Value in code when actually code is unknow, ccd document

Question

I am currently working on building CCD for my project.

I have a problem in code. For example let me take an example of payers section.

CONF-60:A covered party in a policy activity SHOULD contain exactly one participant / participantRole / code, to represent the reason for coverage (e.g. Self, Family dependent, student).
CONF-61:The value for “participant / participantRole / code” in a policy activity’s covered party MAY be selected from ValueSet 2.16.840.1.113883.1.11.19809 PolicyOrProgramCoverageRoleType DYNAMIC.

Above is the line i have copied from hl7 official document.

<code code="SELF" codeSystem="2.16.840.1.113883.5.111" displayName="Self"/>

Its copied from sample ccd document. Going to http://wiki.hl7.de/index.php/2.16.840.1.113883.5.111 we can see there are codes. But my system has values for which i cant find the codes there.

So my question is if cant get the codes there can i just use following and still produce a valid ccd document

<code displayName="Organ Donor"/>

In other words is it necessary to set code and code system in ccd document??

Answer 1

No, that particular line will not be valid and yes - It is necessary. These codes and coding systems are how other systems or programs will recognize the component. They are based in standard language meant to be recognized across EHR platforms and applications - such as LOINC (2.16.840.1.113883.6.1).

The whole purpose of the C-CDA, as the name "continuity of care" would suggest, is the seamless transition of patient information in a recognizable format to other organizations who may not utilize the same EHR.

Take a look at SMART CCDA Scorecard http://ccda-scorecard.smartplatforms.org/static/ccdaScorecard/#/

Also, what system are you using? Your system, especially for those values, should have the correct coding system because the values "SELF, MTH, FTH" are very common for documenting any demographic, insurance or patient related information. Otherwise, it might not meet the requirements of a certified EHR.

Answer 2

When the coding system doesn't contain an appropriate value you can use a NULL value and show the text, although usage of such is disallowed for certain elements. So your example should actually look something like this.

<code nullFlavor="OTH">
    <originalText>Organ Donor</originalText>
</code>

But in general you should always try to use a valid concept code where one exists. That's the only way you'll achieve meaningful interoperability with third-party systems.