The 'code' element has been specified correctly and the problem with the submission is the Diagnostic Study, Result (result) (i.e. the 'value' element). All clinical codes in a submission must include a valueSet. As you can see in the 'Description' section of this JIRA ticket, the result 'value' element does not have a valueSet specified for code '312905005' and so that value was rejected. The PQRS_10710 error message that stated the valueSet was not compatible should have specified the exact xPath of the offending 'value' element. By the way, the code that was provided for this value (i.e. '312905005') is not a valid code for CMS167v3, for a Diagnostic Study, Result (result) so, even if a valueSet was provided for this code it would still be rejected. Measure CMS 167v3 it states the following... Numerator = ◾AND: ◾AND: "Occurrence A of Diagnostic Study, Result: Macular Exam (result: 'Level of Severity of Retinopathy Findings')" ◾AND: ◾OR: "Occurrence A of Diagnostic Study, Result: Macular Exam (result: 'Macular Edema Findings Absent')" ◾OR: "Occurrence A of Diagnostic Study, Result: Macular Exam (result: 'Macular Edema Findings Present')" Attribute: "Result: Level of Severity of Retinopathy Findings" using "Level of Severity of Retinopathy Findings Grouping Value Set (2.16.840.1.113883.3.526.3.1283)" ◾Attribute: "Result: Macular Edema Findings Absent" using "Macular Edema Findings Absent Grouping Value Set (2.16.840.1.113883.3.526.3.1284)" ◾Attribute: "Result: Macular Edema Findings Present" using "Macular Edema Findings Present Grouping Value Set (2.16.840.1.113883.3.526.3.1320)" This indicates that only the following three valueSets are acceptable for Diagnostic Study, Result (result) for CMS167v3... ◾2.16.840.1.113883.3.526.3.1283 ◾2.16.840.1.113883.3.526.3.1284 ◾2.16.840.1.113883.3.526.3.1320 Code '312905005' is not in any of these valueSets.