for TNM distant metastases category under AJCC staging rules MUST be selected from this value set, which includes all codes from AJCC and all codes from TNMDistantMetastasesCategoryVS.

TNM Distant Metastases Staging Type Maximum Value Set

Like TNMDistantMetastasesStagingTypeVS, but in addition, contains deprecated LOINC codes (which are still allowed).

TNM Distant Metastases Staging Type Value Set

Identifying codes for the type of cancer staging performed, i.e., clinical, pathological, or other, for distant metastases (M) staging observation, under AJCC staging guidelines.

TNM Primary Tumor Category Value Set

Result values for T category, following AJCC staging guidelines. This value set contains SNOMED-CT equivalents of AJCC codes for the T category, according to AJCC TNM staging rules.

TNM Primary Tumor Maximum Value Set

Values for TNM primary tumor category MUST be selected from this value set, when using AJCC staging guidelines. The value set includes all codes from AJCC and all codes from TNMPrimaryTumorCategoryVS.

TNM Primary Tumor Staging Type Maximum Value Set

Like TNMPrimaryTumorStagingTypeVS, but in addition, contains deprecated LOINC codes (which are still allowed).

TNM Primary Tumor Staging Type Value Set

Identifying codes for the type of cancer staging performed, i.e., clinical, pathological, or other, for primary tumor (T) staging observation, under AJCC guidelines.

TNM Regional Nodes Category Value Set

Result values for AJCC N category. This value set contains SNOMED-CT equivalents of AJCC codes for the N category, according to AJCC TNM staging rules.

TNM Regional Nodes Maximum Value Set

Values for TNM regional nodes category under AJCC staging rules MUST be selected from this value set, which includes all codes from AJCC and all codes from TNMRegionalNodesCategoryVS.

TNM Regional Nodes Staging Type Maximum Value Set

Like TNMRegionalNodesStagingTypeVS, but additionally contains deprecated LOINC codes(which are still allowed).

TNM Regional Nodes Staging Type Value Set

Identifying codes for the type of cancer staging performed for AJCC N category, i.e., clinical, pathological, or other, for regional nodes (N) staging observation.

TNM Stage Group Maximum Value Set

Values for AJCC TNM stage group MUST be selected from this value set, which includes all codes from AJCC and all codes from TNMStageGroupVS.

TNM Stage Group Staging Type Maximum Value Set

Like TNMStageGroupStagingTypeVS, but additionally contains deprecated LOINC codes (which are still allowed).

TNM Stage Group Staging Type Value Set

Identifying codes for the type of cancer staging performed, i.e., clinical, pathological, or other, for AJCC stage group observation.

TNM Stage Group Value Set

Result values for cancer stage group using TNM staging following AJCC staging guidelines. This value set contains SNOMED-CT equivalents of AJCC codes for Stage Group, according to TNM staging rules.

TNM Staging Method Value Set

Staging method used for AJCC TNM staging, e.g., AJCC 8th edition, UICC 7th edition, etc.

Teleradiotherapy Modality Value Set

Codes describing the modalities of teleradiotherapy (external beam) procedures.

Teleradiotherapy Technique Value Set

Codes describing the techniques of teleradiotherapy (external beam) procedures.

Treatment Termination Reason Value Set

Values used to describe the reasons for stopping a treatment or episode of care. Includes code for ‘treatment completed’ as well as codes for unplanned (early) stoppage. Applies to medications and other treatments that take place over a period of time, such as radiation treatments.

Tumor Marker Test Value Set

Codes representing tests for tumor markers. This value set of LOINC codes is not comprehensive and can be extended. Other vocabularies can be used only if the test of interest is not covered by LOINC. Tumor marker tests differ from genetic tests in that they measure levels of protein or other substances produced downstream from RNA protein synthesis.

Tumor Morphology Code Max Value Set

Contains the preferred codes for tumor morphology and the old, inactive code used in STU2, for backwards compatibility.

