Usage

This profile captures the cancer diagnosis. More information on coding the diagnosis can be found on the page Content by Group -> Disease.

In mCODE, staging information MUST be captured in an Observation that conforms to the CancerStageGroup profile. The resulting stage group MAY appear in this profile, in stage.summary and stage.type, but mCODE Data Senders and Receivers MAY ignore it in favor of the CancerStageGroup Observation. If present, cancer staging information summarized in this profile should reflect the most recent staging assessment on the patient, and should be updated if and when there is a new staging assessment. Past staging assessments will be preserved in instances of the CancerStageGroup, which refer back to PrimaryCancerCondition.

For SNOMED CT coding, use a code from the disorder hierarchy under SNOMED CT 363346000 ‘Malignant neoplastic disease (disorder)’ excluding codes descending from SNOMED CT 128462008 ‘Secondary malignant neoplastic disease (disorder)’. If body location is not precoordinated (i.e., implied by the code), the site of the primary tumor should be specified in the body site attribute.

For ICD-10-CM coding, use one of the codes given in this value set representing primary malignant neoplasms and neoplasms of uncertain or unspecified behavior.

Note that ICD-O-3 specifies morphology and topography, not disorder. If ICD-O-3 is used, the primary cancer disorder code must be specifically be SNOMED CT 363346000  ’Malignant neoplastic disease (disorder)’. The ICD-O-3 morphology and topography codes should be entered in the HistologyMorphologyBehavior and body location fields, respectively.

Conformance

Condition resources associated with an in-scope patient with a Condition.code in the value set [PrimaryOrUncertainBehaviorCancerDisorderVS] MUST conform to this profile. Beyond this requirement, a producer of resources SHOULD ensure that any resource instance associated with an in-scope patient that would reasonably be expected to conform to this profile SHOULD be published in this form.

• Differential Table
• Key Elements Table
• Snapshot Table
• Statistics/References
• All

This structure is derived from USCoreCondition

Name	Flags	Card.	Type	Description & Constraints
Condition		0..*	USCoreCondition	Detailed information about conditions, problems or diagnoses
Slices for extension	S	0..*	Extension	Extension Slice: Unordered, Open by value:url
assertedDate	S	0..1	dateTime	Date the condition was first asserted URL: http://hl7.org/fhir/StructureDefinition/condition-assertedDate
histologyMorphologyBehavior	S	0..1	CodeableConcept	Histology-Morphology-Behavior Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-histology-morphology-behavior Binding: Histology Morphology Behavior Value Set (extensible)
code		1..1	CodeableConcept	Identification of the condition, problem or diagnosis Binding: Primary Cancer Disorder Value Set (extensible)
bodySite	S	0..*	CodeableConcept	Anatomical location, if relevant Binding: Cancer Body Location Value Set (extensible)
locationQualifier	S	0..*	CodeableConcept	Body Location Qualifier Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-body-location-qualifier Binding: Body Location Qualifier Value Set (required)
lateralityQualifier	S	0..1	CodeableConcept	Laterality Qualifier Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-laterality-qualifier Binding: Laterality Qualifier Value Set (required)
stage	S	0..*	BackboneElement	Stage/grade, usually assessed formally
summary		0..1	CodeableConcept	Most recent Stage Group
assessment	S	0..*	Reference(Cancer Stage Group Profile)	Formal record of assessment
type		0..1	CodeableConcept	Staging system used. Binding: Cancer Staging System Value Set (required)
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet
Condition.code	extensible	PrimaryCancerDisorderVS
Condition.bodySite	extensible	CancerBodyLocationVS
Condition.stage.type	required	CancerStagingSystemVS

