We are using Cypress 5.3.0 for creating and validating "Communication Not Performed" template per Hl7 Release 5.1 errata for ambulatory system. For this negation template, as a part of my analysis, I tried putting code belonging to Value Set OID for CMS142 - 7_Manuel_Hughes Patient Id instead of Value Set OID and Cypress threw me an attached error.

1) Per Hl7 Vol 1 - Section 3.4 Page # 24: "QDM elements can now be specified by either binding to value sets or direct referenced codes.". Does this mean, we cannot put code belonging to Value Set OID?

2) Our understanding for Direct Reference Code is, "Code directly specified in the CMS measure specs". If measure specs specifies Value Set OID and that Value Set OID contains n number of codes, we do not consider those codes as direct reference codes. Is this understanding correct?

3) I also tried Cypress 4.0.4 by putting code belonging to Value Set OID for CMS142 – 1_Brandon_Willis for "Communication From Provider to Provider Not Done” instead of OID. There Cypress is not throwing any error. Is this newly added for latest Cypress version?