Patient Cost Transparency Implementation Guide
2.0.0-ballot - STU 2 Ballot US

This page is part of the Da Vinci Patient Cost Transparency Implementation Guide (v2.0.0-ballot: STU 2 Ballot) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 2.0.0. For a full list of available versions, see the Directory of published versions

Resource Profile: PCT Good Faith Estimate Summary

Official URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-summary Version: 2.0.0-ballot
Standards status: Trial-use Maturity Level: 1 Computable Name: PCTGFESummary
Other Identifiers: OID:2.16.840.1.113883.4.642.40.4.42.17

PCT Good Faith Estimate Summary is a profile for summarizing costs associated with a set of Good Faith Estimate Claims for a single Period of Care.

Usage:

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from Claim

NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim Claim
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
... gfeDisclaimer S 0..* string Disclaimers the patient should be made aware of regarding the estimate
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer
... serviceDescription S 0..1 string Service Description
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
... Slices for identifier 0..* Identifier Business Identifier for claim
Slice: Unordered, Open by pattern:type
.... identifier:INTER 0..* Identifier Intermediary System Identifier
..... type 1..1 CodeableConcept Description of identifier
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTIdentifierType
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: INTER
....... display 1..1 string Representation defined by the system
Fixed Value: Intermediary System Identifier
... type 1..1 CodeableConcept Category or discipline
Required Pattern: At least the following
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTEstimateTypeSummaryCSTemporaryTrialUse
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: estimate-summary
... subType 0..0
... use 1..1 code claim | preauthorization | predetermination
Required Pattern: predetermination
... patient 1..1 Reference(HRex Patient Demographics) The recipient of the products and services
... billablePeriod S 0..1 Period The full Period of Care for all services or products included in the estimate from the first event to the last event.
... enterer 0..0
... insurer S 0..1 Reference(PCT Organization) Target
... provider
.... extension 1..* Extension Extension
.... dataAbsentReason 1..1 (Complex) unknown | asked | temp | notasked | masked | unsupported | astext | error
URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
..... value[x] 1..1 code Value of extension
Required Pattern: not-applicable
.... reference 0..0
.... type 0..0
.... identifier 0..0
.... display 0..0
... priority 1..1 CodeableConcept Desired processing ugency
Binding: ProcessPriorityCodes (required)
... fundsReserve 0..0
... prescription 0..0
... originalPrescription 0..0
... payee 0..0
... referral 0..0
... facility 0..0
... Slices for careTeam S 0..* BackboneElement Members of the care team
Slice: Unordered, Open by pattern:role
.... careTeam:All Slices Content/Rules for all slices
..... provider 1..1 Reference(PCT Practitioner | PCT Organization) Practitioner or organization
..... role 1..1 CodeableConcept Function within the team
Binding: PCT Care Team Role Value Set (required)
..... qualification 0..1 CodeableConcept Practitioner credential or specialization
Binding: US Core Provider Role (NUCC) (required)
.... careTeam:attending S 0..1 BackboneElement Members of the care team
..... provider 1..1 Reference(PCT Practitioner) Practitioner or organization
..... role 0..1 CodeableConcept Function within the team
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: attending
..... qualification 1..1 CodeableConcept Practitioner credential or specialization
.... careTeam:operating S 0..2 BackboneElement Members of the care team
..... provider 1..1 Reference(PCT Practitioner) Practitioner or organization
..... role 0..1 CodeableConcept Function within the team
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: operating
.... careTeam:rendering S 0..1 BackboneElement Members of the care team
..... provider 1..1 Reference(PCT Practitioner) Practitioner or organization
..... role 0..1 CodeableConcept Function within the team
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: rendering
.... careTeam:referring S 0..1 BackboneElement Members of the care team
..... role 0..1 CodeableConcept Function within the team
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: referring
... supportingInfo 0..0
... Slices for diagnosis S 1..* BackboneElement Pertinent diagnosis information
Slice: Unordered, Open by pattern:type
.... diagnosis:All Slices Content/Rules for all slices
..... type S 0..* CodeableConcept Timing or nature of the diagnosis
Binding: PCT Diagnosis Type Value Set (required)
.... diagnosis:principal 1..1 BackboneElement Pertinent diagnosis information
..... sequence 1..1 positiveInt Diagnosis instance identifier
Required Pattern: 1
..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Binding: PCT ICD-10 Diagnostic Codes (required)
..... type 1..1 CodeableConcept Timing or nature of the diagnosis
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/ex-diagnosistype
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: principal
.... diagnosis:admitting S 0..1 BackboneElement Pertinent diagnosis information
..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Binding: PCT ICD-10 Diagnostic Codes (required)
..... type 1..1 CodeableConcept Timing or nature of the diagnosis
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/ex-diagnosistype
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: admitting
.... diagnosis:patientReasonForVisit S 0..3 BackboneElement Pertinent diagnosis information
..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Binding: PCT ICD-10 Diagnostic Codes (required)
..... type 1..1 CodeableConcept Timing or nature of the diagnosis
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: patientReasonForVisit
.... diagnosis:externalcauseofinjury S 0..12 BackboneElement Pertinent diagnosis information
..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Binding: PCT ICD-10 Diagnostic Codes (required)
..... type 1..1 CodeableConcept Timing or nature of the diagnosis
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: externalCauseOfInjury
.... diagnosis:other S 0..24 BackboneElement Pertinent diagnosis information
..... diagnosis[x] S 1..1 CodeableConcept Nature of illness or problem
Binding: PCT ICD-10 Diagnostic Codes (required)
..... type 1..1 CodeableConcept Timing or nature of the diagnosis
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: other
... Slices for procedure S 0..* BackboneElement Clinical procedures performed
Slice: Unordered, Open by pattern:type
.... procedure:All Slices Content/Rules for all slices
..... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
..... serviceDescription 1..1 string Service Description
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
..... type S 0..* CodeableConcept Category of Procedure
Binding: PCT Procedure Type Value Set (required)
.... procedure:principal S 0..1 BackboneElement Principal clinical procedure performed
..... serviceDescription 1..1 string Service Description
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
..... sequence 1..1 positiveInt Procedure instance identifier
Required Pattern: 1
..... type 1..1 CodeableConcept Category of Procedure
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: principal
..... procedure[x] 1..1 CodeableConcept Specific clinical procedure
Binding: ICD-10 Procedure Codes (required)
.... procedure:other S 0..24 BackboneElement Clinical procedures performed
..... serviceDescription 1..1 string Service Description
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
..... type 1..1 CodeableConcept Category of Procedure
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: other
..... procedure[x] 1..1 CodeableConcept Specific clinical procedure
Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required)
... insurance
.... coverage 1..1 Reference(PCT Coverage) Insurance information
.... preAuthRef 0..0
... accident
.... location[x] 0..1 Address Where the event occurred
..... country 0..1 string Country (e.g. can be ISO 3166 2 or 3 letter code)
Binding: Iso3166-1-2 (required)
... item 0..0
... total 1..1 Money Total GFE Charges

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSetURI
Claim.priorityrequiredProcessPriorityCodes
http://hl7.org/fhir/ValueSet/process-priority
from the FHIR Standard
Claim.careTeam.rolerequiredPCTCareTeamRoleVS
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTCareTeamRoleVS
from this IG
Claim.careTeam.qualificationrequiredUSCoreProviderRoleNucc
http://hl7.org/fhir/us/core/ValueSet/us-core-provider-role
Claim.diagnosis.typerequiredPCTDiagnosisTypeVS
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosisTypeVS
from this IG
Claim.diagnosis:principal.diagnosis[x]requiredPCTDiagnosticCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes
from this IG
Claim.diagnosis:admitting.diagnosis[x]requiredPCTDiagnosticCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes
from this IG
Claim.diagnosis:patientReasonForVisit.diagnosis[x]requiredPCTDiagnosticCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes
from this IG
Claim.diagnosis:externalcauseofinjury.diagnosis[x]requiredPCTDiagnosticCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes
from this IG
Claim.diagnosis:other.diagnosis[x]requiredPCTDiagnosticCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes
from this IG
Claim.procedure.typerequiredPCTProcedureTypeVS
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureTypeVS
from this IG
Claim.procedure:principal.procedure[x]requiredICD10ProcedureCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/ICD10ProcedureCodes
from this IG
Claim.procedure:other.procedure[x]requiredPCTProcedureSurgicalCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureSurgicalCodes
from this IG
Claim.accident.location[x].countryrequiredIso3166-1-2
http://hl7.org/fhir/ValueSet/iso3166-1-2
from the FHIR Standard
NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim 0..* Claim Claim, Pre-determination or Pre-authorization
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
... gfeDisclaimer S 0..* string Disclaimers the patient should be made aware of regarding the estimate
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... Slices for identifier 0..* Identifier Business Identifier for claim
Slice: Unordered, Open by pattern:type
.... identifier:INTER 0..* Identifier Intermediary System Identifier
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

..... type Σ 1..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTIdentifierType
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: INTER
....... display 1..1 string Representation defined by the system
Fixed Value: Intermediary System Identifier
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

... type Σ 1..1 CodeableConcept Category or discipline
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.


Required Pattern: At least the following
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTEstimateTypeSummaryCSTemporaryTrialUse
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: estimate-summary
... use Σ 1..1 code claim | preauthorization | predetermination
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.


Required Pattern: predetermination
... patient Σ 1..1 Reference(HRex Patient Demographics) The recipient of the products and services
... billablePeriod SΣ 0..1 Period The full Period of Care for all services or products included in the estimate from the first event to the last event.
... created Σ 1..1 dateTime Resource creation date
... insurer SΣ 0..1 Reference(PCT Organization) Target
... provider Σ 1..1 Reference(Practitioner | PractitionerRole | Organization) Party responsible for the claim
.... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
.... dataAbsentReason 1..1 (Complex) unknown | asked | temp | notasked | masked | unsupported | astext | error
URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
..... extension 0..0
..... url 1..1 uri "http://hl7.org/fhir/StructureDefinition/data-absent-reason"
..... value[x] 1..1 code Value of extension
Binding: DataAbsentReason (required): Used to specify why the normally expected content of the data element is missing.