Tumor Morphology Code Value Set

Contains the preferred preferred (active) code for tumor morphology.

Tumor Size Method Value Set

Code for methods of measuring tumor size, including physical examination, pathology, and imaging.

Tumor Size Units Value Set

Acceptable units for measuring tumor size

Wilms Tumor Body Site Value Set

Codes indicating the location of the Wilms Tumor.

Wilms Tumor Stage Value Set

Codes in the National Wilms Tumor Study Group representing Wilms Tumor stage.

Terminology: Code Systems

These define new code systems used by systems conforming to this implementation guide.

Requested SNOMED Codes Code System

Codes requested from SNOMED by mCODE, to be issued at a later date. Where numeric codes are given, these correspond to the expected SNOMED CT codes. Terms beginning with ‘USCRS-‘ (for United States Content Request Service) represent request identifiers with no SNOMED code yet approved or assigned.

Terminology: Concept Maps

These define transformations to convert between codes by systems conforming with this implementation guide.

TG263 Concept Map

A mapping between TG263 Concepts and FHIR TG263 Value Set

Example: Example Instances

These are example instances that show what data produced and consumed by systems conforming with this implementation guide might look like.

all-risk-assessment-high

Example of leukemia with a standard risk assessment.

binet-stage-group-B

Example of Binet staging for CLL.

body-surface-area-example

Example of body surface area.

bodyheight-jenny-m-2018-03-06

Extended example: example of body height vital sign

bodyweight-jenny-m-2018-03-16

Extended example: example of body weight vital sign

bodyweight-jenny-m-2018-04-22

Extended example: body weight vital sign at the time of chemotherapy administration

cancer-disease-status-improved

Example of Cancer Disease Status

cancer-disease-status-jenny-m

Extended example: example showing disease status (patient’s condition improved)

cancer-patient-adam-everyman

Example of Patient

cancer-patient-eve-anyperson

Example of Patient

cancer-patient-jenny-m

Extended example: example cancer patient

cancer-patient-john-anyperson

Example of Patient

cancer-patient-lucy-child

Example of Patient

cancer-related-comorbidities-jenny-m

mCODE Example for Cancer-Related Comorbidities

cancer-related-comorbidities-john-anyperson

Example of Cancer-Related Comorbidities

cancer-related-medication-admin-cyclophosphamide-jenny-m

Extended example: example showing chemotherapy medication

cancer-related-medication-admin-doxorubicin-jenny-m

Extended example: example showing chemotherapy medication

cancer-related-medication-admin-paclitaxel-jenny-m

Extended example: example showing chemotherapy medication

cancer-related-medication-request-anastrozole-jenny-m

Extended example: example showing chemotherapy medication

cancer-related-medication-request-cisplatin

Example of CancerRelatedMedicationRequest - Chemo Infusion

cancer-related-medication-request-cisplatin-stopped

Example of CancerRelatedMedicationRequest - Chemo Infusion

cancer-related-medication-request-cyclophosphamide-jenny-m

Extended example: example showing chemotherapy medication

cancer-related-medication-request-doxorubicin-jenny-m

Extended example: example showing chemotherapy medication

cancer-related-medication-request-gefitinib

Example of CancerRelatedMedicationRequest

cancer-related-medication-request-paclitaxel-jenny-m

Extended example: example showing chemotherapy medication

cancer-related-surgical-procedure-jenny-m

Extended example: example showing partial mastectomy surgical procedure

cancer-related-surgical-procedure-lobectomy

Example of Cancer Related Surgical Procedure

deauville-scale-five

Example of Deauville Scale.

ecog-performance-status-fully-active

Example of ECOG Performance Status

ecog-performance-status-jenny-m

Extended example: example showing ECOG performance status

family-member-history-aunt-jenny-m

Extended example: example showing family member history of cancer

family-member-history-sister-jenny-m

Extended example: example showing family member history of cancer

family-member-history-uncle-jenny-m

Extended example: example showing family member history of cancer

figo-stage-IIIA

Example of gynecologic tumor staged by International Federation of Gynecology and Obstetrics (FIGO) Staging System.