Name	Flags	Card.	Type	Description & Constraints
Condition	C	0..*	USCoreCondition	Detailed information about conditions, problems or diagnoses
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension	S	0..*	Extension	Extension Slice: Unordered, Open by value:url
assertedDate	S	0..1	dateTime	Date the condition was first asserted URL: http://hl7.org/fhir/StructureDefinition/condition-assertedDate
histologyMorphologyBehavior	S	0..1	CodeableConcept	Histology-Morphology-Behavior Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-histology-morphology-behavior Binding: Histology Morphology Behavior Value Set (extensible)
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
clinicalStatus	?!SΣC	0..1	CodeableConcept	active | recurrence | relapse | inactive | remission | resolved Binding: ConditionClinicalStatusCodes (required)
verificationStatus	?!SΣC	0..1	CodeableConcept	unconfirmed | provisional | differential | confirmed | refuted | entered-in-error Binding: ConditionVerificationStatus (required)
category	SC	1..*	CodeableConcept	problem-list-item | encounter-diagnosis | health-concern Binding: US Core Condition Category Codes (extensible)
code	SΣ	1..1	CodeableConcept	Identification of the condition, problem or diagnosis Binding: Primary Cancer Disorder Value Set (extensible)
bodySite	SΣ	0..*	CodeableConcept	Anatomical location, if relevant Binding: Cancer Body Location Value Set (extensible)
locationQualifier	S	0..*	CodeableConcept	Body Location Qualifier Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-body-location-qualifier Binding: Body Location Qualifier Value Set (required)
lateralityQualifier	S	0..1	CodeableConcept	Laterality Qualifier Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-laterality-qualifier Binding: Laterality Qualifier Value Set (required)
subject	SΣ	1..1	Reference(US Core Patient Profile)	Who has the condition?
stage	SC	0..*	BackboneElement	Stage/grade, usually assessed formally
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
summary	C	0..1	CodeableConcept	Most recent Stage Group Binding: ConditionStage (example): Codes describing condition stages (e.g. Cancer stages).
assessment	SC	0..*	Reference(Cancer Stage Group Profile)	Formal record of assessment
type		0..1	CodeableConcept	Staging system used. Binding: Cancer Staging System Value Set (required)
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
Condition.clinicalStatus	required	ConditionClinicalStatusCodes
Condition.verificationStatus	required	ConditionVerificationStatus
Condition.category	extensible	USCoreConditionCategoryCodes
Condition.code	extensible	PrimaryCancerDisorderVS
Condition.bodySite	extensible	CancerBodyLocationVS
Condition.stage.summary	example	ConditionStage
Condition.stage.type	required	CancerStagingSystemVS