Required Pattern: not-applicable
... priority Σ 1..1 CodeableConcept Desired processing ugency
Binding: ProcessPriorityCodes (required)
... Slices for careTeam S 0..* BackboneElement Members of the care team
Slice: Unordered, Open by pattern:role
.... careTeam:All Slices Content/Rules for all slices
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Order of care team
..... provider 1..1 Reference(PCT Practitioner | PCT Organization) Practitioner or organization
..... role 1..1 CodeableConcept Function within the team
Binding: PCT Care Team Role Value Set (required)
..... qualification 0..1 CodeableConcept Practitioner credential or specialization
Binding: US Core Provider Role (NUCC) (required)
.... careTeam:attending S 0..1 BackboneElement Members of the care team
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Order of care team
..... provider 1..1 Reference(PCT Practitioner) Practitioner or organization
..... role 0..1 CodeableConcept Function within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: attending
..... qualification 1..1 CodeableConcept Practitioner credential or specialization
Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.

.... careTeam:operating S 0..2 BackboneElement Members of the care team
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Order of care team
..... provider 1..1 Reference(PCT Practitioner) Practitioner or organization
..... role 0..1 CodeableConcept Function within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: operating
.... careTeam:rendering S 0..1 BackboneElement Members of the care team
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Order of care team
..... provider 1..1 Reference(PCT Practitioner) Practitioner or organization
..... role 0..1 CodeableConcept Function within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: rendering
.... careTeam:referring S 0..1 BackboneElement Members of the care team
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Order of care team
..... provider 1..1 Reference(Practitioner | PractitionerRole | Organization) Practitioner or organization
..... role 0..1 CodeableConcept Function within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: referring
... Slices for diagnosis S 1..* BackboneElement Pertinent diagnosis information
Slice: Unordered, Open by pattern:type
.... diagnosis:All Slices Content/Rules for all slices
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Diagnosis instance identifier
..... diagnosis[x] 1..1 Nature of illness or problem
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.

...... diagnosisCodeableConcept CodeableConcept
...... diagnosisReference Reference(Condition)
..... type S 0..* CodeableConcept Timing or nature of the diagnosis
Binding: PCT Diagnosis Type Value Set (required)
.... diagnosis:principal 1..1 BackboneElement Pertinent diagnosis information
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Diagnosis instance identifier
Required Pattern: 1
..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Binding: PCT ICD-10 Diagnostic Codes (required)
..... type 1..1 CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.



Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/ex-diagnosistype
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: principal
.... diagnosis:admitting S 0..1 BackboneElement Pertinent diagnosis information
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Diagnosis instance identifier
..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Binding: PCT ICD-10 Diagnostic Codes (required)
..... type 1..1 CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.



Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/ex-diagnosistype
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: admitting
.... diagnosis:patientReasonForVisit S 0..3 BackboneElement Pertinent diagnosis information
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Diagnosis instance identifier
..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Binding: PCT ICD-10 Diagnostic Codes (required)
..... type 1..1 CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.



Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: patientReasonForVisit
.... diagnosis:externalcauseofinjury S 0..12 BackboneElement Pertinent diagnosis information
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Diagnosis instance identifier
..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Binding: PCT ICD-10 Diagnostic Codes (required)
..... type 1..1 CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.



Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: externalCauseOfInjury
.... diagnosis:other S 0..24 BackboneElement Pertinent diagnosis information
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Diagnosis instance identifier
..... diagnosis[x] S 1..1 CodeableConcept Nature of illness or problem
Binding: PCT ICD-10 Diagnostic Codes (required)
..... type 1..1 CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.



Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: other
... Slices for procedure S 0..* BackboneElement Clinical procedures performed
Slice: Unordered, Open by pattern:type
.... procedure:All Slices Content/Rules for all slices
..... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
..... serviceDescription 1..1 string Service Description
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Procedure instance identifier
..... type S 0..* CodeableConcept Category of Procedure
Binding: PCT Procedure Type Value Set (required)
..... procedure[x] 1..1 Specific clinical procedure
Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.

...... procedureCodeableConcept CodeableConcept
...... procedureReference Reference(Procedure)
.... procedure:principal S 0..1 BackboneElement Principal clinical procedure performed
..... serviceDescription 1..1 string Service Description
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Procedure instance identifier
Required Pattern: 1
..... type 1..1 CodeableConcept Category of Procedure
Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.



Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: principal
..... procedure[x] 1..1 CodeableConcept Specific clinical procedure
Binding: ICD-10 Procedure Codes (required)
.... procedure:other S 0..24 BackboneElement Clinical procedures performed
..... serviceDescription 1..1 string Service Description
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Procedure instance identifier
..... type 1..1 CodeableConcept Category of Procedure
Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.



Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: other
..... procedure[x] 1..1 CodeableConcept Specific clinical procedure
Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required)
... insurance Σ 1..* BackboneElement Patient insurance information
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence Σ 1..1 positiveInt Insurance instance identifier
.... focal Σ 1..1 boolean Coverage to be used for adjudication
.... coverage Σ 1..1 Reference(PCT Coverage) Insurance information
... total 1..1 Money Total GFE Charges

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
Claim.identifier:INTER.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
Claim.identifier:INTER.typeextensiblePattern: INTER("Intermediary System Identifier")
http://hl7.org/fhir/ValueSet/identifier-type
from the FHIR Standard
Claim.statusrequiredFinancialResourceStatusCodes
http://hl7.org/fhir/ValueSet/fm-status|4.0.1
from the FHIR Standard
Claim.typeextensiblePattern: estimate-summary
http://hl7.org/fhir/ValueSet/claim-type
from the FHIR Standard
Claim.userequiredPattern: predetermination
http://hl7.org/fhir/ValueSet/claim-use|4.0.1
from the FHIR Standard
Claim.provider.extension:dataAbsentReason.value[x]requiredPattern: not-applicable
http://hl7.org/fhir/ValueSet/data-absent-reason|4.0.1
from the FHIR Standard
Claim.priorityrequiredProcessPriorityCodes
http://hl7.org/fhir/ValueSet/process-priority
from the FHIR Standard
Claim.payee.typeexampleClaim Payee Type Codes
http://hl7.org/fhir/ValueSet/payeetype
from the FHIR Standard
Claim.careTeam.rolerequiredPCTCareTeamRoleVS
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTCareTeamRoleVS
from this IG
Claim.careTeam.qualificationrequiredUSCoreProviderRoleNucc
http://hl7.org/fhir/us/core/ValueSet/us-core-provider-role
Claim.careTeam:attending.roleexamplePattern: attending
http://hl7.org/fhir/ValueSet/claim-careteamrole
from the FHIR Standard
Claim.careTeam:attending.qualificationexampleExampleProviderQualificationCodes
http://hl7.org/fhir/ValueSet/provider-qualification
from the FHIR Standard
Claim.careTeam:operating.roleexamplePattern: operating
http://hl7.org/fhir/ValueSet/claim-careteamrole
from the FHIR Standard
Claim.careTeam:rendering.roleexamplePattern: rendering
http://hl7.org/fhir/ValueSet/claim-careteamrole
from the FHIR Standard
Claim.careTeam:referring.roleexamplePattern: referring
http://hl7.org/fhir/ValueSet/claim-careteamrole
from the FHIR Standard
Claim.supportingInfo.categoryexampleClaimInformationCategoryCodes
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.diagnosis.diagnosis[x]exampleICD-10Codes
http://hl7.org/fhir/ValueSet/icd-10
from the FHIR Standard
Claim.diagnosis.typerequiredPCTDiagnosisTypeVS
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosisTypeVS
from this IG
Claim.diagnosis:principal.diagnosis[x]requiredPCTDiagnosticCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes
from this IG
Claim.diagnosis:principal.typeexamplePattern: principal
http://hl7.org/fhir/ValueSet/ex-diagnosistype
from the FHIR Standard
Claim.diagnosis:admitting.diagnosis[x]requiredPCTDiagnosticCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes
from this IG
Claim.diagnosis:admitting.typeexamplePattern: admitting
http://hl7.org/fhir/ValueSet/ex-diagnosistype
from the FHIR Standard
Claim.diagnosis:patientReasonForVisit.diagnosis[x]requiredPCTDiagnosticCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes
from this IG
Claim.diagnosis:patientReasonForVisit.typeexamplePattern: patientReasonForVisit
http://hl7.org/fhir/ValueSet/ex-diagnosistype
from the FHIR Standard
Claim.diagnosis:externalcauseofinjury.diagnosis[x]requiredPCTDiagnosticCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes
from this IG
Claim.diagnosis:externalcauseofinjury.typeexamplePattern: externalCauseOfInjury
http://hl7.org/fhir/ValueSet/ex-diagnosistype
from the FHIR Standard
Claim.diagnosis:other.diagnosis[x]requiredPCTDiagnosticCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes
from this IG
Claim.diagnosis:other.typeexamplePattern: other
http://hl7.org/fhir/ValueSet/ex-diagnosistype
from the FHIR Standard
Claim.procedure.typerequiredPCTProcedureTypeVS
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureTypeVS
from this IG
Claim.procedure.procedure[x]exampleICD-10ProcedureCodes
http://hl7.org/fhir/ValueSet/icd-10-procedures
from the FHIR Standard
Claim.procedure:principal.typeexamplePattern: principal
http://hl7.org/fhir/ValueSet/ex-procedure-type
from the FHIR Standard
Claim.procedure:principal.procedure[x]requiredICD10ProcedureCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/ICD10ProcedureCodes
from this IG
Claim.procedure:other.typeexamplePattern: other
http://hl7.org/fhir/ValueSet/ex-procedure-type
from the FHIR Standard
Claim.procedure:other.procedure[x]requiredPCTProcedureSurgicalCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureSurgicalCodes
from this IG
Claim.item.productOrServiceexampleUSCLSCodes
http://hl7.org/fhir/ValueSet/service-uscls
from the FHIR Standard
NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim 0..* Claim Claim, Pre-determination or Pre-authorization
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
... contained 0..* Resource Contained, inline Resources
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
... gfeDisclaimer S 0..* string Disclaimers the patient should be made aware of regarding the estimate
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer
... serviceDescription S 0..1 string Service Description
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... Slices for identifier 0..* Identifier Business Identifier for claim
Slice: Unordered, Open by pattern:type
.... identifier:INTER 0..* Identifier Intermediary System Identifier
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

..... type Σ 1..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.


Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTIdentifierType
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: INTER
....... display 1..1 string Representation defined by the system
Fixed Value: Intermediary System Identifier
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... system Σ 0..1 uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value Σ 0..1 string The value that is unique
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

... type Σ 1..1 CodeableConcept Category or discipline
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.