genomic-region-studied-jenny-m

Extended example: example showing which regions were included in the genomics panel

genomic-region-studied-stk11

mCODE Example for Genomic Region Studied

genomic-variant-fusion

mCODE Example for Genomic Variant gene fusion event

genomic-variant-germline-deletion

mCODE Example for Genomic Variant

genomic-variant-jenny-m

Extended example: example showing genomic variant found by breast cancer genomics panel

genomic-variant-somatic-single-nucleotide

mCODE Example for Genomic Variant

genomics-report-jenny-m

Extended example: example of gene panel report

genomics-report-john-anyperson

mCODE Example for Genomics Report

gleason-grade-group-4

Example of Gleason Grade Group for prostatic cancer, with Gleason score 3 + 5 = 8.

gx-cancer-patient-adam-anyperson

GenomeX Example of NGS Patient

gx-genomic-bundle-adam-anyperson

Extended genomics example conformant with an mCODE Bundle.

gx-genomic-diagnostic-implication-bap1

GenomeX mCODE Example for functional effect (loss of function) - BAP1

gx-genomic-diagnostic-implication-pof1b

GenomeX mCODE Example for Clinical Significance of VUS - POF1B

gx-genomic-diagnostic-implication-polrmt

GenomeX mCODE Example for Clinical Significance of VUS - POLRMT

gx-genomic-msi

Example for Microsatellite Instability

gx-genomic-specimen-tumornormal-normal

GenomeX mCODE Example for Genomic Specimen - Tumor specimen of the TumorNormal test

gx-genomic-specimen-tumornormal-tumor

GenomeX mCODE Example for Genomic Specimen - Tumor specimen of the TumorNormal test

gx-genomic-therapeutic-implication-alectinib

Example of how Genomics Reporting IG Therapeutic Implications fits with mCODE

gx-genomic-therapeutic-implication-brigatinib

Example of how Genomics Reporting IG Therapeutic Implications fits with mCODE

gx-genomic-therapeutic-implication-ceritinib

Example of how Genomics Reporting IG Therapeutic Implications fits with mCODE

gx-genomic-therapeutic-implication-crizotinib

Example of how Genomics Reporting IG Therapeutic Implications fits with mCODE

gx-genomic-therapeutic-implication-lorlatinib

Example of how Genomics Reporting IG Therapeutic Implications fits with mCODE

gx-genomic-tmb

Example for Tumor Mutation Burden

gx-genomic-variant-fusion-met-alk

mCODE Example for Genomic Variant gene fusion event

gx-genomic-variant-pertinent-negative-nras-kit-braf

GenomeX mCODE Example for the absence of a notable variant - KIT and BRAF

gx-genomic-variant-somatic-bap1-indel

GenomeX mCODE Example for Genomic Variant - BAP1

gx-genomic-variant-somatic-cdkn2a-cnv

GenomeX mCODE Example for Genomic Variant - CDKN2A

gx-genomic-variant-somatic-cdkn2b-cnv

GenomeX mCODE Example for Genomic Variant - CDKN2B

gx-genomic-variant-somatic-kdm5d

GenomeX mCODE Example for Genomic Variant - KDM5D

gx-genomic-variant-somatic-mtap

GenomeX mCODE Example for Genomic Variant - MTAP

gx-genomic-variant-somatic-mycn

GenomeX mCODE Example for Genomic Variant - MYCN

gx-genomic-variant-somatic-pof1b

GenomeX mCODE Example for Genomic Variant - POF1B

gx-genomic-variant-somatic-polrmt

GenomeX mCODE Example for Genomic Variant - POLRMT

gx-genomics-report-adam-anyperson

GenomeX Example for Genomics Report

gx-order-tumornormal-gensop-inc

GenomeX example: Order information

gx-practitioner-test-pathologist

GenomeX mCODE example: results interpreter of the NGS test.