Name	Flags	Card.	Type	Description & Constraints
Condition	C	0..*	USCoreCondition	Detailed information about conditions, problems or diagnoses
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose ​AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
Slices for extension	S	0..*	Extension	Extension Slice: Unordered, Open by value:url
assertedDate	S	0..1	dateTime	Date the condition was first asserted URL: http://hl7.org/fhir/StructureDefinition/condition-assertedDate
histologyMorphologyBehavior	S	0..1	CodeableConcept	Histology-Morphology-Behavior Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-histology-morphology-behavior Binding: Histology Morphology Behavior Value Set (extensible)
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	External Ids for this condition
clinicalStatus	?!SΣC	0..1	CodeableConcept	active | recurrence | relapse | inactive | remission | resolved Binding: ConditionClinicalStatusCodes (required)
verificationStatus	?!SΣC	0..1	CodeableConcept	unconfirmed | provisional | differential | confirmed | refuted | entered-in-error Binding: ConditionVerificationStatus (required)
category	SC	1..*	CodeableConcept	problem-list-item | encounter-diagnosis | health-concern Binding: US Core Condition Category Codes (extensible)
severity		0..1	CodeableConcept	Subjective severity of condition Binding: Condition/DiagnosisSeverity (preferred): A subjective assessment of the severity of the condition as evaluated by the clinician.
code	SΣ	1..1	CodeableConcept	Identification of the condition, problem or diagnosis Binding: Primary Cancer Disorder Value Set (extensible)
bodySite	SΣ	0..*	CodeableConcept	Anatomical location, if relevant Binding: Cancer Body Location Value Set (extensible)
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
locationQualifier	S	0..*	CodeableConcept	Body Location Qualifier Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-body-location-qualifier Binding: Body Location Qualifier Value Set (required)
lateralityQualifier	S	0..1	CodeableConcept	Laterality Qualifier Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-laterality-qualifier Binding: Laterality Qualifier Value Set (required)
coding	Σ	0..*	Coding	Code defined by a terminology system
text	Σ	0..1	string	Plain text representation of the concept
subject	SΣ	1..1	Reference(US Core Patient Profile)	Who has the condition?
encounter	Σ	0..1	Reference(Encounter)	Encounter created as part of
onset[x]	Σ	0..1		Estimated or actual date, date-time, or age
onsetDateTime			dateTime
onsetAge			Age
onsetPeriod			Period
onsetRange			Range
onsetString			string
abatement[x]	C	0..1		When in resolution/remission
abatementDateTime			dateTime
abatementAge			Age
abatementPeriod			Period
abatementRange			Range
abatementString			string
recordedDate	Σ	0..1	dateTime	Date record was first recorded
recorder	Σ	0..1	Reference(Practitioner | PractitionerRole | Patient | RelatedPerson)	Who recorded the condition
asserter	Σ	0..1	Reference(Practitioner | PractitionerRole | Patient | RelatedPerson)	Person who asserts this condition
stage	SC	0..*	BackboneElement	Stage/grade, usually assessed formally
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
summary	C	0..1	CodeableConcept	Most recent Stage Group Binding: ConditionStage (example): Codes describing condition stages (e.g. Cancer stages).
assessment	SC	0..*	Reference(Cancer Stage Group Profile)	Formal record of assessment
type		0..1	CodeableConcept	Staging system used. Binding: Cancer Staging System Value Set (required)
evidence	C	0..*	BackboneElement	Supporting evidence
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	ΣC	0..*	CodeableConcept	Manifestation/symptom Binding: ManifestationAndSymptomCodes (example): Codes that describe the manifestation or symptoms of a condition.
detail	ΣC	0..*	Reference(Resource)	Supporting information found elsewhere
note		0..*	Annotation	Additional information about the Condition
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
Condition.language	preferred	CommonLanguages Additional Bindings Purpose ​ AllLanguages Max Binding
Condition.clinicalStatus	required	ConditionClinicalStatusCodes
Condition.verificationStatus	required	ConditionVerificationStatus
Condition.category	extensible	USCoreConditionCategoryCodes
Condition.severity	preferred	Condition/DiagnosisSeverity
Condition.code	extensible	PrimaryCancerDisorderVS
Condition.bodySite	extensible	CancerBodyLocationVS
Condition.stage.summary	example	ConditionStage
Condition.stage.type	required	CancerStagingSystemVS
Condition.evidence.code	example	ManifestationAndSymptomCodes

Differential View

This structure is derived from USCoreCondition

Name	Flags	Card.	Type	Description & Constraints
Condition		0..*	USCoreCondition	Detailed information about conditions, problems or diagnoses
Slices for extension	S	0..*	Extension	Extension Slice: Unordered, Open by value:url
assertedDate	S	0..1	dateTime	Date the condition was first asserted URL: http://hl7.org/fhir/StructureDefinition/condition-assertedDate
histologyMorphologyBehavior	S	0..1	CodeableConcept	Histology-Morphology-Behavior Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-histology-morphology-behavior Binding: Histology Morphology Behavior Value Set (extensible)
code		1..1	CodeableConcept	Identification of the condition, problem or diagnosis Binding: Primary Cancer Disorder Value Set (extensible)
bodySite	S	0..*	CodeableConcept	Anatomical location, if relevant Binding: Cancer Body Location Value Set (extensible)
locationQualifier	S	0..*	CodeableConcept	Body Location Qualifier Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-body-location-qualifier Binding: Body Location Qualifier Value Set (required)
lateralityQualifier	S	0..1	CodeableConcept	Laterality Qualifier Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-laterality-qualifier Binding: Laterality Qualifier Value Set (required)
stage	S	0..*	BackboneElement	Stage/grade, usually assessed formally
summary		0..1	CodeableConcept	Most recent Stage Group
assessment	S	0..*	Reference(Cancer Stage Group Profile)	Formal record of assessment
type		0..1	CodeableConcept	Staging system used. Binding: Cancer Staging System Value Set (required)
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet
Condition.code	extensible	PrimaryCancerDisorderVS
Condition.bodySite	extensible	CancerBodyLocationVS
Condition.stage.type	required	CancerStagingSystemVS