Required Pattern: At least the following
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTEstimateTypeSummaryCSTemporaryTrialUse
..... version 0..1 string Version of the system - if relevant
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: estimate-summary
..... display 0..1 string Representation defined by the system
..... userSelected 0..1 boolean If this coding was chosen directly by the user
.... text 0..1 string Plain text representation of the concept
... use Σ 1..1 code claim | preauthorization | predetermination
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.


Required Pattern: predetermination
... patient Σ 1..1 Reference(HRex Patient Demographics) The recipient of the products and services
... billablePeriod SΣ 0..1 Period The full Period of Care for all services or products included in the estimate from the first event to the last event.
... created Σ 1..1 dateTime Resource creation date
... insurer SΣ 0..1 Reference(PCT Organization) Target
... provider Σ 1..1 Reference(Practitioner | PractitionerRole | Organization) Party responsible for the claim
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
.... dataAbsentReason 1..1 (Complex) unknown | asked | temp | notasked | masked | unsupported | astext | error
URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..0
..... url 1..1 uri "http://hl7.org/fhir/StructureDefinition/data-absent-reason"
..... value[x] 1..1 code Value of extension
Binding: DataAbsentReason (required): Used to specify why the normally expected content of the data element is missing.


Required Pattern: not-applicable
... priority Σ 1..1 CodeableConcept Desired processing ugency
Binding: ProcessPriorityCodes (required)
... related 0..* BackboneElement Prior or corollary claims
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... claim 0..1 Reference(Claim) Reference to the related claim
.... relationship 0..1 CodeableConcept How the reference claim is related
Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.

.... reference 0..1 Identifier File or case reference
... Slices for careTeam S 0..* BackboneElement Members of the care team
Slice: Unordered, Open by pattern:role
.... careTeam:All Slices Content/Rules for all slices
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Order of care team
..... provider 1..1 Reference(PCT Practitioner | PCT Organization) Practitioner or organization
..... responsible 0..1 boolean Indicator of the lead practitioner
..... role 1..1 CodeableConcept Function within the team
Binding: PCT Care Team Role Value Set (required)
..... qualification 0..1 CodeableConcept Practitioner credential or specialization
Binding: US Core Provider Role (NUCC) (required)
.... careTeam:attending S 0..1 BackboneElement Members of the care team
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Order of care team
..... provider 1..1 Reference(PCT Practitioner) Practitioner or organization
..... responsible 0..1 boolean Indicator of the lead practitioner
..... role 0..1 CodeableConcept Function within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.


Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: attending
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... qualification 1..1 CodeableConcept Practitioner credential or specialization
Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.

.... careTeam:operating S 0..2 BackboneElement Members of the care team
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Order of care team
..... provider 1..1 Reference(PCT Practitioner) Practitioner or organization
..... responsible 0..1 boolean Indicator of the lead practitioner
..... role 0..1 CodeableConcept Function within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.


Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: operating
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... qualification 0..1 CodeableConcept Practitioner credential or specialization
Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.

.... careTeam:rendering S 0..1 BackboneElement Members of the care team
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Order of care team
..... provider 1..1 Reference(PCT Practitioner) Practitioner or organization
..... responsible 0..1 boolean Indicator of the lead practitioner
..... role 0..1 CodeableConcept Function within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.


Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: rendering
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... qualification 0..1 CodeableConcept Practitioner credential or specialization
Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.

.... careTeam:referring S 0..1 BackboneElement Members of the care team
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Order of care team
..... provider 1..1 Reference(Practitioner | PractitionerRole | Organization) Practitioner or organization
..... responsible 0..1 boolean Indicator of the lead practitioner
..... role 0..1 CodeableConcept Function within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.


Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: referring
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... qualification 0..1 CodeableConcept Practitioner credential or specialization
Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.

... Slices for diagnosis S 1..* BackboneElement Pertinent diagnosis information
Slice: Unordered, Open by pattern:type
.... diagnosis:All Slices Content/Rules for all slices
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Diagnosis instance identifier
..... diagnosis[x] 1..1 Nature of illness or problem
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.

...... diagnosisCodeableConcept CodeableConcept
...... diagnosisReference Reference(Condition)
..... type S 0..* CodeableConcept Timing or nature of the diagnosis
Binding: PCT Diagnosis Type Value Set (required)
..... onAdmission 0..1 CodeableConcept Present on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.

..... packageCode 0..1 CodeableConcept Package billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.

.... diagnosis:principal 1..1 BackboneElement Pertinent diagnosis information
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Diagnosis instance identifier
Required Pattern: 1
..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Binding: PCT ICD-10 Diagnostic Codes (required)
..... type 1..1 CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.



Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/ex-diagnosistype
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: principal
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... onAdmission 0..1 CodeableConcept Present on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.

..... packageCode 0..1 CodeableConcept Package billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.

.... diagnosis:admitting S 0..1 BackboneElement Pertinent diagnosis information
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Diagnosis instance identifier
..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Binding: PCT ICD-10 Diagnostic Codes (required)
..... type 1..1 CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.



Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/ex-diagnosistype
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: admitting
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... onAdmission 0..1 CodeableConcept Present on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.

..... packageCode 0..1 CodeableConcept Package billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.

.... diagnosis:patientReasonForVisit S 0..3 BackboneElement Pertinent diagnosis information
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Diagnosis instance identifier
..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Binding: PCT ICD-10 Diagnostic Codes (required)
..... type 1..1 CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.



Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: patientReasonForVisit
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... onAdmission 0..1 CodeableConcept Present on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.

..... packageCode 0..1 CodeableConcept Package billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.

.... diagnosis:externalcauseofinjury S 0..12 BackboneElement Pertinent diagnosis information
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Diagnosis instance identifier
..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Binding: PCT ICD-10 Diagnostic Codes (required)
..... type 1..1 CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.



Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: externalCauseOfInjury
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... onAdmission 0..1 CodeableConcept Present on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.

..... packageCode 0..1 CodeableConcept Package billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.

.... diagnosis:other S 0..24 BackboneElement Pertinent diagnosis information
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Diagnosis instance identifier
..... diagnosis[x] S 1..1 CodeableConcept Nature of illness or problem
Binding: PCT ICD-10 Diagnostic Codes (required)
..... type 1..1 CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.



Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: other
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... onAdmission 0..1 CodeableConcept Present on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.

..... packageCode 0..1 CodeableConcept Package billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.

... Slices for procedure S 0..* BackboneElement Clinical procedures performed
Slice: Unordered, Open by pattern:type
.... procedure:All Slices Content/Rules for all slices
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
..... serviceDescription 1..1 string Service Description
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Procedure instance identifier
..... type S 0..* CodeableConcept Category of Procedure
Binding: PCT Procedure Type Value Set (required)
..... date 0..1 dateTime When the procedure was performed
..... procedure[x] 1..1 Specific clinical procedure
Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.

...... procedureCodeableConcept CodeableConcept
...... procedureReference Reference(Procedure)
..... udi 0..* Reference(Device) Unique device identifier
.... procedure:principal S 0..1 BackboneElement Principal clinical procedure performed
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... serviceDescription 1..1 string Service Description
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Procedure instance identifier
Required Pattern: 1
..... type 1..1 CodeableConcept Category of Procedure
Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.



Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: principal
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... date 0..1 dateTime When the procedure was performed
..... procedure[x] 1..1 CodeableConcept Specific clinical procedure
Binding: ICD-10 Procedure Codes (required)
..... udi 0..* Reference(Device) Unique device identifier
.... procedure:other S 0..24 BackboneElement Clinical procedures performed
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... serviceDescription 1..1 string Service Description
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Procedure instance identifier
..... type 1..1 CodeableConcept Category of Procedure
Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.



Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: other
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... date 0..1 dateTime When the procedure was performed
..... procedure[x] 1..1 CodeableConcept Specific clinical procedure
Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required)
..... udi 0..* Reference(Device) Unique device identifier
... insurance Σ 1..* BackboneElement Patient insurance information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence Σ 1..1 positiveInt Insurance instance identifier
.... focal Σ 1..1 boolean Coverage to be used for adjudication
.... identifier 0..1 Identifier Pre-assigned Claim number
.... coverage Σ 1..1 Reference(PCT Coverage) Insurance information
.... businessArrangement 0..1 string Additional provider contract number
.... claimResponse 0..1 Reference(ClaimResponse) Adjudication results
... accident 0..1 BackboneElement Details of the event
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... date 1..1 date When the incident occurred
.... type 0..1 CodeableConcept The nature of the accident
Binding: ActIncidentCode (extensible): Type of accident: work place, auto, etc.

.... location[x] 0..1 Address Where the event occurred
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 0..1 code home | work | temp | old | billing - purpose of this address
Binding: AddressUse (required): The use of an address.


Example General: home
..... type Σ 0..1 code postal | physical | both
Binding: AddressType (required): The type of an address (physical / postal).


Example General: both
..... text Σ 0..1 string Text representation of the address
Example General: 137 Nowhere Street, Erewhon 9132
..... line Σ 0..* string Street name, number, direction & P.O. Box etc.
This repeating element order: The order in which lines should appear in an address label
Example General: 137 Nowhere Street
..... city Σ 0..1 string Name of city, town etc.
Example General: Erewhon
..... district Σ 0..1 string District name (aka county)
Example General: Madison
..... state Σ 0..1 string Sub-unit of country (abbreviations ok)
..... postalCode Σ 0..1 string Postal code for area
Example General: 9132
..... country Σ 0..1 string Country (e.g. can be ISO 3166 2 or 3 letter code)
Binding: Iso3166-1-2 (required)
..... period Σ 0..1 Period Time period when address was/is in use
Example General: {"start":"2010-03-23","end":"2010-07-01"}
... total 1..1 Money Total GFE Charges