gx-us-core-organization-gensop-inc

GenomeX example: example organization

histologic-behavior-and-type-non-small-cell

Example of non-small cell lung cancer.

histologic-grade-intermediate

Example of intermediate histologic grade.

history-of-cancer-metastatic-to-liver

Example showing history of metastatic cancer in liver.

hodgkins-lymphoma-stage-IIIe

Example of staging using Cotswold staging of Hodgkin’s disease.

human-specimen-left-breast-jenny-m

Extended example: example showing human specimen for genomic sequencing

human-specimen-lung

mCODE Example of human specimen

jenny-m-chest-wall-lymph-nodes-treatment-volume

Anatomic volume 2 for Jenny M’s teleradiotherapy.

jenny-m-chest-wall-treatment-volume

Anatomic volume 1 for Jenny M’s teleradiotherapy.

john-anyperson-chf

Example of comorbid condition (congestive heart failure) present

john-anyperson-hd

Example of past heart disease

john-anyperson-treatment-volume

Anatomic volume for John Anyperson’s brachytherapy.

karnofsky-performance-status-normal-activity

Example of Karnofsky Performance Status

lab-result-observation-hemoglobin

Hemoglobin lab result to support TNMStageGroup example

lansky-play-performance-status-twenty

Example of Lansky Play Performance Status.

mCODE Patient Group Example

Example of a Group identifying in-scope patients

mcode-patient-bundle-jenny-m

Extended example as a mCODE Patient Bundle

melanoma-breslow-depth-stage

Example of Breslow depth stage for melanoma.

melanoma-clark-level-4

Example of Clark level staging for melanoma.

multiple-myeloma-iss-stage-II

Example of use of International Staging System (ISS) for myeloma staging.

multiple-myeloma-riss-stage-II

Example of Revised International Staging System (RISS) for myeloma staging.

neuroblastoma-inrgss-stage-MS

Example of International Neuroblastoma Risk Group Staging System (INSS) for neuroblastoma staging.

neuroblastoma-inss-stage-III

Example of International Neuroblastoma Staging System (INSS) for neuroblastoma staging.

no-history-of-metastatic-cancer

Example showing no history of metastatic cancer

observation-smoking-pack-years-jenny-m

Extended example: example showing smoking history

primary-cancer-condition-breast

mCODE Example for Primary Cancer Condition (breast). The example shows post-coordinated coding using SNOMED CT, with separate codes for morphology and bodySite.

primary-cancer-condition-cll

Example of Primary Cancer Condition - hematologic cancer

primary-cancer-condition-jenny-m

Extended example: example showing primary cancer condition

primary-cancer-condition-nonspecific

An unspecific Primary Cancer Condition (PCC) used in IG examples. Any real PCC would use a specific diagnostic code.

primary-cancer-condition-nsclc

Example of Primary Cancer Condition

radiotherapy-treatment-summary-chest-wall-jenny-m

Example of radiotherapy treatment summary involving external beam radiation to chest wall and regional node radiation with a chest wall boost

radiotherapy-treatment-summary-other-with-text

Example of radiotherapy treatment summary involving external beam radiation to chest wall and regional node radiation with a chest wall boost

rai-stage-II

Example of Rai staging for CLL.

rhabdomyosarcoma-clinical-group-stage-IA

Example of Rhabdomyosarcoma Clinical Group Stage for rhabdomyosarcoma staging.

rhabdomyosarcoma-risk-assessment-low

Example of rhabdomyosarcoma with a low risk assessment.

