Problem TargetSiteCode Qualifier

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Approval Status

  • Approval Status: Approved
  • Example Task Force: 2/2/2017
  • SDWG: 5/18/2017

C-CDA 2.1 Example:

  • 2.16.840.1.113883.
  • Problem Section: 2.16.840.1.113883.
  • Problem Act: 2.16.840.1.113883.
  • Problem Observation: 2.16.840.1.113883.

Reference to full CDA sample:

  • Problems in empty CCD

Validation location


  • This is an example of adding a SNOMED qualifier to an ambiguous ICD-9 which could be used in qualifying patients related to QRDA/eCQM measure


  • John D'Amore (GitHub: jddamore)


  • problem, qualifier, QRDA, eCQM, laterality, targetSiteCod




Example: download example view on GitHub

<!-- An example of how to use a qualifier. This example shows presence of a problem/value/translation, although it could also be used to refine the problem/value -->
<!-- The use of qualifiers could also be used on other sections, such as qualifying a procedure -->
    <templateId root="2.16.840.1.113883." extension="2015-08-01"/>
    <code code="11450-4" codeSystem="2.16.840.1.113883.6.1" displayName="Problem List"/>
    <title>Problem List</title>
                <tr ID="Problem1">
                    <td ID="ProblemDescription1">Below Knee Amputation</td>
                        <content>Onset: Apr 2 2014</content>
        <act classCode="ACT" moodCode="EVN">
            <templateId root="2.16.840.1.113883." extension="2015-08-01"/>
            <id root="e5fbc288-659f-4aeb-a5e1-eb7cc8fcdfaf" />
            <code code="CONC" codeSystem="2.16.840.1.113883.5.6" />
            <!-- While clinicians can track resolved problems, generally active problems will have active concern status and resolved concerns will be completed -->
            <statusCode code="active" />
                <!-- This represents the time that the clinician began tracking the concern. This may frequently be an EHR timestamp-->
                <low value="20140403124536-0500" />
            <entryRelationship typeCode="SUBJ">
                <observation classCode="OBS" moodCode="EVN">
                    <templateId root="2.16.840.1.113883." extension="2015-08-01"/>
                    <id root="ac416033-3cc1-4485-ab31-36ce7669f55c" />
                    <code codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" code="55607006" displayName="Problem">
                        <translation code="75326-9" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Problem"/>
                        <reference value="#Problem1" />
                    <statusCode code="completed" />
                        <!-- This represents the date of biological onset. This can be before the patient vistited the clinician, as illustrated in this example-->
                        <low value="20140402" />
                    <!-- This is a SNOMED code as the primary vocabulary for problem lists. It would be preferable to have a SNOMED code but no direct translation is available here. -->
                    <value xsi:type="CD" nullFlavor="OTH">
                            <reference value="#ProblemDescription1" />
                        <translation xsi:type="CD" code="V49.75" codeSystem="2.16.840.1.113883.6.103" codeSystemName="ICD-9" displayName="Below Knee Amputation Status" />
                    <!-- Recommendation of task force that laterality on problems should be in targetSiteCode rather than on the value or value/translation elements -->
                    <targetSiteCode xsi:type="CD" code="30021000" codeSystem="2.16.840.1.113883.6.96" displayName="Structure of lower extremity from knee to ankle">
                        <!-- This is an example of a qualifer which would affect a quality measure (e.g. cms 123 Diabetes Foot Exam) -->
                            <name code="272741003" codeSystem="2.16.840.1.113883.6.96" displayName="Laterality" />
                            <value code="7771000" codeSystem="2.16.840.1.113883.6.96" displayName="Left"/>
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