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
Claim.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
Claim.identifier:INTER.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
Claim.identifier:INTER.typeextensiblePattern: INTER("Intermediary System Identifier")
http://hl7.org/fhir/ValueSet/identifier-type
from the FHIR Standard
Claim.statusrequiredFinancialResourceStatusCodes
http://hl7.org/fhir/ValueSet/fm-status|4.0.1
from the FHIR Standard
Claim.typeextensiblePattern: estimate-summary
http://hl7.org/fhir/ValueSet/claim-type
from the FHIR Standard
Claim.userequiredPattern: predetermination
http://hl7.org/fhir/ValueSet/claim-use|4.0.1
from the FHIR Standard
Claim.provider.extension:dataAbsentReason.value[x]requiredPattern: not-applicable
http://hl7.org/fhir/ValueSet/data-absent-reason|4.0.1
from the FHIR Standard
Claim.priorityrequiredProcessPriorityCodes
http://hl7.org/fhir/ValueSet/process-priority
from the FHIR Standard
Claim.related.relationshipexampleExampleRelatedClaimRelationshipCodes
http://hl7.org/fhir/ValueSet/related-claim-relationship
from the FHIR Standard
Claim.payee.typeexampleClaim Payee Type Codes
http://hl7.org/fhir/ValueSet/payeetype
from the FHIR Standard
Claim.careTeam.rolerequiredPCTCareTeamRoleVS
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTCareTeamRoleVS
from this IG
Claim.careTeam.qualificationrequiredUSCoreProviderRoleNucc
http://hl7.org/fhir/us/core/ValueSet/us-core-provider-role
Claim.careTeam:attending.roleexamplePattern: attending
http://hl7.org/fhir/ValueSet/claim-careteamrole
from the FHIR Standard
Claim.careTeam:attending.qualificationexampleExampleProviderQualificationCodes
http://hl7.org/fhir/ValueSet/provider-qualification
from the FHIR Standard
Claim.careTeam:operating.roleexamplePattern: operating
http://hl7.org/fhir/ValueSet/claim-careteamrole
from the FHIR Standard
Claim.careTeam:operating.qualificationexampleExampleProviderQualificationCodes
http://hl7.org/fhir/ValueSet/provider-qualification
from the FHIR Standard
Claim.careTeam:rendering.roleexamplePattern: rendering
http://hl7.org/fhir/ValueSet/claim-careteamrole
from the FHIR Standard
Claim.careTeam:rendering.qualificationexampleExampleProviderQualificationCodes
http://hl7.org/fhir/ValueSet/provider-qualification
from the FHIR Standard
Claim.careTeam:referring.roleexamplePattern: referring
http://hl7.org/fhir/ValueSet/claim-careteamrole
from the FHIR Standard
Claim.careTeam:referring.qualificationexampleExampleProviderQualificationCodes
http://hl7.org/fhir/ValueSet/provider-qualification
from the FHIR Standard
Claim.supportingInfo.categoryexampleClaimInformationCategoryCodes
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo.codeexampleExceptionCodes
http://hl7.org/fhir/ValueSet/claim-exception
from the FHIR Standard
Claim.supportingInfo.reasonexampleMissingToothReasonCodes
http://hl7.org/fhir/ValueSet/missing-tooth-reason
from the FHIR Standard
Claim.diagnosis.diagnosis[x]exampleICD-10Codes
http://hl7.org/fhir/ValueSet/icd-10
from the FHIR Standard
Claim.diagnosis.typerequiredPCTDiagnosisTypeVS
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosisTypeVS
from this IG
Claim.diagnosis.onAdmissionexampleExampleDiagnosisOnAdmissionCodes
http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission
from the FHIR Standard
Claim.diagnosis.packageCodeexampleExampleDiagnosisRelatedGroupCodes
http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup
from the FHIR Standard
Claim.diagnosis:principal.diagnosis[x]requiredPCTDiagnosticCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes
from this IG
Claim.diagnosis:principal.typeexamplePattern: principal
http://hl7.org/fhir/ValueSet/ex-diagnosistype
from the FHIR Standard
Claim.diagnosis:principal.onAdmissionexampleExampleDiagnosisOnAdmissionCodes
http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission
from the FHIR Standard
Claim.diagnosis:principal.packageCodeexampleExampleDiagnosisRelatedGroupCodes
http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup
from the FHIR Standard
Claim.diagnosis:admitting.diagnosis[x]requiredPCTDiagnosticCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes
from this IG
Claim.diagnosis:admitting.typeexamplePattern: admitting
http://hl7.org/fhir/ValueSet/ex-diagnosistype
from the FHIR Standard
Claim.diagnosis:admitting.onAdmissionexampleExampleDiagnosisOnAdmissionCodes
http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission
from the FHIR Standard
Claim.diagnosis:admitting.packageCodeexampleExampleDiagnosisRelatedGroupCodes
http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup
from the FHIR Standard
Claim.diagnosis:patientReasonForVisit.diagnosis[x]requiredPCTDiagnosticCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes
from this IG
Claim.diagnosis:patientReasonForVisit.typeexamplePattern: patientReasonForVisit
http://hl7.org/fhir/ValueSet/ex-diagnosistype
from the FHIR Standard
Claim.diagnosis:patientReasonForVisit.onAdmissionexampleExampleDiagnosisOnAdmissionCodes
http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission
from the FHIR Standard
Claim.diagnosis:patientReasonForVisit.packageCodeexampleExampleDiagnosisRelatedGroupCodes
http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup
from the FHIR Standard
Claim.diagnosis:externalcauseofinjury.diagnosis[x]requiredPCTDiagnosticCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes
from this IG
Claim.diagnosis:externalcauseofinjury.typeexamplePattern: externalCauseOfInjury
http://hl7.org/fhir/ValueSet/ex-diagnosistype
from the FHIR Standard
Claim.diagnosis:externalcauseofinjury.onAdmissionexampleExampleDiagnosisOnAdmissionCodes
http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission
from the FHIR Standard
Claim.diagnosis:externalcauseofinjury.packageCodeexampleExampleDiagnosisRelatedGroupCodes
http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup
from the FHIR Standard
Claim.diagnosis:other.diagnosis[x]requiredPCTDiagnosticCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes
from this IG
Claim.diagnosis:other.typeexamplePattern: other
http://hl7.org/fhir/ValueSet/ex-diagnosistype
from the FHIR Standard
Claim.diagnosis:other.onAdmissionexampleExampleDiagnosisOnAdmissionCodes
http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission
from the FHIR Standard
Claim.diagnosis:other.packageCodeexampleExampleDiagnosisRelatedGroupCodes
http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup
from the FHIR Standard
Claim.procedure.typerequiredPCTProcedureTypeVS
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureTypeVS
from this IG
Claim.procedure.procedure[x]exampleICD-10ProcedureCodes
http://hl7.org/fhir/ValueSet/icd-10-procedures
from the FHIR Standard
Claim.procedure:principal.typeexamplePattern: principal
http://hl7.org/fhir/ValueSet/ex-procedure-type
from the FHIR Standard
Claim.procedure:principal.procedure[x]requiredICD10ProcedureCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/ICD10ProcedureCodes
from this IG
Claim.procedure:other.typeexamplePattern: other
http://hl7.org/fhir/ValueSet/ex-procedure-type
from the FHIR Standard
Claim.procedure:other.procedure[x]requiredPCTProcedureSurgicalCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureSurgicalCodes
from this IG
Claim.accident.typeextensibleActIncidentCode
http://terminology.hl7.org/ValueSet/v3-ActIncidentCode
Claim.accident.location[x].userequiredAddressUse
http://hl7.org/fhir/ValueSet/address-use|4.0.1
from the FHIR Standard
Claim.accident.location[x].typerequiredAddressType
http://hl7.org/fhir/ValueSet/address-type|4.0.1
from the FHIR Standard
Claim.accident.location[x].countryrequiredIso3166-1-2
http://hl7.org/fhir/ValueSet/iso3166-1-2
from the FHIR Standard
Claim.item.revenueexampleExampleRevenueCenterCodes
http://hl7.org/fhir/ValueSet/ex-revenue-center
from the FHIR Standard
Claim.item.categoryexampleBenefitCategoryCodes
http://hl7.org/fhir/ValueSet/ex-benefitcategory
from the FHIR Standard
Claim.item.productOrServiceexampleUSCLSCodes
http://hl7.org/fhir/ValueSet/service-uscls
from the FHIR Standard
Claim.item.modifierexampleModifierTypeCodes
http://hl7.org/fhir/ValueSet/claim-modifiers
from the FHIR Standard
Claim.item.programCodeexampleExampleProgramReasonCodes
http://hl7.org/fhir/ValueSet/ex-program-code
from the FHIR Standard
Claim.item.location[x]exampleExampleServicePlaceCodes
http://hl7.org/fhir/ValueSet/service-place
from the FHIR Standard
Claim.item.bodySiteexampleOralSiteCodes
http://hl7.org/fhir/ValueSet/tooth
from the FHIR Standard
Claim.item.subSiteexampleSurfaceCodes
http://hl7.org/fhir/ValueSet/surface
from the FHIR Standard
Claim.item.detail.revenueexampleExampleRevenueCenterCodes
http://hl7.org/fhir/ValueSet/ex-revenue-center
from the FHIR Standard
Claim.item.detail.categoryexampleBenefitCategoryCodes
http://hl7.org/fhir/ValueSet/ex-benefitcategory
from the FHIR Standard
Claim.item.detail.productOrServiceexampleUSCLSCodes
http://hl7.org/fhir/ValueSet/service-uscls
from the FHIR Standard
Claim.item.detail.modifierexampleModifierTypeCodes
http://hl7.org/fhir/ValueSet/claim-modifiers
from the FHIR Standard
Claim.item.detail.programCodeexampleExampleProgramReasonCodes
http://hl7.org/fhir/ValueSet/ex-program-code
from the FHIR Standard
Claim.item.detail.subDetail.revenueexampleExampleRevenueCenterCodes
http://hl7.org/fhir/ValueSet/ex-revenue-center
from the FHIR Standard
Claim.item.detail.subDetail.categoryexampleBenefitCategoryCodes
http://hl7.org/fhir/ValueSet/ex-benefitcategory
from the FHIR Standard
Claim.item.detail.subDetail.productOrServiceexampleUSCLSCodes
http://hl7.org/fhir/ValueSet/service-uscls
from the FHIR Standard
Claim.item.detail.subDetail.modifierexampleModifierTypeCodes
http://hl7.org/fhir/ValueSet/claim-modifiers
from the FHIR Standard
Claim.item.detail.subDetail.programCodeexampleExampleProgramReasonCodes
http://hl7.org/fhir/ValueSet/ex-program-code
from the FHIR Standard

This structure is derived from Claim

Summary

Mandatory: 6 elements(13 nested mandatory elements)
Must-Support: 20 elements
Prohibited: 15 elements

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

Slices

This structure defines the following Slices:

  • The element 1 is sliced based on the value of Claim.identifier
  • The element 1 is sliced based on the value of Claim.careTeam
  • The element 1 is sliced based on the value of Claim.diagnosis
  • The element 1 is sliced based on the value of Claim.procedure

