The valueset-reference extension is being used to indicate a set of items not done, as part of the negation profiles in QI-Core. For example, to indicate that a medication was not administered, the valueset-reference extension is used to reference a value set containing medications that were not administered. However, it is confusing and potentially ambiguous to specify this at the Coding, it should be possible to specify this at the CodeableConcept level so that an empty Coding does not have to provided.

A change requiring this expanded context is committed to support this tracker:

https://jira.hl7.org/browse/FHIR-32055

The usage can be seen in this profile:

http://build.fhir.org/ig/HL7/fhir-qi-core/StructureDefinition-qicore-mednotadministered.html

Including examples of both a specific medication not administered, as well as the valueset-reference extension to indicate a set of medications not administered.