MedicationRequest - Unable to extract codes from fhirType Reference

[jbyrdevans]

The following error is encountered when attempting to filter a QICore6 MedicationRequest by valueset. It occurs when a MedicationRequest.medication code is defined using a reference to a Medication resource. Encountered in the https://github.com/cqframework/dqm-content-qicore-2025 repo while testing at Connectathon 40.

org.opencds.cqf.cql.engine.exception.CqlException: Unable to extract codes from fhirType Reference
	at org.opencds.cqf.cql.engine.execution.EvaluationVisitor.visitExpression(EvaluationVisitor.java:28)
	...
Caused by: java.lang.IllegalArgumentException: Unable to extract codes from fhirType Reference
	at org.opencds.cqf.fhir.cql.engine.utility.CodeExtractor.getCodesFromBase(CodeExtractor.java:86)
	...

CQL minimal repro

library Repro version '1.0.000'

using QICore version '6.0.0'

include FHIRHelpers version '4.4.000' called FHIRHelpers

valueset "ACE Inhibitor or ARB or ARNI": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1139'

context Patient

define "CqlException: Unable to extract codes from fhirType Reference":
    [MedicationRequest: "ACE Inhibitor or ARB or ARNI"]

Patient

{
  "resourceType": "Patient",
  "id": "c095195c-8893-4bf1-aa7d-ad2bfd9bafa5",
  "meta": {
    "profile": [ "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient" ]
  },
  "name": [ {
    "family": "DENOMFail",
    "given": [ "EFLT40Obsv1MinAfterEncEdge" ]
  } ],
  "gender": "female",
  "birthDate": "1958-12-21"
}

MedicationRequest

{
  "resourceType": "MedicationRequest",
  "id": "07d579bf-dbf5-4122-82c4-40fccb1922dd",
  "meta": {
    "profile": [ "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest" ]
  },
  "status": "completed",
  "intent": "order",
  "medicationReference": {
    "reference": "Medication/5256de90-9f37-4c32-a9db-c45b3383d841"
  },
  "subject": {
    "reference": "Patient/c095195c-8893-4bf1-aa7d-ad2bfd9bafa5"
  },
  "authoredOn": "2026-04-15T10:30:00.000+00:00"
}

Medication

{
  "resourceType": "Medication",
  "id": "5256de90-9f37-4c32-a9db-c45b3383d841",
  "meta": {
    "profile": [ "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medication" ]
  },
  "code": {
    "coding": [ {
      "system": "http://www.nlm.nih.gov/research/umls/rxnorm",
      "version": "06052023",
      "code": "1000001",
      "display": "amlodipine 5 MG / hydrochlorothiazide 25 MG / olmesartan medoxomil 40 MG Oral Tablet"
    } ]
  }
}