• Content
• Examples
• Detailed Descriptions
• Mappings
• Profiles & Extensions
• Operations
• R3 R4 Conversions
• Search Params

8.24 2.16.10 Resource ChargeItem MessageHeader - Content Operations

Patient Administration Infrastructure And Messaging Work Group

Maturity Level : 0 N/A

Trial Use Standards Status : Informative

Security Category : Patient Not Classified

Compartments : Device , Encounter , Patient , Practitioner , RelatedPerson

The resource ChargeItem describes the provision of healthcare provider products for a certain patient, therefore referring not only to the product, but containing in addition details of the provision, like date, time, amounts and participating organizations and persons. Main Usage of the ChargeItem is to enable the billing process and internal cost allocation. 8.24.1 Scope and Usage Tracking Financial information is vital in Patient Administration and Finance systems in most Healthcare Organizations. The resource ChargeItem describes the charge for provision of healthcare provider products for a certain patient, therefore referring not only to the product, but containing in addition details of the provision, like date, time, amounts and participating organizations and persons. Main Usage of the ChargeItem is to enable the billing process and internal cost allocation. They are created as soon as the products are planned or provisioned, references to Encounters and/or Accounts can be maintained in a later process step. The target of ChargeItem.definition may provide information on the Charge code such as pricing and inclusion/exclusion rules as well as factors that apply under certain conditions. In many cases however this information may have been drawn from sources outside of FHIR depending on the distribution format of the code catalogue. The ChargeItem assumes that such information is either implicitly known by the communicating systems or explicitly shared through the ChargeItem.definition. Therefore explicit pricing information is not shared within the ChargeItem resource. Also, the systems posting the ChargeItems are not expected to apply the rules associated with the charge codes as they may not know the whole context of the patient/encounter to evaluate such rules. It lies within the responsibility of a billing engine, to collect the ChargeItems in the context of an Account or Encounter at a certain point in time (e.g. discharge of the patient) and to evaluate the associated rules resulting in some of the ChargeItems to be set to the status "not billable" in case the rules exclude them from being billed, or to create financial transactions according to base price and factors. Additional references to Encounter/EpisodeOfCare, Patient/Group and Services provide further context to help billing systems determine the appropriate account and establish the clinical/financial context to evaluate the rules associated with the charge codes. 8.24.2 Boundaries and Relationships This resource is not an actual financial transaction (such as an item on an invoice or any concise monetary amount being transferred from one Account to another) but is the base administrative data that may be used by a billing engine to create the financial transactions based on rules, factors and base prices associated with the charge code. Unlike the Financial Transaction the ChargeItem primarily describes the provision, whereas the Financial Transaction documents cash flow. Therefore, the Financial Transaction results from ChargeItems created via the subsequent billing- or cost allocation process. The actual financial transaction resulting from the evaluation of these rules against the clinical and financial context may be represented in formats appropriate to the financial realm. These are considered out of scope for the FHIR Standard, as they are not specific to the healthcare domain. The FHIR Claim resource does contain line items, and this ChargeItem resource provides the source material for the billing engine to create the items on the claim (which may be different due to business rules). This resource is referenced by itself and Invoice 8.24.3 Resource Content Structure UML XML JSON Turtle R3 Diff All Structure Name Flags Card. Type Description & Constraints ChargeItem TU DomainResource Item containing charge code(s) associated with the provision of healthcare provider products Elements defined in Ancestors: id , meta , implicitRules , language , text , contained , extension , modifierExtension identifier Σ 0..* Identifier Business Identifier for item definitionUri 0..* uri Defining information about the code of this charge item definitionCanonical 0..* canonical ( ChargeItemDefinition ) Resource defining the code of this ChargeItem status ?! Σ 1..1 code planned | billable | not-billable | aborted | billed | entered-in-error | unknown ChargeItemStatus ( Required ) partOf 0..* Reference ( ChargeItem ) Part of referenced ChargeItem code Σ 1..1 CodeableConcept A code that identifies the charge, like a billing code ChargeItemCode ( Example ) subject Σ 1..1 Reference ( Patient | Group ) Individual service was done for/to context Σ 0..1 Reference ( Encounter | EpisodeOfCare ) Encounter / Episode associated with event occurrence[x] Σ 0..1 When the charged service was applied occurrenceDateTime dateTime occurrencePeriod Period occurrenceTiming Timing performer 0..