This page is part of the Da Vinci Payer Data Exchange (v0.1.0: STU 1 Ballot 1) based on FHIR R4. The current version which supercedes this version is 1.0.0. For a full list of available versions, see the Directory of published versions

3-6-7 US Core Procedure

Section Guide:

Implementation... - Actors - Exchange Interactions - Data Payloads - Interaction Methods - Interaction and Payload Matrix - Data Mapping

3-6-1 US Core Patient 3-6-2 Coverage 3-6-3 US Core Encounter 3-6-4 US Core Location 3-6-5 MedicationDispense 3-6-6 US Core Practitioner 3-6-7 US Core Procedure 3-6-8 US Core Condition

3-6-9 US Core AllergyIntolerance 3-6-10 US Core Immunization 3-6-11 US Core DiagnosticReport 3-6-12 US Core Observation 3-6-13 US Core DocumentReference 3-6-14 US Core PractitionerRole 3-6-15 US Core Device 3-6-16 US Core Organization

3-6-17 US Core CarePlan 3-6-18 US Core CareTeam 3-6-19 US Core Medication 3-6-20 US Core MedicationRequest 3-6-21 US Core MedicationStatement 3-6-22 US Core Goal Profile

The US Core Procedure profile SHALL be used to record a members health events.

The essential fields to be provided in the US Core Procedure resource are:

R4 Hierarchical Name	R4 Name	Card.	Type
Procedure	Procedure	0..*
Procedure.id	id	0..1	id
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	dateTime, Period
Procedure.performer.actor	actor	1..1	Reference(Practitioner	PractitionerRole	Organization	Patient	RelatedPerson	Device)

3-6-3-1 Health Plan Mapping Assistance

A collaboration of Health Plan experts have 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:

Line	PayerSourceRecord	CMS BB 2.0 Field	Data Descriptor	FHIR Profile	Profile Field	ValueSet	Notes
1.4	Member	BENE_ID	Patientid	US Core Procedure	.subject		Reference(Patient)
1.1	Claim-Line		Service (from) date	US Core Procedure	.occurence.occurrencePeriod.start
1.1	Procedure		Procedure code	US Core Procedure	.code
2.1	Procedure		Procedure date	US Core Procedure	.performed.dateTime
3.1	Procedure		Procedure code type	US Core Procedure	.category
4.1	Procedure		Procedure type	US Core Procedure	.code.coding.system
5.1	Procedure		Modifier Code -1	US Core Procedure	.modifierExtension
6.1	Procedure		Modifier Code -2	US Core Procedure	.modifierExtension
7.1	Procedure		Modifier Code -3	US Core Procedure	.modifierExtension
8.1	Procedure		Modifier Code -4	US Core Procedure	.modifierExtension

Where an entry is provided in the CMS BB2.0 FIELD column the definition of the field can be reviewed using the following URL:

https://bluebutton.cms.gov/resources/variables/{CMS_BB2.0_FIELD}/

Where {CMS_BB2.0_FIELD} is replaced with the Field value in lower case. For example:

https://bluebutton.cms.gov/resources/variables/bene_id/ https://bluebutton.cms.gov/resources/variables/dob_dt/

3-6-7-2 Example Procedure Resource

An example mapping of an Procedure resource for a medical impiant is shown here:

{
  "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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