Maturity: 1

Differential View

This structure is derived from Claim

NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim Claim
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
... gfeDisclaimer S 0..* string Disclaimers the patient should be made aware of regarding the estimate
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer
... serviceDescription S 0..1 string Service Description
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
... Slices for identifier 0..* Identifier Business Identifier for claim
Slice: Unordered, Open by pattern:type
.... identifier:INTER 0..* Identifier Intermediary System Identifier
..... type 1..1 CodeableConcept Description of identifier
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTIdentifierType
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: INTER
....... display 1..1 string Representation defined by the system
Fixed Value: Intermediary System Identifier
... type 1..1 CodeableConcept Category or discipline
Required Pattern: At least the following
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTEstimateTypeSummaryCSTemporaryTrialUse
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: estimate-summary
... subType 0..0
... use 1..1 code claim | preauthorization | predetermination
Required Pattern: predetermination
... patient 1..1 Reference(HRex Patient Demographics) The recipient of the products and services
... billablePeriod S 0..1 Period The full Period of Care for all services or products included in the estimate from the first event to the last event.
... enterer 0..0
... insurer S 0..1 Reference(PCT Organization) Target
... provider
.... extension 1..* Extension Extension
.... dataAbsentReason 1..1 (Complex) unknown | asked | temp | notasked | masked | unsupported | astext | error
URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
..... value[x] 1..1 code Value of extension
Required Pattern: not-applicable
.... reference 0..0
.... type 0..0
.... identifier 0..0
.... display 0..0
... priority 1..1 CodeableConcept Desired processing ugency
Binding: ProcessPriorityCodes (required)
... fundsReserve 0..0
... prescription 0..0
... originalPrescription 0..0
... payee 0..0
... referral 0..0
... facility 0..0
... Slices for careTeam S 0..* BackboneElement Members of the care team
Slice: Unordered, Open by pattern:role
.... careTeam:All Slices Content/Rules for all slices
..... provider 1..1 Reference(PCT Practitioner | PCT Organization) Practitioner or organization
..... role 1..1 CodeableConcept Function within the team
Binding: PCT Care Team Role Value Set (required)
..... qualification 0..1 CodeableConcept Practitioner credential or specialization
Binding: US Core Provider Role (NUCC) (required)
.... careTeam:attending S 0..1 BackboneElement Members of the care team
..... provider 1..1 Reference(PCT Practitioner) Practitioner or organization
..... role 0..1 CodeableConcept Function within the team
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: attending
..... qualification 1..1 CodeableConcept Practitioner credential or specialization
.... careTeam:operating S 0..2 BackboneElement Members of the care team
..... provider 1..1 Reference(PCT Practitioner) Practitioner or organization
..... role 0..1 CodeableConcept Function within the team
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: operating
.... careTeam:rendering S 0..1 BackboneElement Members of the care team
..... provider 1..1 Reference(PCT Practitioner) Practitioner or organization
..... role 0..1 CodeableConcept Function within the team
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: rendering
.... careTeam:referring S 0..1 BackboneElement Members of the care team
..... role 0..1 CodeableConcept Function within the team
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: referring
... supportingInfo 0..0
... Slices for diagnosis S 1..* BackboneElement Pertinent diagnosis information
Slice: Unordered, Open by pattern:type
.... diagnosis:All Slices Content/Rules for all slices
..... type S 0..* CodeableConcept Timing or nature of the diagnosis
Binding: PCT Diagnosis Type Value Set (required)
.... diagnosis:principal 1..1 BackboneElement Pertinent diagnosis information
..... sequence 1..1 positiveInt Diagnosis instance identifier
Required Pattern: 1
..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Binding: PCT ICD-10 Diagnostic Codes (required)
..... type 1..1 CodeableConcept Timing or nature of the diagnosis
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/ex-diagnosistype
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: principal
.... diagnosis:admitting S 0..1 BackboneElement Pertinent diagnosis information
..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Binding: PCT ICD-10 Diagnostic Codes (required)
..... type 1..1 CodeableConcept Timing or nature of the diagnosis
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/ex-diagnosistype
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: admitting
.... diagnosis:patientReasonForVisit S 0..3 BackboneElement Pertinent diagnosis information
..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Binding: PCT ICD-10 Diagnostic Codes (required)
..... type 1..1 CodeableConcept Timing or nature of the diagnosis
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: patientReasonForVisit
.... diagnosis:externalcauseofinjury S 0..12 BackboneElement Pertinent diagnosis information
..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Binding: PCT ICD-10 Diagnostic Codes (required)
..... type 1..1 CodeableConcept Timing or nature of the diagnosis
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: externalCauseOfInjury
.... diagnosis:other S 0..24 BackboneElement Pertinent diagnosis information
..... diagnosis[x] S 1..1 CodeableConcept Nature of illness or problem
Binding: PCT ICD-10 Diagnostic Codes (required)
..... type 1..1 CodeableConcept Timing or nature of the diagnosis
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: other
... Slices for procedure S 0..* BackboneElement Clinical procedures performed
Slice: Unordered, Open by pattern:type
.... procedure:All Slices Content/Rules for all slices
..... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
..... serviceDescription 1..1 string Service Description
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
..... type S 0..* CodeableConcept Category of Procedure
Binding: PCT Procedure Type Value Set (required)
.... procedure:principal S 0..1 BackboneElement Principal clinical procedure performed
..... serviceDescription 1..1 string Service Description
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
..... sequence 1..1 positiveInt Procedure instance identifier
Required Pattern: 1
..... type 1..1 CodeableConcept Category of Procedure
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: principal
..... procedure[x] 1..1 CodeableConcept Specific clinical procedure
Binding: ICD-10 Procedure Codes (required)
.... procedure:other S 0..24 BackboneElement Clinical procedures performed
..... serviceDescription 1..1 string Service Description
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
..... type 1..1 CodeableConcept Category of Procedure
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: other
..... procedure[x] 1..1 CodeableConcept Specific clinical procedure
Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required)
... insurance
.... coverage 1..1 Reference(PCT Coverage) Insurance information
.... preAuthRef 0..0
... accident
.... location[x] 0..1 Address Where the event occurred
..... country 0..1 string Country (e.g. can be ISO 3166 2 or 3 letter code)
Binding: Iso3166-1-2 (required)
... item 0..0
... total 1..1 Money Total GFE Charges

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSetURI
Claim.priorityrequiredProcessPriorityCodes
http://hl7.org/fhir/ValueSet/process-priority
from the FHIR Standard
Claim.careTeam.rolerequiredPCTCareTeamRoleVS
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTCareTeamRoleVS
from this IG
Claim.careTeam.qualificationrequiredUSCoreProviderRoleNucc
http://hl7.org/fhir/us/core/ValueSet/us-core-provider-role
Claim.diagnosis.typerequiredPCTDiagnosisTypeVS
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosisTypeVS
from this IG
Claim.diagnosis:principal.diagnosis[x]requiredPCTDiagnosticCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes
from this IG
Claim.diagnosis:admitting.diagnosis[x]requiredPCTDiagnosticCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes
from this IG
Claim.diagnosis:patientReasonForVisit.diagnosis[x]requiredPCTDiagnosticCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes
from this IG
Claim.diagnosis:externalcauseofinjury.diagnosis[x]requiredPCTDiagnosticCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes
from this IG
Claim.diagnosis:other.diagnosis[x]requiredPCTDiagnosticCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes
from this IG
Claim.procedure.typerequiredPCTProcedureTypeVS
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureTypeVS
from this IG
Claim.procedure:principal.procedure[x]requiredICD10ProcedureCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/ICD10ProcedureCodes
from this IG
Claim.procedure:other.procedure[x]requiredPCTProcedureSurgicalCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureSurgicalCodes
from this IG
Claim.accident.location[x].countryrequiredIso3166-1-2
http://hl7.org/fhir/ValueSet/iso3166-1-2
from the FHIR Standard

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim 0..* Claim Claim, Pre-determination or Pre-authorization
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
... gfeDisclaimer S 0..* string Disclaimers the patient should be made aware of regarding the estimate
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... Slices for identifier 0..* Identifier Business Identifier for claim
Slice: Unordered, Open by pattern:type
.... identifier:INTER 0..* Identifier Intermediary System Identifier
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

..... type Σ 1..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTIdentifierType
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: INTER
....... display 1..1 string Representation defined by the system
Fixed Value: Intermediary System Identifier
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

... type Σ 1..1 CodeableConcept Category or discipline
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.


Required Pattern: At least the following
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTEstimateTypeSummaryCSTemporaryTrialUse
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: estimate-summary
... use Σ 1..1 code claim | preauthorization | predetermination
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.


Required Pattern: predetermination
... patient Σ 1..1 Reference(HRex Patient Demographics) The recipient of the products and services
... billablePeriod SΣ 0..1 Period The full Period of Care for all services or products included in the estimate from the first event to the last event.
... created Σ 1..1 dateTime Resource creation date
... insurer SΣ 0..1 Reference(PCT Organization) Target
... provider Σ 1..1 Reference(Practitioner | PractitionerRole | Organization) Party responsible for the claim
.... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
.... dataAbsentReason 1..1 (Complex) unknown | asked | temp | notasked | masked | unsupported | astext | error
URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
..... extension 0..0
..... url 1..1 uri "http://hl7.org/fhir/StructureDefinition/data-absent-reason"
..... value[x] 1..1 code Value of extension
Binding: DataAbsentReason (required): Used to specify why the normally expected content of the data element is missing.


Required Pattern: not-applicable
... priority Σ 1..1 CodeableConcept Desired processing ugency
Binding: ProcessPriorityCodes (required)
... Slices for careTeam S 0..* BackboneElement Members of the care team
Slice: Unordered, Open by pattern:role
.... careTeam:All Slices Content/Rules for all slices
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Order of care team
..... provider 1..1 Reference(PCT Practitioner | PCT Organization) Practitioner or organization
..... role 1..1 CodeableConcept Function within the team
Binding: PCT Care Team Role Value Set (required)
..... qualification 0..1 CodeableConcept Practitioner credential or specialization
Binding: US Core Provider Role (NUCC) (required)
.... careTeam:attending S 0..1 BackboneElement Members of the care team
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Order of care team
..... provider 1..1 Reference(PCT Practitioner) Practitioner or organization
..... role 0..1 CodeableConcept Function within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: attending
..... qualification 1..1 CodeableConcept Practitioner credential or specialization
Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.