* BackboneElement Who performed charged service function 0..1 CodeableConcept What type of performance was done Procedure Performer Role Codes ( Example ) actor 1..1 Reference ( Practitioner | PractitionerRole | Organization | CareTeam | Patient | Device | RelatedPerson ) Individual who was performing performingOrganization 0..1 Reference ( Organization ) Organization providing the charged service requestingOrganization 0..1 Reference ( Organization ) Organization requesting the charged service costCenter 0..1 Reference ( Organization ) Organization that has ownership of the (potential, future) revenue quantity Σ 0..1 Quantity Quantity of which the charge item has been serviced bodysite Σ 0..* CodeableConcept Anatomical location, if relevant SNOMED CT Body Structures ( Example ) factorOverride 0..1 decimal Factor overriding the associated rules priceOverride 0..1 Money Price overriding the associated rules overrideReason 0..1 string Reason for overriding the list price/factor enterer Σ 0..1 Reference ( Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson ) Individual who was entering enteredDate Σ 0..1 dateTime Date the charge item was entered reason 0..* CodeableConcept Why was the charged service rendered? ICD-10 Codes ( Example ) service 0..* Reference ( DiagnosticReport | ImagingStudy | Immunization | MedicationAdministration | MedicationDispense | Observation | Procedure | SupplyDelivery ) Which rendered service is being charged? product[x] 0..1 Product charged FHIR Device Types ( Example ) productReference Reference ( Device | Medication | Substance ) productCodeableConcept CodeableConcept account Σ 0..* Reference ( Account ) Account to place this charge note 0..* Annotation Comments made about the ChargeItem supportingInformation 0..* Reference ( Any ) Further information supporting this charge Documentation for this format UML Diagram ( Legend ) ChargeItem ( DomainResource ) Identifiers assigned to this event performer or other systems identifier : Identifier [0..*] References the (external) source of pricing information, rules of application for the code this ChargeItem uses definitionUri : uri [0..*] References the source of pricing information, rules of application for the code this ChargeItem uses definitionCanonical : canonical [0..*] « ChargeItemDefinition » The current state of the ChargeItem (this element modifies the meaning of other elements) status : code [1..1] « Codes identifying the lifecycle stage of a ChargeItem. (Strength=Required) ChargeItemStatus ! » ChargeItems can be grouped to larger ChargeItems covering the whole set partOf : Reference [0..*] « ChargeItem » A code that identifies the charge, like a billing code code : CodeableConcept [1..1] « Example set of codes that can be used for billing purposes. (Strength=Example) ChargeItemCode ?? » The individual or set of individuals the action is being or was performed on subject : Reference [1..1] « Patient | Group » The encounter or episode of care that establishes the context for this event context : Reference [0..1] « Encounter | EpisodeOfCare » Date/time(s) or duration when the charged service was applied occurrence[x] : Type [0..1] « dateTime | Period | Timing » The organization requesting the service performingOrganization : Reference [0..1] « Organization » The organization performing the service requestingOrganization : Reference [0..1] « Organization » The financial cost center permits the tracking of charge attribution costCenter : Reference [0..1] « Organization » Quantity of which the charge item has been serviced quantity : Quantity [0..1] The anatomical location where the related service has been applied bodysite : CodeableConcept [0..*] « Codes describing anatomical locations. May include laterality. (Strength=Example) SNOMEDCTBodyStructures ?? » Factor overriding the factor determined by the rules associated with the code factorOverride : decimal [0..1] Total price of the charge overriding the list price associated with the code priceOverride : Money [0..1] If the list price or the rule-based factor associated with the code is overridden, this attribute can capture a text to indicate the reason for this action overrideReason : string [0..1] The device, practitioner, etc. who entered the charge item enterer : Reference [0..1] « Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson » Date the charge item was entered enteredDate : dateTime [0..1] Describes why the event occurred in coded or textual form reason : CodeableConcept [0..*] « Example binding for reason. (Strength=Example) ICD-10Codes ?? » Indicated the rendered service that caused this charge service : Reference [0..*] « DiagnosticReport | ImagingStudy | Immunization | MedicationAdministration | MedicationDispense | Observation | Procedure | SupplyDelivery » Identifies the device, food, drug or other product being charged either by type code or reference to an instance product[x] : Type [0..1] « Reference ( Device | Medication | Substance )| CodeableConcept ; Example binding for product type. (Strength=Example) FHIRDeviceTypes ?? » Account into which this ChargeItems belongs account : Reference [0..*] « Account » Comments made about the event by the performer, subject or other participants note : Annotation [0..*] Further information supporting this charge supportingInformation : Reference [0..*] « Any » Performer Describes the type of performance or participation(e.g. primary surgeon, anesthesiologiest, etc.) function : CodeableConcept [0..1] « Codes describing the types of functional roles performers can take on when performing events. (Strength=Example) ProcedurePerformerRoleCodes ?? » The device, practitioner, etc. who performed or participated in the service actor : Reference [1..1] « Practitioner | PractitionerRole | Organization | CareTeam | Patient | Device | RelatedPerson » Indicates who or what performed or participated in the charged service performer [0..