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
Condition	C	0..*	USCoreCondition	Detailed information about conditions, problems or diagnoses
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension	S	0..*	Extension	Extension Slice: Unordered, Open by value:url
assertedDate	S	0..1	dateTime	Date the condition was first asserted URL: http://hl7.org/fhir/StructureDefinition/condition-assertedDate
histologyMorphologyBehavior	S	0..1	CodeableConcept	Histology-Morphology-Behavior Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-histology-morphology-behavior Binding: Histology Morphology Behavior Value Set (extensible)
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
clinicalStatus	?!SΣC	0..1	CodeableConcept	active | recurrence | relapse | inactive | remission | resolved Binding: ConditionClinicalStatusCodes (required)
verificationStatus	?!SΣC	0..1	CodeableConcept	unconfirmed | provisional | differential | confirmed | refuted | entered-in-error Binding: ConditionVerificationStatus (required)
category	SC	1..*	CodeableConcept	problem-list-item | encounter-diagnosis | health-concern Binding: US Core Condition Category Codes (extensible)
code	SΣ	1..1	CodeableConcept	Identification of the condition, problem or diagnosis Binding: Primary Cancer Disorder Value Set (extensible)
bodySite	SΣ	0..*	CodeableConcept	Anatomical location, if relevant Binding: Cancer Body Location Value Set (extensible)
locationQualifier	S	0..*	CodeableConcept	Body Location Qualifier Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-body-location-qualifier Binding: Body Location Qualifier Value Set (required)
lateralityQualifier	S	0..1	CodeableConcept	Laterality Qualifier Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-laterality-qualifier Binding: Laterality Qualifier Value Set (required)
subject	SΣ	1..1	Reference(US Core Patient Profile)	Who has the condition?
stage	SC	0..*	BackboneElement	Stage/grade, usually assessed formally
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
summary	C	0..1	CodeableConcept	Most recent Stage Group Binding: ConditionStage (example): Codes describing condition stages (e.g. Cancer stages).
assessment	SC	0..*	Reference(Cancer Stage Group Profile)	Formal record of assessment
type		0..1	CodeableConcept	Staging system used. Binding: Cancer Staging System Value Set (required)
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
Condition.clinicalStatus	required	ConditionClinicalStatusCodes
Condition.verificationStatus	required	ConditionVerificationStatus
Condition.category	extensible	USCoreConditionCategoryCodes
Condition.code	extensible	PrimaryCancerDisorderVS
Condition.bodySite	extensible	CancerBodyLocationVS
Condition.stage.summary	example	ConditionStage
Condition.stage.type	required	CancerStagingSystemVS

