R4 Draft for Comment

This page is part of the FHIR Specification (v3.2.0: R4 Ballot 1). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3

Patient Administration Work GroupMaturity Level: 0 Draft Compartments: Device, Encounter, Patient, Practitioner, RelatedPerson

Detailed Descriptions for the elements in the ChargeItem resource.

ChargeItem
Definition

The resource ChargeItem describes the provision of healthcare provider products for a certain patient, therefore referring not only to the product, but containing in addition details of the provision, like date, time, amounts and participating organizations and persons. Main Usage of the ChargeItem is to enable the billing process and internal cost allocation.

Control1..1
ChargeItem.identifier
Definition

Identifiers assigned to this event performer or other systems.

NoteThis is a business identifer, not a resource identifier (see discussion)
Control0..1
TypeIdentifier
Requirements

Allows identification of the charge Item as it is known by various participating systems and in a way that remains consistent across servers.

Summarytrue
ChargeItem.definition
Definition

References the source of pricing information, rules of application for the code this ChargeItem uses.

Control0..*
Typeuri
Summaryfalse
Comments

Target Resource is yet to be defined as a container that holds information about list prices and rules applicable to the charge item code. Once defined, change type back to Reference(Definition Type).

ChargeItem.status
Definition

The current state of the ChargeItem.

Control1..1
Terminology BindingChargeItemStatus (Required)
Typecode
Is Modifiertrue
Summarytrue
Comments

Unknown does not represent "other" - one of the defined statuses must apply. Unknown is used when the authoring system is not sure what the current status is.

This element is labeled as a modifier because the status contains the code entered-in-error that marks the charge item as not currently valid.

ChargeItem.partOf
Definition

ChargeItems can be grouped to larger ChargeItems covering the whole set.

Control0..*
TypeReference(ChargeItem)
Requirements

E.g. Drug administration as part of a procedure, procedure as part of observation, etc.

Alternate Namescontainer
Summaryfalse
ChargeItem.code
Definition

A code that identifies the charge, like a billing code.

Control1..1
Terminology BindingChargeItemCode (Example)
TypeCodeableConcept
Alternate Namestype
Summarytrue
ChargeItem.subject
Definition

The individual or set of individuals the action is being or was performed on.

Control1..1
TypeReference(Patient | Group)
Requirements

Links the event to the Patient context.

Alternate Namespatient
Summarytrue
ChargeItem.context
Definition

The encounter or episode of care that establishes the context for this event.

Control0..1
TypeReference(Encounter | EpisodeOfCare)
Requirements

Links the request to the Encounter context.

Alternate Namesencounter
Summarytrue
ChargeItem.occurrence[x]
Definition

Date/time(s) or duration when the charged service was applied.

Control0..1
TypedateTime|Period|Timing
[x] NoteSee Choice of Data Types for further information about how to use [x]
Alternate Namestiming
Summarytrue
Comments

The list of types may be constrained as appropriate for the type of charge item.

ChargeItem.participant
Definition

Indicates who or what performed or participated in the charged service.

Control0..*
Summaryfalse
ChargeItem.participant.role
Definition

Describes the type of performance or participation(e.g. primary surgeon, anaesthesiologiest, etc.).

Control0..1
Terminology BindingProcedure Performer Role Codes (Example)
TypeCodeableConcept
Summaryfalse
ChargeItem.participant.actor
Definition

The device, practitioner, etc. who performed or participated in the service.

Control1..1
TypeReference(Practitioner | Organization | Patient | Device | RelatedPerson)
Summaryfalse
ChargeItem.performingOrganization
Definition

The organization requesting the service.

Control0..1
TypeReference(Organization)
Summaryfalse
Comments

Practitioners and Devices can be associated with multiple organizations. It has to be made clear, on behalf of which Organization the services have been rendered.

ChargeItem.requestingOrganization
Definition

The organization performing the service.

Control0..1
TypeReference(Organization)
Summaryfalse
Comments

The rendered Service might not be associated with a Request. It has to be made clear, ob which Organization's Request, the services have been rendered. (In many cases, this may just be the Department associated with the Encounter.location).

ChargeItem.quantity
Definition

Quantity of which the charge item has been serviced.

Control0..1
TypeQuantity
Summarytrue
Comments

In many cases this may just be a value, if the underlying units are implicit in the definition of the charge item code.

ChargeItem.bodysite
Definition

The anatomical location where the related service has been applied.

Control0..*
Terminology BindingSNOMED CT Body Structures (Example)
TypeCodeableConcept
Summarytrue
Comments

Only used if not implicit in code found in Condition.code. If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension body-structure. May be a summary code, or a reference to a very precise definition of the location, or both.

ChargeItem.factorOverride
Definition

Factor overriding the factor determined by the rules associated with the code.

Control0..1
Typedecimal
Summaryfalse
Comments

There is no reason to carry the factor in the instance of a ChargeItem unless special circumstances require a manual override. The factors are usually defined by a set of rules in a back catalogue of the billing codes (see ChargeItem.definition). Derived profiles may require a ChargeItem.overrideReason to be provided if either factor or price are manually overriden.

ChargeItem.priceOverride
Definition

Total price of the charge overriding the list price associated with the code.

Control0..1
TypeMoney
Summaryfalse
Comments

There is no reason to carry the price in the instance of a ChargeItem unless circumstances require a manual override. The list prices or are usually defined in a back catalogue of the billing codes (see ChargeItem.definition). Derived profiles may require a ChargeItem.overrideReason to be provided if either factor or price are manually overriden.

ChargeItem.overrideReason
Definition

If the list price or the rule based factor associated with the code is overridden, this attribute can capture a text to indicate the reason for this action.

Control0..1
Typestring
Summaryfalse
Comments

Derived Profiles may chose to add invariants requiring this field to be populated if either priceOverride or factorOverride have been filled.

ChargeItem.enterer
Definition

The device, practitioner, etc. who entered the charge item.

Control0..1
TypeReference(Practitioner | Organization | Patient | Device | RelatedPerson)
Summarytrue
Comments

The enterer is also te person considered responsible for factor/priceOverrides if applicable.

ChargeItem.enteredDate
Definition

Date the charge item was entered.

Control0..1
TypedateTime
Summarytrue
Comments

The actual date when the service associated with the charge has been rendered is captured in occurrence[x].

ChargeItem.reason
Definition

Describes why the event occurred in coded or textual form.

Control0..*
Terminology BindingICD-10 Codes (Example)
TypeCodeableConcept
Summaryfalse
Comments

If the application of the charge item requires a reason to be given, it can be captured here. Textual reasons can be captured using reasonCode.text.

ChargeItem.service
Definition

Indicated the rendered service that caused this charge.

Control0..*
TypeReference(DiagnosticReport | ImagingStudy | Immunization | MedicationAdministration | MedicationDispense | Observation | Procedure | SupplyDelivery)
Summaryfalse
ChargeItem.account
Definition

Account into which this ChargeItems belongs.

Control0..*
TypeReference(Account)
Summarytrue
Comments

Systems posting the ChargeItems might not always be able to determine, which accounts the Items need to be places into. It is up to the potprocessing Financial System to apply internal rules to decide based on the Encounter/EpisodeOfCare/Patient/Coverage context and the type of ChargeItem, which Account is appropriate.

ChargeItem.note
Definition

Comments made about the event by the performer, subject or other participants.

Control0..*
TypeAnnotation
Summaryfalse
ChargeItem.supportingInformation
Definition

Further information supporting the this charge.

Control0..*
TypeReference(Any)
Summaryfalse