*] XML Template < <!-- from --> <!-- from --> <</identifier> < <</definitionCanonical> < <</partOf> <</code> <</subject> <</context> <</occurrence[x]> < <</function> <| </actor> </performer> <</performingOrganization> <</requestingOrganization> <</costCenter> <</quantity> <</bodysite> < <</priceOverride> < <| </enterer> < <</reason> <| | </service> <</product[x]> <</account> <</note> <</supportingInformation> </ChargeItem> JSON Template { "resourceType" : "", // from // from " " " " " " " " ">", " }, " }, " " "| }], " " " " " " " " "| " " "| | " }, " }, " " " } Turtle Template @prefix fhir: <http://hl7.org/fhir/> . [ a fhir:; fhir:nodeRole fhir:treeRoot; # if this is the parser root # from # from fhir: fhir: fhir: fhir: fhir: fhir: fhir: fhir: # . One of these 3 fhir: ] fhir: ] fhir: ] fhir: fhir: fhir: ], ...; fhir: fhir: fhir: fhir: fhir: fhir: fhir: fhir: fhir: fhir: fhir: fhir:| # . One of these 2 fhir:) ] fhir: ] fhir: fhir: fhir: ] Changes since R3 ChargeItem ChargeItem.identifier Max Cardinality changed from 1 to * ChargeItem.definitionUri Added Element ChargeItem.definitionCanonical Added Element ChargeItem.status Change value set from http://hl7.org/fhir/ValueSet/chargeitem-status to http://hl7.org/fhir/ValueSet/chargeitem-status|4.0.1 ChargeItem.performer Added Element ChargeItem.performer.function Added Element ChargeItem.performer.actor Added Mandatory Element ChargeItem.costCenter Added Element ChargeItem.enterer Type Reference: Added Target Type PractitionerRole ChargeItem.product[x] Added Element ChargeItem.definition deleted ChargeItem.participant deleted See the Full Difference for further information This analysis is available as XML or JSON . See R3 <--> R4 Conversion Maps (status = 1 test that all execute ok. All tests pass round-trip testing and all r3 resources are valid.) Structure Name Flags Card. Type Description & Constraints ChargeItem TU DomainResource Item containing charge code(s) associated with the provision of healthcare provider products Elements defined in Ancestors: id , meta , implicitRules , language , text , contained , extension , modifierExtension identifier Σ 0..* Identifier Business Identifier for item definitionUri 0..* uri Defining information about the code of this charge item definitionCanonical 0..* canonical ( ChargeItemDefinition ) Resource defining the code of this ChargeItem status ?! Σ 1..1 code planned | billable | not-billable | aborted | billed | entered-in-error | unknown ChargeItemStatus ( Required ) partOf 0..* Reference ( ChargeItem ) Part of referenced ChargeItem code Σ 1..1 CodeableConcept A code that identifies the charge, like a billing code ChargeItemCode ( Example ) subject Σ 1..1 Reference ( Patient | Group ) Individual service was done for/to context Σ 0..1 Reference ( Encounter | EpisodeOfCare ) Encounter / Episode associated with event occurrence[x] Σ 0..1 When the charged service was applied occurrenceDateTime dateTime occurrencePeriod Period occurrenceTiming Timing performer 0..* BackboneElement Who performed charged service function 0..1 CodeableConcept What type of performance was done Procedure Performer Role Codes ( Example ) actor 1..1 Reference ( Practitioner | PractitionerRole | Organization | CareTeam | Patient | Device | RelatedPerson ) Individual who was performing performingOrganization 0..1 Reference ( Organization ) Organization providing the charged service requestingOrganization 0..1 Reference ( Organization ) Organization requesting the charged service costCenter 0..1 Reference ( Organization ) Organization that has ownership of the (potential, future) revenue quantity Σ 0..1 Quantity Quantity of which the charge item has been serviced bodysite Σ 0..* CodeableConcept Anatomical location, if relevant SNOMED CT Body Structures ( Example ) factorOverride 0..1 decimal Factor overriding the associated rules priceOverride 0..1 Money Price overriding the associated rules overrideReason 0..1 string Reason for overriding the list price/factor enterer Σ 0..1 Reference ( Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson ) Individual who was entering enteredDate Σ 0..1 dateTime Date the charge item was entered reason 0..* CodeableConcept Why was the charged service rendered? ICD-10 Codes ( Example ) service 0..* Reference ( DiagnosticReport | ImagingStudy | Immunization | MedicationAdministration | MedicationDispense | Observation | Procedure | SupplyDelivery ) Which rendered service is being charged? product[x] 0..1 Product charged FHIR Device Types ( Example ) productReference Reference ( Device | Medication | Substance ) productCodeableConcept CodeableConcept account Σ 0..* Reference ( Account ) Account to place this charge note 0..* Annotation Comments made about the ChargeItem supportingInformation 0..* Reference ( Any ) Further information supporting this charge Documentation for this format UML Diagram ( Legend ) ChargeItem ( DomainResource ) Identifiers assigned to this event performer or other systems identifier : Identifier [0..*] References the (external) source of pricing information, rules of application for the code this ChargeItem uses definitionUri : uri [0..*] References the source of pricing information, rules of application for the code this ChargeItem uses definitionCanonical : canonical [0..