Da Vinci Payer Data Exchange
1.0.0 - STU1

This page is part of the Da Vinci Payer Data Exchange (v1.0.0: STU1) based on FHIR R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

US Core Condition

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The essential fields (Must Support or Cardinality greater than 0..*) to be provided in the US Core Condition resource are:

R4 Element Name Cardinality Type
Condition.clinicalStatus clinicalStatus 0..1 CodeableConcept
Condition.verificationStatus verificationStatus 0..1 CodeableConcept
Condition.category category 1..* CodeableConcept
Condition.code code 1..1 CodeableConcept
Condition.subject subject 1..1 Reference(US Core Patient Profile)

Table Definition

The essential fields to be provided in the Condition resource from the CPCDS file are:

US Core Element Must Support Cardinality CARIN-BB Element CPCDS Element Mapping or Implementer Note
- Condition.meta.lastUpdated   0..1 ExplanationOfBenefit.meta.lastUpdated [{“163”:”EOB Last Updated Date”}]
Condition.clinicalStatus S 0..1   . Note: active | recurrence | relapse | inactive | remission | resolved
Condition.verificationStatus S 0..1   . Note: active | recurrence | relapse | inactive | remission | resolved
Condition.category S 1..*   . Note: Based on Diagnosis from claim pick appropriate condition category from: [problem-list-item | encounter-diagnosis | health-concern]
Condition.code S 1..1 ExplanationOfBenefit.diagnosis.diagnosis [{“22, 23”:”Diagnosis Code”}
Condition.subject S 1..1 ExplanationOfBenefit.patient [{“Ref (1)”:”Member id”}
Condition.recorder   0..1 ExplanationOfBenefit.careTeam.provider [{“Ref (95, 96, 99)”:”Provider rendering, PCP and referring NPIs”}, {“Ref (168, 169, 170, 171)”:”Provider rendering, PCP and referring names”}

Table Definition

Example Condition Resource

An example mapping of a problem using the Condition is shown below:

{
  "resourceType" : "Condition",
  "id" : "example",
  "meta" : {
    "profile" : [
      "http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition"
    ]
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">
Generated Narrative with Details
id: example
meta: 
clinicalStatus: Active <span style=\"background: LightGoldenRodYellow\">(Details : {http://terminology.hl7.org/CodeSystem/condition-clinical code 'active' = 'Active', given as 'Active'})</span>
verificationStatus: Confirmed <span style=\"background: LightGoldenRodYellow\">(Details : {http://terminology.hl7.org/CodeSystem/condition-ver-status code 'confirmed' = 'Confirmed', given as 'Confirmed'})</span>
category: Problem <span style=\"background: LightGoldenRodYellow\">(Details : {http://terminology.hl7.org/CodeSystem/condition-category code 'problem-list-item' = 'Problem List Item', given as 'Problem List Item'})</span>
code: Single liveborn, born in hospital <span style=\"background: LightGoldenRodYellow\">(Details : {SNOMED CT code '442311008' = 'Liveborn born in hospital', given as 'Liveborn born in hospital'})</span>
subject: <a href=\"Patient-example.html\">Amy V. Shaw. Generated Summary: id: example; Medical Record Number = 1032702 (USUAL); active; Amy V. Shaw ; ph: 555-555-5555(HOME), amy.shaw@example.com; gender: female; birthDate: Feb 20, 2007</a>
onset: Aug 10, 2016, 12:00:00 AM
</div>"
  },
  "clinicalStatus" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/condition-clinical",
        "code" : "active",
        "display" : "Active"
      }
    ],
    "text" : "Active"
  },
  "verificationStatus" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/condition-ver-status",
        "code" : "confirmed",
        "display" : "Confirmed"
      }
    ],
    "text" : "Confirmed"
  },
  "category" : [
    {
      "coding" : [
        {
          "system" : "http://terminology.hl7.org/CodeSystem/condition-category",
          "code" : "problem-list-item",
          "display" : "Problem List Item"
        }
      ],
      "text" : "Problem"
    }
  ],
  "code" : {
    "coding" : [
      {
        "system" : "http://snomed.info/sct",
        "code" : "442311008",
        "display" : "Liveborn born in hospital"
      }
    ],
    "text" : "Single liveborn, born in hospital"
  },
  "subject" : {
    "reference" : "Patient/example",
    "display" : "Amy V. Shaw"
  },
  "onsetDateTime" : "2016-08-10"
}

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