.... careTeam:operating S 0..2 BackboneElement Members of the care team
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Order of care team
..... provider 1..1 Reference(PCT Practitioner) Practitioner or organization
..... role 0..1 CodeableConcept Function within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: operating
.... careTeam:rendering S 0..1 BackboneElement Members of the care team
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Order of care team
..... provider 1..1 Reference(PCT Practitioner) Practitioner or organization
..... role 0..1 CodeableConcept Function within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: rendering
.... careTeam:referring S 0..1 BackboneElement Members of the care team
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Order of care team
..... provider 1..1 Reference(Practitioner | PractitionerRole | Organization) Practitioner or organization
..... role 0..1 CodeableConcept Function within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.


Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: referring
... Slices for diagnosis S 1..* BackboneElement Pertinent diagnosis information
Slice: Unordered, Open by pattern:type
.... diagnosis:All Slices Content/Rules for all slices
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Diagnosis instance identifier
..... diagnosis[x] 1..1 Nature of illness or problem
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.

...... diagnosisCodeableConcept CodeableConcept
...... diagnosisReference Reference(Condition)
..... type S 0..* CodeableConcept Timing or nature of the diagnosis
Binding: PCT Diagnosis Type Value Set (required)
.... diagnosis:principal 1..1 BackboneElement Pertinent diagnosis information
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Diagnosis instance identifier
Required Pattern: 1
..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Binding: PCT ICD-10 Diagnostic Codes (required)
..... type 1..1 CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.



Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/ex-diagnosistype
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: principal
.... diagnosis:admitting S 0..1 BackboneElement Pertinent diagnosis information
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Diagnosis instance identifier
..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Binding: PCT ICD-10 Diagnostic Codes (required)
..... type 1..1 CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.



Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/ex-diagnosistype
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: admitting
.... diagnosis:patientReasonForVisit S 0..3 BackboneElement Pertinent diagnosis information
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Diagnosis instance identifier
..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Binding: PCT ICD-10 Diagnostic Codes (required)
..... type 1..1 CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.



Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: patientReasonForVisit
.... diagnosis:externalcauseofinjury S 0..12 BackboneElement Pertinent diagnosis information
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Diagnosis instance identifier
..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Binding: PCT ICD-10 Diagnostic Codes (required)
..... type 1..1 CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.



Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: externalCauseOfInjury
.... diagnosis:other S 0..24 BackboneElement Pertinent diagnosis information
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Diagnosis instance identifier
..... diagnosis[x] S 1..1 CodeableConcept Nature of illness or problem
Binding: PCT ICD-10 Diagnostic Codes (required)
..... type 1..1 CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.



Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: other
... Slices for procedure S 0..* BackboneElement Clinical procedures performed
Slice: Unordered, Open by pattern:type
.... procedure:All Slices Content/Rules for all slices
..... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
..... serviceDescription 1..1 string Service Description
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Procedure instance identifier
..... type S 0..* CodeableConcept Category of Procedure
Binding: PCT Procedure Type Value Set (required)
..... procedure[x] 1..1 Specific clinical procedure
Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.

...... procedureCodeableConcept CodeableConcept
...... procedureReference Reference(Procedure)
.... procedure:principal S 0..1 BackboneElement Principal clinical procedure performed
..... serviceDescription 1..1 string Service Description
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Procedure instance identifier
Required Pattern: 1
..... type 1..1 CodeableConcept Category of Procedure
Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.



Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: principal
..... procedure[x] 1..1 CodeableConcept Specific clinical procedure
Binding: ICD-10 Procedure Codes (required)
.... procedure:other S 0..24 BackboneElement Clinical procedures performed
..... serviceDescription 1..1 string Service Description
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Procedure instance identifier
..... type 1..1 CodeableConcept Category of Procedure
Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.



Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: other
..... procedure[x] 1..1 CodeableConcept Specific clinical procedure
Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required)
... insurance Σ 1..* BackboneElement Patient insurance information
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence Σ 1..1 positiveInt Insurance instance identifier
.... focal Σ 1..1 boolean Coverage to be used for adjudication
.... coverage Σ 1..1 Reference(PCT Coverage) Insurance information
... total 1..1 Money Total GFE Charges

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
Claim.identifier:INTER.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
Claim.identifier:INTER.typeextensiblePattern: INTER("Intermediary System Identifier")
http://hl7.org/fhir/ValueSet/identifier-type
from the FHIR Standard
Claim.statusrequiredFinancialResourceStatusCodes
http://hl7.org/fhir/ValueSet/fm-status|4.0.1
from the FHIR Standard
Claim.typeextensiblePattern: estimate-summary
http://hl7.org/fhir/ValueSet/claim-type
from the FHIR Standard
Claim.userequiredPattern: predetermination
http://hl7.org/fhir/ValueSet/claim-use|4.0.1
from the FHIR Standard
Claim.provider.extension:dataAbsentReason.value[x]requiredPattern: not-applicable
http://hl7.org/fhir/ValueSet/data-absent-reason|4.0.1
from the FHIR Standard
Claim.priorityrequiredProcessPriorityCodes
http://hl7.org/fhir/ValueSet/process-priority
from the FHIR Standard
Claim.payee.typeexampleClaim Payee Type Codes
http://hl7.org/fhir/ValueSet/payeetype
from the FHIR Standard
Claim.careTeam.rolerequiredPCTCareTeamRoleVS
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTCareTeamRoleVS
from this IG
Claim.careTeam.qualificationrequiredUSCoreProviderRoleNucc
http://hl7.org/fhir/us/core/ValueSet/us-core-provider-role
Claim.careTeam:attending.roleexamplePattern: attending
http://hl7.org/fhir/ValueSet/claim-careteamrole
from the FHIR Standard
Claim.careTeam:attending.qualificationexampleExampleProviderQualificationCodes
http://hl7.org/fhir/ValueSet/provider-qualification
from the FHIR Standard
Claim.careTeam:operating.roleexamplePattern: operating
http://hl7.org/fhir/ValueSet/claim-careteamrole
from the FHIR Standard
Claim.careTeam:rendering.roleexamplePattern: rendering
http://hl7.org/fhir/ValueSet/claim-careteamrole
from the FHIR Standard
Claim.careTeam:referring.roleexamplePattern: referring
http://hl7.org/fhir/ValueSet/claim-careteamrole
from the FHIR Standard
Claim.supportingInfo.categoryexampleClaimInformationCategoryCodes
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.diagnosis.diagnosis[x]exampleICD-10Codes
http://hl7.org/fhir/ValueSet/icd-10
from the FHIR Standard
Claim.diagnosis.typerequiredPCTDiagnosisTypeVS
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosisTypeVS
from this IG
Claim.diagnosis:principal.diagnosis[x]requiredPCTDiagnosticCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes
from this IG
Claim.diagnosis:principal.typeexamplePattern: principal
http://hl7.org/fhir/ValueSet/ex-diagnosistype
from the FHIR Standard
Claim.diagnosis:admitting.diagnosis[x]requiredPCTDiagnosticCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes
from this IG
Claim.diagnosis:admitting.typeexamplePattern: admitting
http://hl7.org/fhir/ValueSet/ex-diagnosistype
from the FHIR Standard
Claim.diagnosis:patientReasonForVisit.diagnosis[x]requiredPCTDiagnosticCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes
from this IG
Claim.diagnosis:patientReasonForVisit.typeexamplePattern: patientReasonForVisit
http://hl7.org/fhir/ValueSet/ex-diagnosistype
from the FHIR Standard
Claim.diagnosis:externalcauseofinjury.diagnosis[x]requiredPCTDiagnosticCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes
from this IG
Claim.diagnosis:externalcauseofinjury.typeexamplePattern: externalCauseOfInjury
http://hl7.org/fhir/ValueSet/ex-diagnosistype
from the FHIR Standard
Claim.diagnosis:other.diagnosis[x]requiredPCTDiagnosticCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes
from this IG
Claim.diagnosis:other.typeexamplePattern: other
http://hl7.org/fhir/ValueSet/ex-diagnosistype
from the FHIR Standard
Claim.procedure.typerequiredPCTProcedureTypeVS
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureTypeVS
from this IG
Claim.procedure.procedure[x]exampleICD-10ProcedureCodes
http://hl7.org/fhir/ValueSet/icd-10-procedures
from the FHIR Standard
Claim.procedure:principal.typeexamplePattern: principal
http://hl7.org/fhir/ValueSet/ex-procedure-type
from the FHIR Standard
Claim.procedure:principal.procedure[x]requiredICD10ProcedureCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/ICD10ProcedureCodes
from this IG
Claim.procedure:other.typeexamplePattern: other
http://hl7.org/fhir/ValueSet/ex-procedure-type
from the FHIR Standard
Claim.procedure:other.procedure[x]requiredPCTProcedureSurgicalCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureSurgicalCodes
from this IG
Claim.item.productOrServiceexampleUSCLSCodes
http://hl7.org/fhir/ValueSet/service-uscls
from the FHIR Standard

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Claim 0..* Claim Claim, Pre-determination or Pre-authorization
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
... contained 0..* Resource Contained, inline Resources
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
... gfeDisclaimer S 0..* string Disclaimers the patient should be made aware of regarding the estimate
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer
... serviceDescription S 0..1 string Service Description
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... Slices for identifier 0..* Identifier Business Identifier for claim
Slice: Unordered, Open by pattern:type
.... identifier:INTER 0..* Identifier Intermediary System Identifier
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

..... type Σ 1..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.


Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTIdentifierType
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: INTER
....... display 1..1 string Representation defined by the system
Fixed Value: Intermediary System Identifier
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... system Σ 0..1 uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value Σ 0..1 string The value that is unique
Example General: 123456
..... period Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

... type Σ 1..1 CodeableConcept Category or discipline
Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.


Required Pattern: At least the following
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTEstimateTypeSummaryCSTemporaryTrialUse
..... version 0..1 string Version of the system - if relevant
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: estimate-summary
..... display 0..1 string Representation defined by the system
..... userSelected 0..1 boolean If this coding was chosen directly by the user
.... text 0..1 string Plain text representation of the concept
... use Σ 1..1 code claim | preauthorization | predetermination
Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.