*] « ChargeItemDefinition » The current state of the ChargeItem (this element modifies the meaning of other elements) status : code [1..1] « Codes identifying the lifecycle stage of a ChargeItem. (Strength=Required) ChargeItemStatus ! » ChargeItems can be grouped to larger ChargeItems covering the whole set partOf : Reference [0..*] « ChargeItem » A code that identifies the charge, like a billing code code : CodeableConcept [1..1] « Example set of codes that can be used for billing purposes. (Strength=Example) ChargeItemCode ?? » The individual or set of individuals the action is being or was performed on subject : Reference [1..1] « Patient | Group » The encounter or episode of care that establishes the context for this event context : Reference [0..1] « Encounter | EpisodeOfCare » Date/time(s) or duration when the charged service was applied occurrence[x] : Type [0..1] « dateTime | Period | Timing » The organization requesting the service performingOrganization : Reference [0..1] « Organization » The organization performing the service requestingOrganization : Reference [0..1] « Organization » The financial cost center permits the tracking of charge attribution costCenter : Reference [0..1] « Organization » Quantity of which the charge item has been serviced quantity : Quantity [0..1] The anatomical location where the related service has been applied bodysite : CodeableConcept [0..*] « Codes describing anatomical locations. May include laterality. (Strength=Example) SNOMEDCTBodyStructures ?? » Factor overriding the factor determined by the rules associated with the code factorOverride : decimal [0..1] Total price of the charge overriding the list price associated with the code priceOverride : Money [0..1] If the list price or the rule-based factor operation operations associated with the code is overridden, this attribute can capture a text to indicate the reason for this action overrideReason : string [0..1] The device, practitioner, etc. who entered the charge item enterer : Reference [0..1] « Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson » Date the charge item was entered enteredDate : dateTime [0..1] Describes why the event occurred in coded or textual form reason : CodeableConcept [0..*] « Example binding for reason. (Strength=Example) ICD-10Codes ?? » Indicated the rendered service that caused this charge service : Reference [0..*] « DiagnosticReport | ImagingStudy | Immunization | MedicationAdministration | MedicationDispense | Observation | Procedure | SupplyDelivery » Identifies the device, food, drug or other product being charged either by type code or reference to an instance product[x] : Type [0..1] « Reference ( Device | Medication | Substance )| CodeableConcept ; Example binding for product type. (Strength=Example) FHIRDeviceTypes ?? » Account into which this ChargeItems belongs account : Reference [0..*] « Account » Comments made about the event by the performer, subject or other participants note : Annotation [0..*] Further information supporting this charge supportingInformation : Reference [0..*] « Any » Performer Describes the type of performance or participation(e.g. primary surgeon, anesthesiologiest, etc.) function : CodeableConcept [0..1] « Codes describing the types of functional roles performers can take on when performing events. (Strength=Example) ProcedurePerformerRoleCodes ?? » The device, practitioner, etc. who performed or participated in the service actor : Reference [1..1] « Practitioner | PractitionerRole | Organization | CareTeam | Patient | Device | RelatedPerson » Indicates who or what performed or participated in the charged service performer [0..*] XML Template < <!-- from --> <!-- from --> <</identifier> < <</definitionCanonical> < <</partOf> <</code> <</subject> <</context> <</occurrence[x]> < <</function> <| </actor> </performer> <</performingOrganization> <</requestingOrganization> <</costCenter> <</quantity> <</bodysite> < <</priceOverride> < <| </enterer> < <</reason> <| | </service> <</product[x]> <</account> <</note> <</supportingInformation> </ChargeItem> JSON Template { "resourceType" : "", // from // from " " " " " " " " ">", " }, " }, " " "| }], " " " " " " " " "| " " "| | " }, " }, " " " } Turtle Template @prefix fhir: <http://hl7.org/fhir/> . [ a fhir:; fhir:nodeRole fhir:treeRoot; # if this is the parser root # from # from fhir: fhir: fhir: fhir: fhir: fhir: fhir: fhir: # . One of these 3 fhir: ] fhir: ] fhir: ] fhir: fhir: fhir: ], ...; fhir: fhir: fhir: fhir: fhir: fhir: fhir: fhir: fhir: fhir: fhir: fhir:| # . One of these 2 fhir:) ] fhir: ] fhir: fhir: fhir: ] Changes since Release 3 ChargeItem ChargeItem.identifier Max Cardinality changed from 1 to * ChargeItem.definitionUri Added Element ChargeItem.definitionCanonical Added Element ChargeItem.status Change value set from http://hl7.org/fhir/ValueSet/chargeitem-status to http://hl7.org/fhir/ValueSet/chargeitem-status|4.0.1 ChargeItem.performer Added Element ChargeItem.performer.function Added Element ChargeItem.performer.actor Added Mandatory Element ChargeItem.costCenter Added Element ChargeItem.enterer Type Reference: Added Target Type PractitionerRole ChargeItem.product[x] Added Element ChargeItem.definition deleted ChargeItem.participant deleted See the Full Difference for further information This analysis is available as XML or JSON . See R3 <--> R4 Conversion Maps (status = 1 test that all execute ok. All tests pass round-trip testing and all r3 resources are valid.)   See the Profiles & Extensions and the alternate definitions: Master Definition XML + JSON , XML Schema / Schematron + JSON Schema , ShEx (for Turtle ) + see the extensions & the dependency analysis it:

