Condition, diagnosis, or reason for seeking medical attention.

Data Element

Problems

Applicable Vocabulary Standard(s)

Applicable Standards (*Please confirm or update this field for the new USCDI version*)
  • Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT®) U.S. Edition, September 2019 Release

View guidance on Applicable Vocabulary Standards and versioning.

Comment

Coded values and descriptions for problem entries

Diagnosis entries frequently arrive with a code but no description, or a description but no code. Both limit downstream use: an uncoded entry cannot be aggregated, and a code without its description is harder to validate. I recommend USCDI encourage reporting of problem-list coding completeness, the share of entries carrying both a valid code and its description, alongside conformance.

NCPDP Comment

NCPDP submits problems in the diagnosis code field (either ICD-10 or SNOMED). NCPDP agrees that both values are acceptable.

Suggest renaming Problems to Condition Code

MedMorph suggests that the Problems element be renamed to Condition Code to align with US Core.  Currently, Problems is a very generic term and  is not "the most granular level at which a piece of data is exchanged" (definition of a USCDI Data Element). It also lends to confusion having an element named the same as the class.  MedMorph is also suggesting the Problems class be renamed to Condition.

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