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Condition	C	0..*	USCoreCondition	Detailed information about conditions, problems or diagnoses
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose ​AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
Slices for extension	S	0..*	Extension	Extension Slice: Unordered, Open by value:url
assertedDate	S	0..1	dateTime	Date the condition was first asserted URL: http://hl7.org/fhir/StructureDefinition/condition-assertedDate
histologyMorphologyBehavior	S	0..1	CodeableConcept	Histology-Morphology-Behavior Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-histology-morphology-behavior Binding: Histology Morphology Behavior Value Set (extensible)
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	External Ids for this condition
clinicalStatus	?!SΣC	0..1	CodeableConcept	active | recurrence | relapse | inactive | remission | resolved Binding: ConditionClinicalStatusCodes (required)
verificationStatus	?!SΣC	0..1	CodeableConcept	unconfirmed | provisional | differential | confirmed | refuted | entered-in-error Binding: ConditionVerificationStatus (required)
category	SC	1..*	CodeableConcept	problem-list-item | encounter-diagnosis | health-concern Binding: US Core Condition Category Codes (extensible)
severity		0..1	CodeableConcept	Subjective severity of condition Binding: Condition/DiagnosisSeverity (preferred): A subjective assessment of the severity of the condition as evaluated by the clinician.
code	SΣ	1..1	CodeableConcept	Identification of the condition, problem or diagnosis Binding: Primary Cancer Disorder Value Set (extensible)
bodySite	SΣ	0..*	CodeableConcept	Anatomical location, if relevant Binding: Cancer Body Location Value Set (extensible)
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
locationQualifier	S	0..*	CodeableConcept	Body Location Qualifier Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-body-location-qualifier Binding: Body Location Qualifier Value Set (required)
lateralityQualifier	S	0..1	CodeableConcept	Laterality Qualifier Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-laterality-qualifier Binding: Laterality Qualifier Value Set (required)
coding	Σ	0..*	Coding	Code defined by a terminology system
text	Σ	0..1	string	Plain text representation of the concept
subject	SΣ	1..1	Reference(US Core Patient Profile)	Who has the condition?
encounter	Σ	0..1	Reference(Encounter)	Encounter created as part of
onset[x]	Σ	0..1		Estimated or actual date, date-time, or age
onsetDateTime			dateTime
onsetAge			Age
onsetPeriod			Period
onsetRange			Range
onsetString			string
abatement[x]	C	0..1		When in resolution/remission
abatementDateTime			dateTime
abatementAge			Age
abatementPeriod			Period
abatementRange			Range
abatementString			string
recordedDate	Σ	0..1	dateTime	Date record was first recorded
recorder	Σ	0..1	Reference(Practitioner | PractitionerRole | Patient | RelatedPerson)	Who recorded the condition
asserter	Σ	0..1	Reference(Practitioner | PractitionerRole | Patient | RelatedPerson)	Person who asserts this condition
stage	SC	0..*	BackboneElement	Stage/grade, usually assessed formally
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
summary	C	0..1	CodeableConcept	Most recent Stage Group Binding: ConditionStage (example): Codes describing condition stages (e.g. Cancer stages).
assessment	SC	0..*	Reference(Cancer Stage Group Profile)	Formal record of assessment
type		0..1	CodeableConcept	Staging system used. Binding: Cancer Staging System Value Set (required)
evidence	C	0..*	BackboneElement	Supporting evidence
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	ΣC	0..*	CodeableConcept	Manifestation/symptom Binding: ManifestationAndSymptomCodes (example): Codes that describe the manifestation or symptoms of a condition.
detail	ΣC	0..*	Reference(Resource)	Supporting information found elsewhere
note		0..*	Annotation	Additional information about the Condition
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
Condition.language	preferred	CommonLanguages Additional Bindings Purpose ​ AllLanguages Max Binding
Condition.clinicalStatus	required	ConditionClinicalStatusCodes
Condition.verificationStatus	required	ConditionVerificationStatus
Condition.category	extensible	USCoreConditionCategoryCodes
Condition.severity	preferred	Condition/DiagnosisSeverity
Condition.code	extensible	PrimaryCancerDisorderVS
Condition.bodySite	extensible	CancerBodyLocationVS
Condition.stage.summary	example	ConditionStage
Condition.stage.type	required	CancerStagingSystemVS
Condition.evidence.code	example	ManifestationAndSymptomCodes

This structure is derived from USCoreCondition

Summary

Must-Support: 8 elements

Structures

This structure refers to these other structures:

• Cancer Stage Group Profile (http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-cancer-stage-group)

Extensions

This structure refers to these extensions:

• http://hl7.org/fhir/StructureDefinition/condition-assertedDate
• http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-histology-morphology-behavior
• http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-body-location-qualifier
• http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-laterality-qualifier