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.

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element.

This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.

An Extension

R4: ChargeItem.definitionCanonical (new:canonical(ChargeItemDefinition))

Element ChargeItem.definitionCanonical has a context of ChargeItem based on following the parent source element upwards and mapping to ChargeItem. Element ChargeItem.definitionCanonical has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

R4: ChargeItem.costCenter (new:Reference(Organization))

Element ChargeItem.costCenter has a context of ChargeItem based on following the parent source element upwards and mapping to ChargeItem. Element ChargeItem.costCenter has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). The costCenter could either be given as a reference to an Organization(Role) resource or as the identifier of the cost center determined by Reference.identifier.value and Reference.identifier.system, depending on use case requirements.

R4: ChargeItem.product[x] (new:CodeableConcept, Reference(Device,Medication,Substance))

Element ChargeItem.product[x] has a context of ChargeItem based on following the parent source element upwards and mapping to ChargeItem. Element ChargeItem.product[x] has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

The current state of the ChargeItem.

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.

Codes identifying the stage lifecycle stage of a ChargeItem

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

Example set of codes that can be used for billing purposes

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

Links the event to the Patient context.

R4: ChargeItem.definitionCanonical (new:canonical(ChargeItemDefinition))

Element ChargeItem.definitionCanonical has a context of ChargeItem based on following the parent source element upwards and mapping to ChargeItem. Element ChargeItem.definitionCanonical has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

R4: ChargeItem.costCenter (new:Reference(Organization))

Element ChargeItem.costCenter has a context of ChargeItem based on following the parent source element upwards and mapping to ChargeItem. Element ChargeItem.costCenter has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). The costCenter could either be given as a reference to an Organization(Role) resource or as the identifier of the cost center determined by Reference.identifier.value and Reference.identifier.system, depending on use case requirements.

R4: ChargeItem.product[x] (new:CodeableConcept, Reference(Device,Medication,Substance))

Element ChargeItem.product[x] has a context of ChargeItem based on following the parent source element upwards and mapping to ChargeItem. Element ChargeItem.product[x] has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

R4: ChargeItem.performer.actor

Element ChargeItem.performer.actor is mapped to FHIR STU3 element ChargeItem.participant.actor as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R4 element ChargeItem.performer.actor with unmapped reference targets: CareTeam, PractitionerRole.

R4: ChargeItem.enterer

Element ChargeItem.enterer is mapped to FHIR STU3 element ChargeItem.enterer as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R4 element ChargeItem.enterer with unmapped reference targets: PractitionerRole. The enterer is also the person considered responsible for factor/price overrides if applicable.

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.

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource.

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element.

This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.

The base language in which the resource is written.

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

A human language.

A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded in formation is added later.

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again.

An Extension

R4: ChargeItem.definitionCanonical (new:canonical(ChargeItemDefinition))

Element ChargeItem.definitionCanonical has a context of ChargeItem based on following the parent source element upwards and mapping to ChargeItem. Element ChargeItem.definitionCanonical has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

R4: ChargeItem.costCenter (new:Reference(Organization))

Element ChargeItem.costCenter has a context of ChargeItem based on following the parent source element upwards and mapping to ChargeItem. Element ChargeItem.costCenter has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). The costCenter could either be given as a reference to an Organization(Role) resource or as the identifier of the cost center determined by Reference.identifier.value and Reference.identifier.system, depending on use case requirements.

R4: ChargeItem.product[x] (new:CodeableConcept, Reference(Device,Medication,Substance))

Element ChargeItem.product[x] has a context of ChargeItem based on following the parent source element upwards and mapping to ChargeItem. Element ChargeItem.product[x] has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Identifiers assigned to this event performer or other systems.

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

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

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).

The current state of the ChargeItem.

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.

Codes identifying the stage lifecycle stage of a ChargeItem

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

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

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

Example set of codes that can be used for billing purposes

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

Links the event to the Patient context.

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

Links the request to the Encounter context.

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

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

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

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

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

Codes describing the types of functional roles performers can take on when performing events

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

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

R4: ChargeItem.performer.actor

Element ChargeItem.performer.actor is mapped to FHIR STU3 element ChargeItem.participant.actor as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R4 element ChargeItem.performer.actor with unmapped reference targets: CareTeam, PractitionerRole.

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Plain text narrative that identifies the resource in addition to the resource reference.

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

The organization requesting the service.

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.

The organization performing the service.

The rendered Service may 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).

Quantity of which the charge item has been serviced.

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

The anatomical location where the related service has been applied.

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-site-instance. May be a summary code, or a reference to a very precise definition of the location, or both.

Codes describing anatomical locations. May include laterality.

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

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.

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

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.

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.

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

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

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

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

R4: ChargeItem.enterer

Element ChargeItem.enterer is mapped to FHIR STU3 element ChargeItem.enterer as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R4 element ChargeItem.enterer with unmapped reference targets: PractitionerRole. The enterer is also the person considered responsible for factor/price overrides if applicable.

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Plain text narrative that identifies the resource in addition to the resource reference.

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Date the charge item was entered.

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

Describes why the event occurred in coded or textual form.

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.

Example binding for reason

Indicated the rendered service that caused this charge.

Account into which this ChargeItems belongs.

Systems posting the ChargeItems may 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.

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

Further information supporting the this charge.