secondary-cancer-condition-brain-mets

Example of Secondary Cancer Condition

tnm-clinical-distant-metastases-category-cM0

Example of TNM Clinical Distant Metastases Category

tnm-clinical-distant-metastases-category-jenny-m

Extended example: example showing TNM staging (M)

tnm-clinical-primary-tumor-category-cT3

Example of TNM Clinical Primary Tumor Category

tnm-clinical-primary-tumor-category-jenny-m

Extended example: example showing TNM staging (T)

tnm-clinical-regional-nodes-category-cN3

Example of TNM Clinical Regional Nodes Category

tnm-clinical-regional-nodes-category-jenny-m

Extended example: example showing TNM staging (N)

tnm-clinical-stage-group-3c

Example of TNM Clinical Stage Group

tnm-clinical-stage-group-jenny-m

Extended example: example showing TNM staging (stage group)

tnm-pathologic-distant-metastases-category-jenny-m

Extended example: example showing TNM staging (M)

tnm-pathologic-primary-tumor-category-jenny-m

Extended example: example showing TNM staging (T)

tnm-pathologic-regional-nodes-category-jenny-m

Extended example: example showing TNM staging (N)

tnm-pathologic-stage-group-jenny-m

Extended example: example showing TNM staging (stage group)

tumor-lobular-carcinoma-left-breast

Example of a resource conforming to the tumor profile.

tumor-marker-test-egf

mCODE Example for Tumor Marker Test

tumor-marker-test-er-jenny-m

Extended example: example showing ER status

tumor-marker-test-her2-jenny-m

Extended example: example showing HER2 status

tumor-marker-test-oncotype-dx-jenny-m

Extended example: example showing Oncotype DX breast recurrence score. Note that this test has no assigned LOINC code, so GTR is being used as a backup. Only the score from the Oncotype DX panel (as opposed to variant data from the genes in the panel) is represented here.

tumor-marker-test-pr-jenny-m

Extended example: example showing PR status

tumor-morphology-report-non-small-cell-intermediate-grade

Example of a tumor morphology report showing non-small cell cancer with an intermediate histologic grade.

tumor-size-jenny-m

Extended example: example showing tumor size

tumor-size-pathology

Example of a resource conforming to the tumor size profile.

tumor-specimen-left-breast-jenny-m

Extended example: example tumor specimen

tumor-specimen-lobular-carcinoma-left-breast

Example of a tumor specimen, linked to this Tumor via identifier.

us-core-condition-anxiety-jenny-m

Extended example: example showing comorbid condition (anxiety)

us-core-condition-depression-jenny-m

Extended example: example showing comorbid condition (depression)

us-core-condition-hypertension-jenny-m

Extended example: example showing comorbid condition (hypertension)

us-core-diagnosticreport-lab-jenny-m

Extended example: example of pathology findings represented as a DiagnosticReport resource.

us-core-observation-lab-neutrophils-jenny-m

Extended example: neutrophils lab test

us-core-observation-lab-sentinel-nodes-jenny-m

Extended example: example showing 3 sentinel lymph nodes were examined

us-core-observation-lab-tumor-dcis-jenny-m

Extended example: example showing DCIS diagnosis

us-core-observation-lab-tumor-grade-jenny-m

Extended example: example showing DCIS diagnosis

us-core-observation-lab-tumor-invasion-jenny-m

Extended example: example showing negative invasion for the removed tumor

us-core-observation-lab-tumor-margins-jenny-m

Extended example: example showing negative margins for the removed tumor

us-core-organization-bedrock-medicine

Example of US Core Organization

us-core-organization-physician-services-inc

Extended example: example organization

us-core-practitioner-jane-radiotech

Extended example: example PCP practitioner

us-core-practitioner-kyle-anydoc

Example of Practitioner

us-core-practitioner-mary-obgyn

Extended example: example PCP practitioner

us-core-practitioner-nancy-oncology-nurse

Extended example: example RN practitioner

us-core-practitioner-owen-oncologist

Extended example: example practitioner

us-core-practitioner-peter-pathologist

Extended example: example practitioner (pathologist)

us-core-procedure-biopsy-jenny-m

Extended example: example biopsy procedure

us-core-procedure-mammogram-jenny-m

Extended example: example mammogram

us-core-smokingstatus-jenny-m

Extended example: example showing smoking status

wilms-tumor-stage-III

Example of National Wilms Tumor Study Group stage for Wilms Tumor staging.