Required Pattern: predetermination
... patient Σ 1..1 Reference(HRex Patient Demographics) The recipient of the products and services
... billablePeriod SΣ 0..1 Period The full Period of Care for all services or products included in the estimate from the first event to the last event.
... created Σ 1..1 dateTime Resource creation date
... insurer SΣ 0..1 Reference(PCT Organization) Target
... provider Σ 1..1 Reference(Practitioner | PractitionerRole | Organization) Party responsible for the claim
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
.... dataAbsentReason 1..1 (Complex) unknown | asked | temp | notasked | masked | unsupported | astext | error
URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..0
..... url 1..1 uri "http://hl7.org/fhir/StructureDefinition/data-absent-reason"
..... value[x] 1..1 code Value of extension
Binding: DataAbsentReason (required): Used to specify why the normally expected content of the data element is missing.


Required Pattern: not-applicable
... priority Σ 1..1 CodeableConcept Desired processing ugency
Binding: ProcessPriorityCodes (required)
... related 0..* BackboneElement Prior or corollary claims
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... claim 0..1 Reference(Claim) Reference to the related claim
.... relationship 0..1 CodeableConcept How the reference claim is related
Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.

.... reference 0..1 Identifier File or case reference
... Slices for careTeam S 0..* BackboneElement Members of the care team
Slice: Unordered, Open by pattern:role
.... careTeam:All Slices Content/Rules for all slices
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Order of care team
..... provider 1..1 Reference(PCT Practitioner | PCT Organization) Practitioner or organization
..... responsible 0..1 boolean Indicator of the lead practitioner
..... role 1..1 CodeableConcept Function within the team
Binding: PCT Care Team Role Value Set (required)
..... qualification 0..1 CodeableConcept Practitioner credential or specialization
Binding: US Core Provider Role (NUCC) (required)
.... careTeam:attending S 0..1 BackboneElement Members of the care team
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Order of care team
..... provider 1..1 Reference(PCT Practitioner) Practitioner or organization
..... responsible 0..1 boolean Indicator of the lead practitioner
..... role 0..1 CodeableConcept Function within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.


Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: attending
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... qualification 1..1 CodeableConcept Practitioner credential or specialization
Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.

.... careTeam:operating S 0..2 BackboneElement Members of the care team
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Order of care team
..... provider 1..1 Reference(PCT Practitioner) Practitioner or organization
..... responsible 0..1 boolean Indicator of the lead practitioner
..... role 0..1 CodeableConcept Function within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.


Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: operating
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... qualification 0..1 CodeableConcept Practitioner credential or specialization
Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.

.... careTeam:rendering S 0..1 BackboneElement Members of the care team
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Order of care team
..... provider 1..1 Reference(PCT Practitioner) Practitioner or organization
..... responsible 0..1 boolean Indicator of the lead practitioner
..... role 0..1 CodeableConcept Function within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.


Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: rendering
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... qualification 0..1 CodeableConcept Practitioner credential or specialization
Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.

.... careTeam:referring S 0..1 BackboneElement Members of the care team
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Order of care team
..... provider 1..1 Reference(Practitioner | PractitionerRole | Organization) Practitioner or organization
..... responsible 0..1 boolean Indicator of the lead practitioner
..... role 0..1 CodeableConcept Function within the team
Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.


Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: referring
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... qualification 0..1 CodeableConcept Practitioner credential or specialization
Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.

... Slices for diagnosis S 1..* BackboneElement Pertinent diagnosis information
Slice: Unordered, Open by pattern:type
.... diagnosis:All Slices Content/Rules for all slices
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Diagnosis instance identifier
..... diagnosis[x] 1..1 Nature of illness or problem
Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.

...... diagnosisCodeableConcept CodeableConcept
...... diagnosisReference Reference(Condition)
..... type S 0..* CodeableConcept Timing or nature of the diagnosis
Binding: PCT Diagnosis Type Value Set (required)
..... onAdmission 0..1 CodeableConcept Present on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.

..... packageCode 0..1 CodeableConcept Package billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.

.... diagnosis:principal 1..1 BackboneElement Pertinent diagnosis information
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Diagnosis instance identifier
Required Pattern: 1
..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Binding: PCT ICD-10 Diagnostic Codes (required)
..... type 1..1 CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.



Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/ex-diagnosistype
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: principal
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... onAdmission 0..1 CodeableConcept Present on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.

..... packageCode 0..1 CodeableConcept Package billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.

.... diagnosis:admitting S 0..1 BackboneElement Pertinent diagnosis information
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Diagnosis instance identifier
..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Binding: PCT ICD-10 Diagnostic Codes (required)
..... type 1..1 CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.



Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/ex-diagnosistype
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: admitting
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... onAdmission 0..1 CodeableConcept Present on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.

..... packageCode 0..1 CodeableConcept Package billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.

.... diagnosis:patientReasonForVisit S 0..3 BackboneElement Pertinent diagnosis information
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Diagnosis instance identifier
..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Binding: PCT ICD-10 Diagnostic Codes (required)
..... type 1..1 CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.



Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: patientReasonForVisit
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... onAdmission 0..1 CodeableConcept Present on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.

..... packageCode 0..1 CodeableConcept Package billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.

.... diagnosis:externalcauseofinjury S 0..12 BackboneElement Pertinent diagnosis information
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Diagnosis instance identifier
..... diagnosis[x] 1..1 CodeableConcept Nature of illness or problem
Binding: PCT ICD-10 Diagnostic Codes (required)
..... type 1..1 CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.



Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: externalCauseOfInjury
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... onAdmission 0..1 CodeableConcept Present on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.

..... packageCode 0..1 CodeableConcept Package billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.

.... diagnosis:other S 0..24 BackboneElement Pertinent diagnosis information
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Diagnosis instance identifier
..... diagnosis[x] S 1..1 CodeableConcept Nature of illness or problem
Binding: PCT ICD-10 Diagnostic Codes (required)
..... type 1..1 CodeableConcept Timing or nature of the diagnosis
Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.



Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: other
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... onAdmission 0..1 CodeableConcept Present on admission
Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.

..... packageCode 0..1 CodeableConcept Package billing code
Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.

... Slices for procedure S 0..* BackboneElement Clinical procedures performed
Slice: Unordered, Open by pattern:type
.... procedure:All Slices Content/Rules for all slices
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
..... serviceDescription 1..1 string Service Description
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Procedure instance identifier
..... type S 0..* CodeableConcept Category of Procedure
Binding: PCT Procedure Type Value Set (required)
..... date 0..1 dateTime When the procedure was performed
..... procedure[x] 1..1 Specific clinical procedure
Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.

...... procedureCodeableConcept CodeableConcept
...... procedureReference Reference(Procedure)
..... udi 0..* Reference(Device) Unique device identifier
.... procedure:principal S 0..1 BackboneElement Principal clinical procedure performed
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... serviceDescription 1..1 string Service Description
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Procedure instance identifier
Required Pattern: 1
..... type 1..1 CodeableConcept Category of Procedure
Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.



Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: principal
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... date 0..1 dateTime When the procedure was performed
..... procedure[x] 1..1 CodeableConcept Specific clinical procedure
Binding: ICD-10 Procedure Codes (required)
..... udi 0..* Reference(Device) Unique device identifier
.... procedure:other S 0..24 BackboneElement Clinical procedures performed
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... serviceDescription 1..1 string Service Description
URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... sequence 1..1 positiveInt Procedure instance identifier
..... type 1..1 CodeableConcept Category of Procedure
Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.



Required Pattern: At least the following
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
....... version 0..1 string Version of the system - if relevant
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: other
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... date 0..1 dateTime When the procedure was performed
..... procedure[x] 1..1 CodeableConcept Specific clinical procedure
Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required)
..... udi 0..* Reference(Device) Unique device identifier
... insurance Σ 1..* BackboneElement Patient insurance information
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... sequence Σ 1..1 positiveInt Insurance instance identifier
.... focal Σ 1..1 boolean Coverage to be used for adjudication
.... identifier 0..1 Identifier Pre-assigned Claim number
.... coverage Σ 1..1 Reference(PCT Coverage) Insurance information
.... businessArrangement 0..1 string Additional provider contract number
.... claimResponse 0..1 Reference(ClaimResponse) Adjudication results
... accident 0..1 BackboneElement Details of the event
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... date 1..1 date When the incident occurred
.... type 0..1 CodeableConcept The nature of the accident
Binding: ActIncidentCode (extensible): Type of accident: work place, auto, etc.

.... location[x] 0..1 Address Where the event occurred
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 0..1 code home | work | temp | old | billing - purpose of this address
Binding: AddressUse (required): The use of an address.


Example General: home
..... type Σ 0..1 code postal | physical | both
Binding: AddressType (required): The type of an address (physical / postal).


Example General: both
..... text Σ 0..1 string Text representation of the address
Example General: 137 Nowhere Street, Erewhon 9132
..... line Σ 0..* string Street name, number, direction & P.O. Box etc.
This repeating element order: The order in which lines should appear in an address label
Example General: 137 Nowhere Street
..... city Σ 0..1 string Name of city, town etc.
Example General: Erewhon
..... district Σ 0..1 string District name (aka county)
Example General: Madison
..... state Σ 0..1 string Sub-unit of country (abbreviations ok)
..... postalCode Σ 0..1 string Postal code for area
Example General: 9132
..... country Σ 0..1 string Country (e.g. can be ISO 3166 2 or 3 letter code)
Binding: Iso3166-1-2 (required)
..... period Σ 0..1 Period Time period when address was/is in use
Example General: {"start":"2010-03-23","end":"2010-07-01"}
... total 1..1 Money Total GFE Charges

