This change request was raised against STU3 version, but does not qualify as a technical correction.  In the emerging R5 build,  http://build.fhir.org/communication-definitions.html#Communication.payload.content_x_ , we did add support for a codified payload.contentCodeableConcept.  However, it is not intended to be a categorization per the comment in the specification that says: The content can be codified or textual. As an example of codified content, when working with machine generated communications, the payload may be drawn from a finite, terminology defined set of communications, especially for short, status update kinds of communications where more of a natural language approach isn't appropriate. If the content isn't codified, contentCodeableConcept.text can be used. When using contentCodeableConcept, the CodeableConcept is what is being communicated and is not a categorization of the content. Recommend using Communication.category = instruction in either STU3 and beyond.