SEVT errors for values with nullFlavor="OTH" and a translation

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    • Type: Implementation Guidance
    • Resolution: Delivered
    • Priority: Major
    • Component/s: None
    • This is preventing us from generating valid QRDA documents for our customers to submit to CMS using the SEVT tool.
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      The CMS QRDA implementation guide has the following statements in the Value Sets section: “There are some cases where the value sets specified in electronic Clinical Quality Measures (eCQMs) contradict the value sets specified in the QRDA-I standard. In these cases, the value sets that are specified in eCQMs take precedence.” For QRDA-I Patient Section’s entry templates, for example, diagnosis active, either SNOMED, ICD10, or ICD9 codes that your system chooses to submit shall be sent directly using value/@code instead of translation. The Cypress validator validates against the HL7 QRDA-I standard, which does not validate the additional constraints/requirements specified in the CMS QRDA implementation guide. The Figure 19 example in the CMS QRDA implementation guide for QRDA-III is an exception; it is the only place where translation is specifically specified in the constraint to send the payer group information.
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      The CMS QRDA implementation guide has the following statements in the Value Sets section: “There are some cases where the value sets specified in electronic Clinical Quality Measures (eCQMs) contradict the value sets specified in the QRDA-I standard. In these cases, the value sets that are specified in eCQMs take precedence.” For QRDA-I Patient Section’s entry templates, for example, diagnosis active, either SNOMED, ICD10, or ICD9 codes that your system chooses to submit shall be sent directly using value/@code instead of translation. The Cypress validator validates against the HL7 QRDA-I standard, which does not validate the additional constraints/requirements specified in the CMS QRDA implementation guide. The Figure 19 example in the CMS QRDA implementation guide for QRDA-III is an exception; it is the only place where translation is specifically specified in the constraint to send the payer group information.

      We are validating QRDA-I and QRDA-III files with teh SEVT tool at QualityNet, and we are receiving errors when trying to submit files that use nullFlavor="OTH" for the value element.

      Below is an example of what we are sending for the QRDA-III.
      <value code="OTH" xsi:type="CD">
      <translation code="D" codeSystem="2.16.840.1.113883.3.249.12" displayName="Other"/>
      </value>
      We get an error:
      This value SHALL contain exactly one [1..1] @nullFlavor="OTH" (CONF:711229).

      The format we are sending the data in appears to be exactly what is
      specified in Figure 19 of the QRDA-III_CMS_EP_2014_IG.

      For the QRDA-I, we have been receiving this error for the measure CMS75, and possibly for others as well. Wehn sending the active diagnosis, we have an ICD10 code to send, but since the coded value is required to be SNOMED, we send nullFlavor="OTH for the main value, and send the data as a translation. This is an exampel of what we send:
      <value code="11838838" codeSystem="2.16.840.1.113883.6.96" displayName="Arrested dental caries (disorder)" xsi:type="CD" sdtc:valueSet="2.16.840.1.113883.3.464.1003.125.12.1004" xmlns:sdtc="urn:hl7-org:sdtc" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
      <translation code="K02.3" codeSystem="2.16.840.1.113883.6.90" codeSystemName="ICD10CM" displayName="Arrested dental caries" sdtc:valueSet="2.16.840.1.113883.3.464.1003.125.12.1004"/>

      This works when validating data against the latest version of Cypress, but the SEVT tool throws the following 2 errors.

      • SHALL contain exactly one [1..1] value with @xsi:type="CD" (CONF:12008).
        and
        *SHALL contain exactly one [1..1] value with @xsi:type="CD", where the @code SHOULD be selected from ValueSet Problem Value Set 2.16.840.1.113883.3.88.12.3221.7.4 DYNAMIC (CONF:9058).

            Assignee:
            Yan Heras
            Reporter:
            David Sundaram-Stukel (Inactive)
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            1 Vote for this issue
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            3 Start watching this issue

              Created:
              Updated:
              Resolved: