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. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of its narrative along with other profiles, value sets, etc.

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning.

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. Contained resources may have profiles and tags in their meta elements, but SHALL NOT have security labels.

An Extension

R4: ChargeItem.factorOverride (new:decimal)

Element ChargeItem.factorOverride has a context of ChargeItem based on following the parent source element upwards and mapping to ChargeItem. Element ChargeItem.factorOverride has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element). 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 overridden.

R4: ChargeItem.priceOverride (new:Money)

Element ChargeItem.priceOverride has a context of ChargeItem based on following the parent source element upwards and mapping to ChargeItem. Element ChargeItem.priceOverride has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element). 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 overridden.

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 and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, 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.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

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.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

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 lifecycle stage of a ChargeItem.

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

Example codes 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.factorOverride (new:decimal)

Element ChargeItem.factorOverride has a context of ChargeItem based on following the parent source element upwards and mapping to ChargeItem. Element ChargeItem.factorOverride has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element). 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 overridden.

R4: ChargeItem.priceOverride (new:Money)

Element ChargeItem.priceOverride has a context of ChargeItem based on following the parent source element upwards and mapping to ChargeItem. Element ChargeItem.priceOverride has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element). 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 overridden.

R4: ChargeItem.context additional types from child elements (display, identifier, reference, type)

Element ChargeItem.context is mapped to FHIR R5 element ChargeItem.encounter as SourceIsBroaderThanTarget. The mappings for ChargeItem.context do not cover the following types based on type expansion: display, identifier, reference, type. The standard extension alternate-reference has been mapped as the representation of FHIR R4 element ChargeItem.context with unmapped reference targets: EpisodeOfCare.

R4: ChargeItem.overrideReason additional types (string) additional types from child elements (value)

Element ChargeItem.overrideReason is mapped to FHIR R5 element ChargeItem.overrideReason as SourceIsBroaderThanTarget. The mappings for ChargeItem.overrideReason do not cover the following types: string. The mappings for ChargeItem.overrideReason do not cover the following types based on type expansion: value. Derived Profiles may choose to add invariants requiring this field to be populated if either priceOverride or factorOverride have been filled.

R4: ChargeItem.service additional types (Reference(http://hl7.org/fhir/StructureDefinition/ImagingStudy), Reference(http://hl7.org/fhir/StructureDefinition/Immunization), Reference(http://hl7.org/fhir/StructureDefinition/MedicationAdministration), Reference(http://hl7.org/fhir/StructureDefinition/MedicationDispense), Reference(http://hl7.org/fhir/StructureDefinition/Observation), Reference(http://hl7.org/fhir/StructureDefinition/Procedure), Reference(http://hl7.org/fhir/StructureDefinition/SupplyDelivery))

Element ChargeItem.service is mapped to FHIR R5 element ChargeItem.service as RelatedTo. The mappings for ChargeItem.service do not cover the following types: Reference.

R4: ChargeItem.product[x] additional types (Reference(http://hl7.org/fhir/StructureDefinition/Medication), Reference(http://hl7.org/fhir/StructureDefinition/Substance))

Element ChargeItem.product[x] is mapped to FHIR R5 element ChargeItem.product as RelatedTo. The mappings for ChargeItem.product[x] do not cover the following types: Reference.

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.

Within the context of the FHIR RESTful interactions, the resource has an id except for cases like the create and conditional update. Otherwise, the use of the resouce id depends on the given use case.

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might 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. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of its narrative along with other profiles, value sets, etc.

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).

IETF language tag for a human language

A human-readable narrative that contains a summary of the resource and can 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 a 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 information is added later.

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning.

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. Contained resources may have profiles and tags in their meta elements, but SHALL NOT have security labels.

An Extension

R4: ChargeItem.factorOverride (new:decimal)

Element ChargeItem.factorOverride has a context of ChargeItem based on following the parent source element upwards and mapping to ChargeItem. Element ChargeItem.factorOverride has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element). 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 overridden.

R4: ChargeItem.priceOverride (new:Money)

Element ChargeItem.priceOverride has a context of ChargeItem based on following the parent source element upwards and mapping to ChargeItem. Element ChargeItem.priceOverride has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element). 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 overridden.

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 and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, 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.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

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.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

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 (external) source of pricing information, rules of application for the code this ChargeItem uses.

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

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 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 codes for billing purposes

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

Links the event to the Patient context.