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
Claim.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
Claim.identifier:INTER.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
Claim.identifier:INTER.typeextensiblePattern: INTER("Intermediary System Identifier")
http://hl7.org/fhir/ValueSet/identifier-type
from the FHIR Standard
Claim.statusrequiredFinancialResourceStatusCodes
http://hl7.org/fhir/ValueSet/fm-status|4.0.1
from the FHIR Standard
Claim.typeextensiblePattern: estimate-summary
http://hl7.org/fhir/ValueSet/claim-type
from the FHIR Standard
Claim.userequiredPattern: predetermination
http://hl7.org/fhir/ValueSet/claim-use|4.0.1
from the FHIR Standard
Claim.provider.extension:dataAbsentReason.value[x]requiredPattern: not-applicable
http://hl7.org/fhir/ValueSet/data-absent-reason|4.0.1
from the FHIR Standard
Claim.priorityrequiredProcessPriorityCodes
http://hl7.org/fhir/ValueSet/process-priority
from the FHIR Standard
Claim.related.relationshipexampleExampleRelatedClaimRelationshipCodes
http://hl7.org/fhir/ValueSet/related-claim-relationship
from the FHIR Standard
Claim.payee.typeexampleClaim Payee Type Codes
http://hl7.org/fhir/ValueSet/payeetype
from the FHIR Standard
Claim.careTeam.rolerequiredPCTCareTeamRoleVS
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTCareTeamRoleVS
from this IG
Claim.careTeam.qualificationrequiredUSCoreProviderRoleNucc
http://hl7.org/fhir/us/core/ValueSet/us-core-provider-role
Claim.careTeam:attending.roleexamplePattern: attending
http://hl7.org/fhir/ValueSet/claim-careteamrole
from the FHIR Standard
Claim.careTeam:attending.qualificationexampleExampleProviderQualificationCodes
http://hl7.org/fhir/ValueSet/provider-qualification
from the FHIR Standard
Claim.careTeam:operating.roleexamplePattern: operating
http://hl7.org/fhir/ValueSet/claim-careteamrole
from the FHIR Standard
Claim.careTeam:operating.qualificationexampleExampleProviderQualificationCodes
http://hl7.org/fhir/ValueSet/provider-qualification
from the FHIR Standard
Claim.careTeam:rendering.roleexamplePattern: rendering
http://hl7.org/fhir/ValueSet/claim-careteamrole
from the FHIR Standard
Claim.careTeam:rendering.qualificationexampleExampleProviderQualificationCodes
http://hl7.org/fhir/ValueSet/provider-qualification
from the FHIR Standard
Claim.careTeam:referring.roleexamplePattern: referring
http://hl7.org/fhir/ValueSet/claim-careteamrole
from the FHIR Standard
Claim.careTeam:referring.qualificationexampleExampleProviderQualificationCodes
http://hl7.org/fhir/ValueSet/provider-qualification
from the FHIR Standard
Claim.supportingInfo.categoryexampleClaimInformationCategoryCodes
http://hl7.org/fhir/ValueSet/claim-informationcategory
from the FHIR Standard
Claim.supportingInfo.codeexampleExceptionCodes
http://hl7.org/fhir/ValueSet/claim-exception
from the FHIR Standard
Claim.supportingInfo.reasonexampleMissingToothReasonCodes
http://hl7.org/fhir/ValueSet/missing-tooth-reason
from the FHIR Standard
Claim.diagnosis.diagnosis[x]exampleICD-10Codes
http://hl7.org/fhir/ValueSet/icd-10
from the FHIR Standard
Claim.diagnosis.typerequiredPCTDiagnosisTypeVS
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosisTypeVS
from this IG
Claim.diagnosis.onAdmissionexampleExampleDiagnosisOnAdmissionCodes
http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission
from the FHIR Standard
Claim.diagnosis.packageCodeexampleExampleDiagnosisRelatedGroupCodes
http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup
from the FHIR Standard
Claim.diagnosis:principal.diagnosis[x]requiredPCTDiagnosticCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes
from this IG
Claim.diagnosis:principal.typeexamplePattern: principal
http://hl7.org/fhir/ValueSet/ex-diagnosistype
from the FHIR Standard
Claim.diagnosis:principal.onAdmissionexampleExampleDiagnosisOnAdmissionCodes
http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission
from the FHIR Standard
Claim.diagnosis:principal.packageCodeexampleExampleDiagnosisRelatedGroupCodes
http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup
from the FHIR Standard
Claim.diagnosis:admitting.diagnosis[x]requiredPCTDiagnosticCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes
from this IG
Claim.diagnosis:admitting.typeexamplePattern: admitting
http://hl7.org/fhir/ValueSet/ex-diagnosistype
from the FHIR Standard
Claim.diagnosis:admitting.onAdmissionexampleExampleDiagnosisOnAdmissionCodes
http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission
from the FHIR Standard
Claim.diagnosis:admitting.packageCodeexampleExampleDiagnosisRelatedGroupCodes
http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup
from the FHIR Standard
Claim.diagnosis:patientReasonForVisit.diagnosis[x]requiredPCTDiagnosticCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes
from this IG
Claim.diagnosis:patientReasonForVisit.typeexamplePattern: patientReasonForVisit
http://hl7.org/fhir/ValueSet/ex-diagnosistype
from the FHIR Standard
Claim.diagnosis:patientReasonForVisit.onAdmissionexampleExampleDiagnosisOnAdmissionCodes
http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission
from the FHIR Standard
Claim.diagnosis:patientReasonForVisit.packageCodeexampleExampleDiagnosisRelatedGroupCodes
http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup
from the FHIR Standard
Claim.diagnosis:externalcauseofinjury.diagnosis[x]requiredPCTDiagnosticCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes
from this IG
Claim.diagnosis:externalcauseofinjury.typeexamplePattern: externalCauseOfInjury
http://hl7.org/fhir/ValueSet/ex-diagnosistype
from the FHIR Standard
Claim.diagnosis:externalcauseofinjury.onAdmissionexampleExampleDiagnosisOnAdmissionCodes
http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission
from the FHIR Standard
Claim.diagnosis:externalcauseofinjury.packageCodeexampleExampleDiagnosisRelatedGroupCodes
http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup
from the FHIR Standard
Claim.diagnosis:other.diagnosis[x]requiredPCTDiagnosticCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosticCodes
from this IG
Claim.diagnosis:other.typeexamplePattern: other
http://hl7.org/fhir/ValueSet/ex-diagnosistype
from the FHIR Standard
Claim.diagnosis:other.onAdmissionexampleExampleDiagnosisOnAdmissionCodes
http://hl7.org/fhir/ValueSet/ex-diagnosis-on-admission
from the FHIR Standard
Claim.diagnosis:other.packageCodeexampleExampleDiagnosisRelatedGroupCodes
http://hl7.org/fhir/ValueSet/ex-diagnosisrelatedgroup
from the FHIR Standard
Claim.procedure.typerequiredPCTProcedureTypeVS
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureTypeVS
from this IG
Claim.procedure.procedure[x]exampleICD-10ProcedureCodes
http://hl7.org/fhir/ValueSet/icd-10-procedures
from the FHIR Standard
Claim.procedure:principal.typeexamplePattern: principal
http://hl7.org/fhir/ValueSet/ex-procedure-type
from the FHIR Standard
Claim.procedure:principal.procedure[x]requiredICD10ProcedureCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/ICD10ProcedureCodes
from this IG
Claim.procedure:other.typeexamplePattern: other
http://hl7.org/fhir/ValueSet/ex-procedure-type
from the FHIR Standard
Claim.procedure:other.procedure[x]requiredPCTProcedureSurgicalCodes
http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureSurgicalCodes
from this IG
Claim.accident.typeextensibleActIncidentCode
http://terminology.hl7.org/ValueSet/v3-ActIncidentCode
Claim.accident.location[x].userequiredAddressUse
http://hl7.org/fhir/ValueSet/address-use|4.0.1
from the FHIR Standard
Claim.accident.location[x].typerequiredAddressType
http://hl7.org/fhir/ValueSet/address-type|4.0.1
from the FHIR Standard
Claim.accident.location[x].countryrequiredIso3166-1-2
http://hl7.org/fhir/ValueSet/iso3166-1-2
from the FHIR Standard
Claim.item.revenueexampleExampleRevenueCenterCodes
http://hl7.org/fhir/ValueSet/ex-revenue-center
from the FHIR Standard
Claim.item.categoryexampleBenefitCategoryCodes
http://hl7.org/fhir/ValueSet/ex-benefitcategory
from the FHIR Standard
Claim.item.productOrServiceexampleUSCLSCodes
http://hl7.org/fhir/ValueSet/service-uscls
from the FHIR Standard
Claim.item.modifierexampleModifierTypeCodes
http://hl7.org/fhir/ValueSet/claim-modifiers
from the FHIR Standard
Claim.item.programCodeexampleExampleProgramReasonCodes
http://hl7.org/fhir/ValueSet/ex-program-code
from the FHIR Standard
Claim.item.location[x]exampleExampleServicePlaceCodes
http://hl7.org/fhir/ValueSet/service-place
from the FHIR Standard
Claim.item.bodySiteexampleOralSiteCodes
http://hl7.org/fhir/ValueSet/tooth
from the FHIR Standard
Claim.item.subSiteexampleSurfaceCodes
http://hl7.org/fhir/ValueSet/surface
from the FHIR Standard
Claim.item.detail.revenueexampleExampleRevenueCenterCodes
http://hl7.org/fhir/ValueSet/ex-revenue-center
from the FHIR Standard
Claim.item.detail.categoryexampleBenefitCategoryCodes
http://hl7.org/fhir/ValueSet/ex-benefitcategory
from the FHIR Standard
Claim.item.detail.productOrServiceexampleUSCLSCodes
http://hl7.org/fhir/ValueSet/service-uscls
from the FHIR Standard
Claim.item.detail.modifierexampleModifierTypeCodes
http://hl7.org/fhir/ValueSet/claim-modifiers
from the FHIR Standard
Claim.item.detail.programCodeexampleExampleProgramReasonCodes
http://hl7.org/fhir/ValueSet/ex-program-code
from the FHIR Standard
Claim.item.detail.subDetail.revenueexampleExampleRevenueCenterCodes
http://hl7.org/fhir/ValueSet/ex-revenue-center
from the FHIR Standard
Claim.item.detail.subDetail.categoryexampleBenefitCategoryCodes
http://hl7.org/fhir/ValueSet/ex-benefitcategory
from the FHIR Standard
Claim.item.detail.subDetail.productOrServiceexampleUSCLSCodes
http://hl7.org/fhir/ValueSet/service-uscls
from the FHIR Standard
Claim.item.detail.subDetail.modifierexampleModifierTypeCodes
http://hl7.org/fhir/ValueSet/claim-modifiers
from the FHIR Standard
Claim.item.detail.subDetail.programCodeexampleExampleProgramReasonCodes
http://hl7.org/fhir/ValueSet/ex-program-code
from the FHIR Standard

This structure is derived from Claim

Summary

Mandatory: 6 elements(13 nested mandatory elements)
Must-Support: 20 elements
Prohibited: 15 elements

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

Slices

This structure defines the following Slices:

  • The element 1 is sliced based on the value of Claim.identifier
  • The element 1 is sliced based on the value of Claim.careTeam
  • The element 1 is sliced based on the value of Claim.diagnosis
  • The element 1 is sliced based on the value of Claim.procedure

Maturity: 1

 

Other representations of profile: CSV, Excel, Schematron