The base HL7 IG and the eCQM measure definitions contradict each other about which code should be provided for the Patient Characteristic Expired Code. If a QRDA1, with a Patient Characteristic Expired Code of '419099009' in it is submitted it will pass Schematron validation but that Code will not satisfy eCQM measures 159v3 and 160v3. If a Patient Characteristic Expired Code is enter that satisfies eCQM measures 159v3 and 160v3 is submitted it will not pass Schematron validation.

Here are the details of the problem...

HL7 IG requires the "Dead" clinical code '419099009'.

8. SHALL contain exactly one [1..1] value with @xsi:type="CD" (CONF:14857).
a. This value SHALL contain exactly one [1..1] @code="419099009" Dead (CodeSystem: SNOMED CT 2.16.840.1.113883.6.96 STATIC) (CONF:15142).

eCQM measures 159v3 and 160v3 require that the code come from valueSet "2.16.840.1.113883.3.67.1.101.11.721". Here is that definition...

"Patient Characteristic Expired: Deceased" using "Deceased Grouping Value Set (2.16.840.1.113883.3.67.1.101.11.721)"

The eCQM valueSet has only two values in it, neither of which is "419099009"...

18632008 Patient status determination, deceased (finding)
371828006 Patient deceased during stay (discharge status = dead) (finding)

"419099009" is a valid code in the SNOMED-CT codeSystem and the VOC does define a valueSet with that code but currently no one references that valueSet. The base Lantana rule requires the "419099009". Here is that rule...

<sch:assert id="a-81-15142" test="cda:value[@xsi:type='CD'][@code='419099009']">This value SHALL contain exactly one [1..1] @code="419099009" Dead (CodeSystem: SNOMED CT 2.16.840.1.113883.6.96 STATIC) (CONF:15142).</sch:assert>

The PQRS rule further validates that the correct codeSystem has been provided...

<sch:assert id="a-15142" test="not(cda:value[@xsi:type='CD'][@code='419099009']) or (cda:value[@xsi:type='CD'][@code='419099009'][@codeSystem='2.16.840.1.113883.6.96'])">This value SHALL contain exactly one [1..1] @code="419099009" Dead (CodeSystem: SNOMED-CT 2.16.840.1.113883.6.96 STATIC) (CONF:15142).</sch:assert>

The R3 HL7 IG to be used for the 2016 submission period has the exact same constraint in it...

8. SHALL contain exactly one [1..1] value with @xsi:type="CD" (CONF:1098-14857).
a. This value SHALL contain exactly one [1..1] @code="419099009" Dead (CodeSystem: SNOMED CT urn:oid:2.16.840.1.113883.6.96 STATIC) (CONF:1098-15142).