8.24.3.1 Terminology Bindings Path Definition Type Reference ChargeItem.status Codes identifying the lifecycle stage of a ChargeItem. Required ChargeItemStatus ChargeItem.code Example set of codes that can be used for billing purposes. Example ChargeItemCode ChargeItem.performer.function Codes describing the types of functional roles performers can take on when performing events. Example ProcedurePerformerRoleCodes ChargeItem.bodysite Codes describing anatomical locations. May include laterality. Example SNOMEDCTBodyStructures ChargeItem.reason Example binding for reason. FHIRDeviceTypes

Example ICD-10Codes $process-message ChargeItem.product[x] Example binding for product type.

Example Process Message

8.24.4 Search Parameters Search parameters for this resource. The common parameters also apply. See Searching for For more information about searching in REST, messaging, and services. operations, including how they are invoked, see Operations .

Name Type Description Expression In Common account reference Account to place this charge ChargeItem.account ( Account ) code token A code that identifies the charge, like a billing code ChargeItem.code context reference Encounter / Episode associated with event ChargeItem.context ( EpisodeOfCare , Encounter ) entered-date date Date the charge item was entered ChargeItem.enteredDate enterer reference Individual who was entering ChargeItem.enterer ( Practitioner , Organization , Device , Patient , PractitionerRole , RelatedPerson ) factor-override number Factor overriding the associated rules ChargeItem.factorOverride identifier token Business Identifier for item ChargeItem.identifier occurrence date When the charged service was applied ChargeItem.occurrence patient reference Individual service was done for/to ChargeItem.subject.where(resolve() is Patient) ( Patient ) performer-actor reference Individual who was performing ChargeItem.performer.actor ( Practitioner , Organization , CareTeam , Device , Patient , PractitionerRole , RelatedPerson ) performer-function token What type of performance was done ChargeItem.performer.function performing-organization reference Organization providing the charged service ChargeItem.performingOrganization ( Organization ) price-override quantity Price overriding the associated rules ChargeItem.priceOverride quantity quantity Quantity of which the charge item has been serviced ChargeItem.quantity requesting-organization reference Organization requesting the charged service ChargeItem.requestingOrganization ( Organization ) service reference Which rendered service is being charged? ChargeItem.service ( Immunization , MedicationDispense , SupplyDelivery , Observation , DiagnosticReport , ImagingStudy , MedicationAdministration , Procedure ) subject reference Individual service was done for/to ChargeItem.subject ( Group , Patient )