This ChargeItem has the details of how the associated Encounter should be billed or otherwise be handled by finance systems.

This ChargeItem may be recorded during planning, execution or after the actual encounter takes place.

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.context additional types from child elements (display, identifier, reference, type)

Element ChargeItem.context is mapped to FHIR R5 element ChargeItem.encounter as SourceIsBroaderThanTarget. The mappings for ChargeItem.context do not cover the following types based on type expansion: display, identifier, reference, type. The standard extension alternate-reference has been mapped as the representation of FHIR R4 element ChargeItem.context with unmapped reference targets: EpisodeOfCare.

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.

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a known RESTful URL) or by resolving the target of the reference.

Unless not suitable, these codes SHALL be taken from ResourceType
(extensible to http://hl7.org/fhir/ValueSet/resource-types|5.0.0)

Aa resource (or, for logical models, the URI of the logical model).

An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents 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.

Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

This element only allows for a single identifier. In the case where additional identifers are required, use the http://hl7.org/fhir/StructureDefinition/additionalIdentifier extension.

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/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. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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 in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

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.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Describes the type of performance or participation(e.g. primary surgeon, anesthesiologiest, 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.

The organization performing 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 requesting the service.

The rendered Service might not be associated with a Request. This property indicates which Organization requested the services to be rendered. (In many cases, this may just be the Department associated with the Encounter.location).

The financial cost center permits the tracking of charge attribution.

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.

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 http://hl7.org/fhir/StructureDefinition/bodySite. May be a summary code, or a reference to a very precise definition of the location, or both.

SNOMED CT Body site concepts

The unit price of the chargable item.

This could be communicated in ChargeItemDefinition. But if ChargeItemDefinition is not supported or not available, the unit price can be communicated in this property.

The total price for the chargable item, accounting for the quantity.

Often, the total price may be be calculated and recorded on the Invoice, but if a calculated total price must be exchanged prior to Invoice creation, it can be communicated in this property.

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.

Local or regional codes covering why a price was overridden

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.overrideReason additional types (string) additional types from child elements (value)

Element ChargeItem.overrideReason is mapped to FHIR R5 element ChargeItem.overrideReason as SourceIsBroaderThanTarget. The mappings for ChargeItem.overrideReason do not cover the following types: string. The mappings for ChargeItem.overrideReason do not cover the following types based on type expansion: value. Derived Profiles may choose to add invariants requiring this field to be populated if either priceOverride or factorOverride have been filled.

A reference to a code defined by a terminology system.

Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

Allows for alternative encodings within a code system, and translations to other code systems.

A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

Very often the text is the same as a displayName of one of the codings.

The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

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

The enterer is also the person considered responsible for factor/price overrides if applicable.

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.

ICD 10 diagnosis codes

Indicated the rendered service that caused this charge.

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.service additional types (Reference(http://hl7.org/fhir/StructureDefinition/ImagingStudy), Reference(http://hl7.org/fhir/StructureDefinition/Immunization), Reference(http://hl7.org/fhir/StructureDefinition/MedicationAdministration), Reference(http://hl7.org/fhir/StructureDefinition/MedicationDispense), Reference(http://hl7.org/fhir/StructureDefinition/Observation), Reference(http://hl7.org/fhir/StructureDefinition/Procedure), Reference(http://hl7.org/fhir/StructureDefinition/SupplyDelivery))

Element ChargeItem.service is mapped to FHIR R5 element ChargeItem.service as RelatedTo. The mappings for ChargeItem.service do not cover the following types: Reference.

A reference to a concept - e.g. the information is identified by its general class to the degree of precision found in the terminology.

A reference to a resource the provides exact details about the information being referenced.

Identifies the device, food, drug or other product being charged either by type code or reference to an instance.

Example binding for product type.

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.product[x] additional types (Reference(http://hl7.org/fhir/StructureDefinition/Medication), Reference(http://hl7.org/fhir/StructureDefinition/Substance))

Element ChargeItem.product[x] is mapped to FHIR R5 element ChargeItem.product as RelatedTo. The mappings for ChargeItem.product[x] do not cover the following types: Reference.

A reference to a concept - e.g. the information is identified by its general class to the degree of precision found in the terminology.

A reference to a resource the provides exact details about the information being referenced.

Account into which this ChargeItems belongs.

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 postprocessing 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 this charge.