Da Vinci Payer Data Exchange
1.0.0 - STU1

This page is part of the Da Vinci Payer Data Exchange (v1.0.0: STU1) based on FHIR R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

US Core Procedure

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The US Core Procedure profile SHALL be used to record a member’s health events.

The essential fields (Must Support or Cardinality greater than 0..*) to be provided in the US Core Procedure profile are:

R4 Element Name Cardinality Type
Procedure.status status 1..1 code
Procedure.code code 1..1 CodeableConcept
Procedure.subject subject 1..1 Reference(US Core Patient Profile)
Procedure.performed[x] performed[x] 1..1  

Table Definition

Health Plan Mapping Assistance

A collaboration of Health Plan experts has performed an evaluation of claims information and developed a mapping of data for Members to the US Core Procedure profile. This is shown below as an assistance to implementers:

US Core Element Must Support Cardinality CARIN-BB Element CPCDS Element Mapping or Implementer Note
- Procedure.meta.lastUpdated   0..1 ExplanationOfBenefit.meta.lastUpdated [{“163”:”EOB Last Updated Date”}]
Procedure.identifier   0..* ExplanationOfBenefit.identifier [{“35”:”Payer claim unique identifier”}]. Note: Assign Payer System URI for Unique Claim Id in Procedure.identifier.system. Set Claim Id in Procedure.identifier.value
Procedure.status S 1..1   . Note: Note: EOB Status 0f [active | cancelled | draft | entered-in-error] = [completed|not-done|unknown|entered-in-error]
Procedure.code S 1..1   [{“24, 26, 146”:”ICD Procedure Code”}, {“40”:”Procedure Code - CPT / HCPCS”}
Procedure.subject S 1..1 ExplanationOfBenefit.patient [{“Ref (1), Ref (109)”:”Member id, Patient account number”}, {“Ref (191)”:”Unique Member ID”}, {“Ref (110)”:”Medical record number”}
Procedure.performed[x] S 1..1   . Note: Enter Procedure.performedPeriod or Procedure.performedDateTime (next field below)
Procedure.performedDateTime     ExplanationOfBenefit.procedure.date, ExplanationOfBenefit.item.serviced.servicedPeriod, ExplanationOfBenefit.item.serviced.servicedDate [{“25, 27”:”Procedure date”}, {“90, 119”:”Service from date, Service to date”}
Procedure.performedPeriod     ExplanationOfBenefit.procedure.date, ExplanationOfBenefit.item.serviced.servicedPeriod, ExplanationOfBenefit.item.serviced.servicedDate [{“25, 27”:”Procedure date”}, {“90, 119”:”Service from date, Service to date”}
Procedure.location   0..1 ExplanationOfBenefit.item.location. locationCodeableConcept, ExplanationOfBenefit.item.supportingInfo.location. locationCodeableConcept [{“46”:”Place of service code”}, {“97, 170, 176”:”Service Facility NPI (if available), Name, Address”}]
Procedure.reasonCode   0..* ExplanationOfBenefit.procedure.procedure, ExplanationOfBenefit.item.productOrService [{“24, 26, 146”:”ICD Procedure Code”}, {“40”:”Procedure Code - CPT / HCPCS”}

Table Definition

Example Procedure Resource

An example mapping of a Procedure resource for a medical implant is presented below:

{
  "resourceType" : "Procedure",
  "id" : "defib-implant",
  "meta" : {
    "profile" : [
      "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure"
    ]
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">
Generated Narrative with Details
id: defib-implant
meta: 
identifier: urn:uuid:b2a737f2-2fdb-49c1-b097-dac173d07aff
status: completed
code: Insertion or replacement of permanent implantable defibrillator system with transvenous lead(s), single or dual chamber <span style=\"background: LightGoldenRodYellow\">(Details : {http://www.ama-assn.org/go/cpt code '33249' = '33249)</span>
subject: <a href=\"Patient-example.html\">Generated Summary: id: example; Medical Record Number = 1032702 (USUAL); active; Amy V. Shaw ; ph: 555-555-5555(HOME), amy.shaw@example.com; gender: female; birthDate: Feb 20, 2007</a>
performed: Mar 26, 2019, 7:55:26 PM --> Mar 26, 2019, 8:25:26 PM
Performers
<table class=\"grid\">-Actor*<a href=\"Practitioner-practitioner-1.html\">Generated Summary: id: practitioner-1; 9941339108, 25456; Ronald Bone </a></table>
FocalDevices
<table class=\"grid\">-Manipulated*<a href=\"Device-udi-2.html\">Generated Summary: id: udi-2; status: active; manufacturer: ACME Biomedical; expirationDate: Jan 1, 2022, 12:00:00 AM; lotNumber: M320; serialNumber: AC221; modelNumber: 1.0; <span title=\"Codes: {http://snomed.info/sct 19257004}\">Implant</span></a></table></div>"
  },
  "identifier" : [
    {
      "system" : "urn:ietf:rfc:3986",
      "value" : "urn:uuid:b2a737f2-2fdb-49c1-b097-dac173d07aff"
    }
  ],
  "status" : "completed",
  "code" : {
    "coding" : [
      {
        "system" : "http://www.ama-assn.org/go/cpt",
        "code" : "33249"
      }
    ],
    "text" : "Insertion or replacement of permanent implantable defibrillator system with transvenous lead(s), single or dual chamber"
  },
  "subject" : {
    "reference" : "Patient/example"
  },
  "performedPeriod" : {
    "start" : "2019-03-26T12:55:26-07:00",
    "end" : "2019-03-26T13:25:26-07:00"
  },
  "performer" : [
    {
      "actor" : {
        "reference" : "Practitioner/practitioner-1"
      }
    }
  ],
  "focalDevice" : [
    {
      "manipulated" : {
        "reference" : "Device/udi-2"
      }
    }
  ]
}

Refer to the US Core Additional examples of the US Core R4 Implementation Guide for further examples of completed US Core Procedure Profiles .

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