From the QDM resources, CQL, and Guidance sections of the specifications, what sources of diagnoses to qualify (EHR physician documentation vs. final professional coding) is needing clarification.  In some measures like VTE and STK (below),  EncounterDiagnoses.rank = 1 is indicated. In other instances like HH-FI it is not (below).

1. Is the intent of rank=1 to qualify the final professional coding and not physician documentation? 
2. If so, and rank is not specified for a data element, should all sources of diagnosis documentation qualify?
3. In some cases, physician documentation is incorrect and is qualifying inappropriately whereas the final coding/claims would be more accurate. Is the intent across measures to qualify diagnosis based on what is accurate per customer?
4. If always a particular source (i.e. professional coding) is more accurate,  could further information be documented in the QDM or measure specific specifications to indicate?
5. If this is already outlined within one of the following QDM links, please point me to where this is indicated for future reference.

Condition/Diagnosis/Problem QDM category - https://ecqi.healthit.gov/mcw/2026/qdm-category/conditiondiagnosisproblem.html

Diagnosis QDM attribute - https://ecqi.healthit.gov/mcw/2026/qdm-attribute/diagnoses.html

"Diagnosis" QDM Datatype - https://ecqi.healthit.gov/mcw/2026/qdm-dataelement/diagnosis.html

Examples:

VTE-1

Encounter With Principal Diagnosis Of Mental Disorder Or Stroke

•   VTE."Encounter With Age Range And Without VTE Diagnosis Or Obstetrical Conditions" QualifyingEncounter
      where exists ( QualifyingEncounter.diagnoses EncounterDiagnoses
          where EncounterDiagnoses.rank = 1
            and ( EncounterDiagnoses.code in "Mental Health Diagnoses"
                or EncounterDiagnoses.code in "Hemorrhagic Stroke"
                or EncounterDiagnoses.code in "Ischemic Stroke"))

STK-2

TJC.Ischemic Stroke Encounter

•   "Non Elective Encounter With Age" NonElectiveEncounterWithAge
      where exists ( NonElectiveEncounterWithAge.diagnoses Diagnosis
          where Diagnosis.code in "Ischemic Stroke"
            and Diagnosis.rank = 1)

HH-FI

Encounter with a Fall Diagnosis

•   "Initial Population" QualifyingEncounter
      where exists ( QualifyingEncounter.diagnoses FallDiagnosis
          where FallDiagnosis.code in "Inpatient Falls")