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  1. FHIR Specification Feedback
  2. FHIR-41505

Add MS elements to QI-Core Claim profile

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    • Icon: Change Request Change Request
    • Resolution: Persuasive with Modification
    • Icon: Medium Medium
    • US QI Core (FHIR)
    • current
    • Clinical Quality Information
    • Claim example
      QICore Claim
    • Profiles, Examples
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      Add MustSupport elements to QI-Core Claim profile to accommodate expression of principal diagnosis and presentOnAdmission. This represents a change in QI-Core 6.0 to use claims to identify principal diagnoses and procedures since they are finalized and considered valid when submitted in claims.

      1.  Add MS for:
        1. Claim.diagnosis:
          1. Claim.diagnosis.diagnosis.diagnosisReference (QICore ConditionEncounterDiagnosis)
          2. Claim.diagnosis.diagnosis.CodeableConcept
          3. Claim.diagnosis.onAdmission (with required binding to [QICore Present on Admission Value Set|http://hl7.org/fhir/us/qicore/STU5/ValueSet-qicore-present-on-admission.html])
          4. Claim.diagnosis.sequence
        2. Claim.procedure.procedure
          1. Claim.procedure.procedure.CodeableConcept
          2. Claim.procedure.procedureReference (QI-Core Procedure)
          3. Claim.procedure.sequence
        3. Claim.encounter Reference (QI-Core Encounter)
      1. Add Example and Guidance for:
        1. Principal diagnosis - use Claim.diagnosis.diagnosis and __ Claim.diagnosis.sequence = 1
        2. Principal procedure - use Claim.procedure.procedure and __ Claim.procedure.sequence = 1
        3. Present on Admission - use Claim.diagnosis.diagnosis and __ Claim.OnAdmission
      Show
      Add MustSupport elements to QI-Core Claim profile to accommodate expression of  principal diagnosis and  presentOnAdmission . This represents a change in QI-Core 6.0 to use claims to identify principal diagnoses and procedures since they are finalized and considered valid when submitted in claims.  Add MS for: Claim.diagnosis: Claim.diagnosis.diagnosis.diagnosisReference (QICore ConditionEncounterDiagnosis) Claim.diagnosis.diagnosis.CodeableConcept Claim.diagnosis.onAdmission (with required binding to [QICore Present on Admission Value Set| http://hl7.org/fhir/us/qicore/STU5/ValueSet-qicore-present-on-admission.html ]) Claim.diagnosis.sequence Claim.procedure.procedure Claim.procedure.procedure.CodeableConcept Claim.procedure.procedureReference (QI-Core Procedure) Claim.procedure.sequence Claim.encounter Reference (QI-Core Encounter) Add Example and Guidance for: Principal diagnosis - use Claim.diagnosis.diagnosis  and  __ Claim.diagnosis.sequence = 1 Principal procedure - use Claim.procedure.procedure  and  __ Claim.procedure.sequence = 1 Present on Admission - use Claim.diagnosis.diagnosis  and __ Claim.OnAdmission
    • Michelle Currie/Abdullah Rafiqi:23-0-1
    • Enhancement
    • Compatible, substantive

    Description

      Add MustSupport elements to QI-Core Claim profile to accommodate expression of principal diagnosis and presentOnAdmission. This represents a change in QI-Core 6.0 to use claims to identify principal diagnoses and procedures since they are finalized and considered valid when submitted in claims.

      1.  Add MS for:
        1. Claim.diagnosis:
          1. Claim.diagnosis.diagnosis.diagnosisReference (QICore ConditionEncounterDiagnosis)
          2. Claim.diagnosis.diagnosis.CodeableConcept
          3. Claim.diagnosis.onAdmission (with required binding to [QICore Present on Admission Value Set|http://hl7.org/fhir/us/qicore/STU5/ValueSet-qicore-present-on-admission.html])
          4. Claim.diagnosis.sequence
        2. Claim.procedure.procedure
          1. Claim.procedure.procedure.CodeableConcept
          2. Claim.procedure.procedureReference (QI-Core Procedure)
          3. Claim.procedure.sequence
      2. Add Example and Guidance for:
        1. Principal diagnosis - use Claim.diagnosis.diagnosis and __ Claim.diagnosis.sequence = 1
        2. Principal procedure - use Claim.procedure.procedure and __ Claim.procedure.sequence = 1
        3. Present on Admission - use Claim.diagnosis.diagnosis and __ Claim.OnAdmission

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            jen_seeman Jennifer Seeman
            feisenberg Floyd Eisenberg
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            Dates

              Created:
              Updated:
              Resolved: