Release 4B Snapshot 3: Connectathon 32 Base

This page is part of the FHIR Specification (v4.3.0: R4B - STU (v5.0.0-snapshot3: R5 Snapshot #3, to support Connectathon 32 ). The current version which supercedes this version is 5.0.0 . For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3

8.24 Resource ChargeItem - Content

Patient Administration icon Work Group Maturity Level : 0   Trial Use Security Category : Patient 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).

8.24.3 References to this Resource

This resource is referenced by itself and Invoice . This resource implements the

8.24.4 Resource Content

Structure

0..1 productCodeableConcept
Name icon Flags icon Card. icon Type icon Description & Constraints icon doco icon
. . 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

. . . 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 encounter Σ 0..1 Reference ( Encounter | EpisodeOfCare ) Encounter / Episode associated with event this ChargeItem
. . . 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 | HealthcareService | 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 . unitPriceComponent 0..1 decimal MonetaryComponent Factor Unit price overriding the associated rules
. . . priceOverride totalPriceComponent 0..1 Money MonetaryComponent Price Total price overriding the associated rules
. . . overrideReason 0..1 string CodeableConcept 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 CodeableReference ( DiagnosticReport | ImagingStudy | Immunization | MedicationAdministration | MedicationDispense | MedicationRequest | Observation | Procedure | ServiceRequest | SupplyDelivery ) Which rendered service is being charged?

. . product[x] . product 0..* Product charged FHIR Device Types ( Example ) productReference Reference CodeableReference ( Device | Medication | Substance ) Product charged
CodeableConcept Device Type ( Example )

. . . 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


doco Documentation for this format icon

See the Extensions for this resource

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] « null (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] « null (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 This ChargeItem has the details of care that establishes how the context for this event associated Encounter should be billed or otherwise be handled by finance systems context encounter : Reference [0..1] « Encounter | EpisodeOfCare » Date/time(s) or duration when the charged service was applied occurrence[x] : Element DataType [0..1] « dateTime | Period | Timing » The organization requesting performing the service performingOrganization : Reference [0..1] « Organization » The organization performing requesting 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..*] « null (Strength=Example) SNOMEDCTBodyStructures ?? » Factor overriding the factor determined by the rules associated with The unit price of the code chargable item factorOverride unitPriceComponent : decimal MonetaryComponent [0..1] Total The total price of the charge overriding for the list price associated with chargable item, accounting for the code quantity priceOverride totalPriceComponent : Money MonetaryComponent [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 CodeableConcept [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..*] « null (Strength=Example) ICD-10Codes ICD10Codes ?? » Indicated the rendered service that caused this charge service : Reference CodeableReference [0..*] « DiagnosticReport | ImagingStudy | Immunization | MedicationAdministration | MedicationDispense | MedicationRequest | Observation | Procedure | ServiceRequest | SupplyDelivery » Identifies the device, food, drug or other product being charged either by type code or reference to an instance product[x] product : Element CodeableReference [0..1] [0..*] « Reference ( Device | Medication | Substance )| CodeableConcept ; null (Strength=Example) FHIRDeviceTypes DeviceType ?? » 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] « null (Strength=Example) ProcedurePerformerRoleCodes ?? » The device, practitioner, etc. who performed or participated in the service actor : Reference [1..1] « Practitioner | PractitionerRole | Organization | HealthcareService | CareTeam | Patient | Device | RelatedPerson » Indicates who or what performed or participated in the charged service performer [0..*]

XML Template 

<ChargeItem xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Business Identifier for item --></identifier>
 <definitionUri value="[uri]"/><!-- 0..* Defining information about the code of this charge item -->
 <definitionCanonical><!-- 0..* canonical(ChargeItemDefinition) Resource defining the code of this ChargeItem --></definitionCanonical>
 <status value="[code]"/><!-- 1..1 planned | billable | not-billable | aborted | billed | entered-in-error | unknown -->
 <partOf><!-- 0..* Reference(ChargeItem) Part of referenced ChargeItem --></partOf>
 <code><!-- 1..1 CodeableConcept A code that identifies the charge, like a billing code --></code>
 <subject><!-- 1..1 Reference(Group|Patient) Individual service was done for/to --></subject>
 <</context>

 <encounter><!-- 0..1 Reference(Encounter) Encounter associated with this ChargeItem --></encounter>

 <occurrence[x]><!-- 0..1 dateTime|Period|Timing When the charged service was applied --></occurrence[x]>
 <performer>  <!-- 0..* Who performed charged service -->
  <function><!-- 0..1 CodeableConcept What type of performance was done --></function>
  <|
    </actor>

  <actor><!-- 1..1 Reference(CareTeam|Device|HealthcareService|Organization|
    Patient|Practitioner|PractitionerRole|RelatedPerson) Individual who was performing --></actor>
 </performer>
 <</performingOrganization>
 <</requestingOrganization>

 <performingOrganization><!-- 0..1 Reference(Organization) Organization providing the charged service --></performingOrganization>
 <requestingOrganization><!-- 0..1 Reference(Organization) Organization requesting the charged service --></requestingOrganization>

 <costCenter><!-- 0..1 Reference(Organization) Organization that has ownership of the (potential, future) revenue --></costCenter>
 <quantity><!-- 0..1 Quantity Quantity of which the charge item has been serviced --></quantity>
 <bodysite><!-- 0..* CodeableConcept Anatomical location, if relevant --></bodysite>
 <
 <</priceOverride>
 <

 <unitPriceComponent><!-- 0..1 MonetaryComponent Unit price overriding the associated rules --></unitPriceComponent>
 <totalPriceComponent><!-- 0..1 MonetaryComponent Total price overriding the associated rules --></totalPriceComponent>
 <overrideReason><!-- 0..1 CodeableConcept Reason for overriding the list price/factor --></overrideReason>

 <enterer><!-- 0..1 Reference(Device|Organization|Patient|Practitioner|
   PractitionerRole|RelatedPerson) Individual who was entering --></enterer>
 <enteredDate value="[dateTime]"/><!-- 0..1 Date the charge item was entered -->
 <reason><!-- 0..* CodeableConcept Why was the charged  service rendered? --></reason>
 <|
   |
   </service>
 <</product[x]>

 <service><!-- 0..* CodeableReference(DiagnosticReport|ImagingStudy|Immunization|
   MedicationAdministration|MedicationDispense|MedicationRequest|Observation|
   Procedure|ServiceRequest|SupplyDelivery) Which rendered service is being charged? --></service>

 <product><!-- 0..* CodeableReference(Device|Medication|Substance) Product charged --></product>

 <account><!-- 0..* Reference(Account) Account to place this charge --></account>
 <note><!-- 0..* Annotation Comments made about the ChargeItem --></note>
 <supportingInformation><!-- 0..* Reference(Any) Further information supporting this charge --></supportingInformation>
</ChargeItem>

JSON Template 

{doco
  "resourceType" : "ChargeItem",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Business Identifier for item
  "definitionUri" : ["<uri>"], // Defining information about the code of this charge item
  "

  "definitionCanonical" : ["<canonical(ChargeItemDefinition)>"], // Resource defining the code of this ChargeItem

  "status" : "<code>", // R!  planned | billable | not-billable | aborted | billed | entered-in-error | unknown
  "partOf" : [{ Reference(ChargeItem) }], // Part of referenced ChargeItem
  "code" : { CodeableConcept }, // R!  A code that identifies the charge, like a billing code
  "subject" : { Reference(Group|Patient) }, // R!  Individual service was done for/to
  "

  "encounter" : { Reference(Encounter) }, // Encounter associated with this ChargeItem

  // occurrence[x]: When the charged service was applied. One of these 3:
  "occurrenceDateTime" : "<dateTime>",
  "occurrencePeriod" : { Period },
  "occurrenceTiming" : { Timing },
  "performer" : [{ // Who performed charged service
    "function" : { CodeableConcept }, // What type of performance was done
    "|
    

    "actor" : { Reference(CareTeam|Device|HealthcareService|Organization|
    Patient|Practitioner|PractitionerRole|RelatedPerson) } // R!  Individual who was performing
  }],
  "
  "

  "performingOrganization" : { Reference(Organization) }, // Organization providing the charged service
  "requestingOrganization" : { Reference(Organization) }, // Organization requesting the charged service

  "costCenter" : { Reference(Organization) }, // Organization that has ownership of the (potential, future) revenue
  "quantity" : { Quantity }, // Quantity of which the charge item has been serviced
  "bodysite" : [{ CodeableConcept }], // Anatomical location, if relevant
  "
  "
  "

  "unitPriceComponent" : { MonetaryComponent }, // Unit price overriding the associated rules
  "totalPriceComponent" : { MonetaryComponent }, // Total price overriding the associated rules
  "overrideReason" : { CodeableConcept }, // Reason for overriding the list price/factor

  "enterer" : { Reference(Device|Organization|Patient|Practitioner|
   PractitionerRole|RelatedPerson) }, // Individual who was entering
  "enteredDate" : "<dateTime>", // Date the charge item was entered
  "reason" : [{ CodeableConcept }], // Why was the charged  service rendered?
  "|
   |
   
  
  " },
  " },

  "service" : [{ CodeableReference(DiagnosticReport|ImagingStudy|Immunization|
   MedicationAdministration|MedicationDispense|MedicationRequest|Observation|
   Procedure|ServiceRequest|SupplyDelivery) }], // Which rendered service is being charged?

  "product" : [{ CodeableReference(Device|Medication|Substance) }], // Product charged

  "account" : [{ Reference(Account) }], // Account to place this charge
  "note" : [{ Annotation }], // Comments made about the ChargeItem
  "supportingInformation" : [{ Reference(Any) }] // Further information supporting this charge
}

Turtle Template 

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:ChargeItem;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:ChargeItem.identifier [ Identifier ], ... ; # 0..* Business Identifier for item
  fhir:ChargeItem.definitionUri [ uri ], ... ; # 0..* Defining information about the code of this charge item
  fhir:ChargeItem.definitionCanonical [ canonical(ChargeItemDefinition) ], ... ; # 0..* Resource defining the code of this ChargeItem
  fhir:ChargeItem.status [ code ]; # 1..1 planned | billable | not-billable | aborted | billed | entered-in-error | unknown
  fhir:ChargeItem.partOf [ Reference(ChargeItem) ], ... ; # 0..* Part of referenced ChargeItem
  fhir:ChargeItem.code [ CodeableConcept ]; # 1..1 A code that identifies the charge, like a billing code
  fhir:ChargeItem.subject [ Reference(Group|Patient) ]; # 1..1 Individual service was done for/to
  fhir:

  fhir:ChargeItem.encounter [ Reference(Encounter) ]; # 0..1 Encounter associated with this ChargeItem

  # ChargeItem.occurrence[x] : 0..1 When the charged service was applied. One of these 3
    fhir:ChargeItem.occurrenceDateTime [ dateTime ]
    fhir:ChargeItem.occurrencePeriod [ Period ]
    fhir:ChargeItem.occurrenceTiming [ Timing ]
  fhir:ChargeItem.performer [ # 0..* Who performed charged service
    fhir:ChargeItem.performer.function [ CodeableConcept ]; # 0..1 What type of performance was done
    fhir:

    fhir:ChargeItem.performer.actor [ Reference(CareTeam|Device|HealthcareService|Organization|Patient|Practitioner|
  PractitionerRole|RelatedPerson) ]; # 1..1 Individual who was performing
  ], ...;
  fhir:
  fhir:

  fhir:ChargeItem.performingOrganization [ Reference(Organization) ]; # 0..1 Organization providing the charged service
  fhir:ChargeItem.requestingOrganization [ Reference(Organization) ]; # 0..1 Organization requesting the charged service

  fhir:ChargeItem.costCenter [ Reference(Organization) ]; # 0..1 Organization that has ownership of the (potential, future) revenue
  fhir:ChargeItem.quantity [ Quantity ]; # 0..1 Quantity of which the charge item has been serviced
  fhir:ChargeItem.bodysite [ CodeableConcept ], ... ; # 0..* Anatomical location, if relevant
  fhir:
  fhir:
  fhir:

  fhir:ChargeItem.unitPriceComponent [ MonetaryComponent ]; # 0..1 Unit price overriding the associated rules
  fhir:ChargeItem.totalPriceComponent [ MonetaryComponent ]; # 0..1 Total price overriding the associated rules
  fhir:ChargeItem.overrideReason [ CodeableConcept ]; # 0..1 Reason for overriding the list price/factor

  fhir:ChargeItem.enterer [ Reference(Device|Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) ]; # 0..1 Individual who was entering
  fhir:ChargeItem.enteredDate [ dateTime ]; # 0..1 Date the charge item was entered
  fhir:ChargeItem.reason [ CodeableConcept ], ... ; # 0..* Why was the charged  service rendered?
  fhir:|
  
  # . One of these 2
    fhir:) ]
    fhir: ]

  fhir:ChargeItem.service [ CodeableReference(DiagnosticReport|ImagingStudy|Immunization|MedicationAdministration|
  MedicationDispense|MedicationRequest|Observation|Procedure|ServiceRequest|
  SupplyDelivery) ], ... ; # 0..* Which rendered service is being charged?

  fhir:ChargeItem.product [ CodeableReference(Device|Medication|Substance) ], ... ; # 0..* Product charged

  fhir:ChargeItem.account [ Reference(Account) ], ... ; # 0..* Account to place this charge
  fhir:ChargeItem.note [ Annotation ], ... ; # 0..* Comments made about the ChargeItem
  fhir:ChargeItem.supportingInformation [ Reference(Any) ], ... ; # 0..* Further information supporting this charge
]

Changes since R4

ChargeItem
ChargeItem.encounter
  • No Changes Added Element
ChargeItem.performer.actor
  • Type Reference: Added Target Type HealthcareService
  • Type Reference: Added Target Type HealthcareService
ChargeItem.unitPriceComponent
  • Added Element
ChargeItem.totalPriceComponent
  • Added Element
ChargeItem.overrideReason
  • Type changed from string to CodeableConcept
  • Type changed from string to CodeableConcept
ChargeItem.service
  • Type changed from Reference(DiagnosticReport | ImagingStudy | Immunization | MedicationAdministration | MedicationDispense | Observation | Procedure | SupplyDelivery) to CodeableReference
  • Type changed from Reference(DiagnosticReport | ImagingStudy | Immunization | MedicationAdministration | MedicationDispense | Observation | Procedure | SupplyDelivery) to CodeableReference
ChargeItem.product
  • Added Element
ChargeItem.context
  • deleted
ChargeItem.factorOverride
  • deleted
ChargeItem.priceOverride
  • deleted
ChargeItem.product[x]
  • deleted

See the Full Difference for further information

This analysis is available as XML or JSON .

Conversions between R3 and R4 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

0..1 productCodeableConcept
Name icon Flags icon Card. icon Type icon Description & Constraints icon doco icon
. . 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

. . . 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 encounter Σ 0..1 Reference ( Encounter | EpisodeOfCare ) Encounter / Episode associated with event this ChargeItem
. . . 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 | HealthcareService | 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 . unitPriceComponent 0..1 decimal MonetaryComponent Factor Unit price overriding the associated rules
. . . priceOverride totalPriceComponent 0..1 Money MonetaryComponent Price Total price overriding the associated rules
. . . overrideReason 0..1 string CodeableConcept 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 CodeableReference ( DiagnosticReport | ImagingStudy | Immunization | MedicationAdministration | MedicationDispense | MedicationRequest | Observation | Procedure | ServiceRequest | SupplyDelivery ) Which rendered service is being charged?

. . product[x] . product 0..* Product charged FHIR Device Types ( Example ) productReference Reference CodeableReference ( Device | Medication | Substance ) Product charged
CodeableConcept Device Type ( Example )

. . . 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


doco Documentation for this format icon

See the Extensions for this resource

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] « null (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] « null (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 This ChargeItem has the details of care that establishes how the context for this event associated Encounter should be billed or otherwise be handled by finance systems context encounter : Reference [0..1] « Encounter | EpisodeOfCare » Date/time(s) or duration when the charged service was applied occurrence[x] : Element DataType [0..1] « dateTime | Period | Timing » The organization requesting performing the service performingOrganization : Reference [0..1] « Organization » The organization performing requesting 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..*] « null (Strength=Example) SNOMEDCTBodyStructures ?? » Factor overriding the factor determined by the rules associated with The unit price of the code chargable item factorOverride unitPriceComponent : decimal MonetaryComponent [0..1] Total The total price of the charge overriding for the list price associated with chargable item, accounting for the code quantity priceOverride totalPriceComponent : Money MonetaryComponent [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 CodeableConcept [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..*] « null (Strength=Example) ICD-10Codes ICD10Codes ?? » Indicated the rendered service that caused this charge service : Reference CodeableReference [0..*] « DiagnosticReport | ImagingStudy | Immunization | MedicationAdministration | MedicationDispense | MedicationRequest | Observation | Procedure | ServiceRequest | SupplyDelivery » Identifies the device, food, drug or other product being charged either by type code or reference to an instance product[x] product : Element CodeableReference [0..1] [0..*] « Reference ( Device | Medication | Substance )| CodeableConcept ; null (Strength=Example) FHIRDeviceTypes DeviceType ?? » 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] « null (Strength=Example) ProcedurePerformerRoleCodes ?? » The device, practitioner, etc. who performed or participated in the service actor : Reference [1..1] « Practitioner | PractitionerRole | Organization | HealthcareService | CareTeam | Patient | Device | RelatedPerson » Indicates who or what performed or participated in the charged service performer [0..*]

XML Template 

<ChargeItem xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Business Identifier for item --></identifier>
 <definitionUri value="[uri]"/><!-- 0..* Defining information about the code of this charge item -->
 <definitionCanonical><!-- 0..* canonical(ChargeItemDefinition) Resource defining the code of this ChargeItem --></definitionCanonical>
 <status value="[code]"/><!-- 1..1 planned | billable | not-billable | aborted | billed | entered-in-error | unknown -->
 <partOf><!-- 0..* Reference(ChargeItem) Part of referenced ChargeItem --></partOf>
 <code><!-- 1..1 CodeableConcept A code that identifies the charge, like a billing code --></code>
 <subject><!-- 1..1 Reference(Group|Patient) Individual service was done for/to --></subject>
 <</context>

 <encounter><!-- 0..1 Reference(Encounter) Encounter associated with this ChargeItem --></encounter>

 <occurrence[x]><!-- 0..1 dateTime|Period|Timing When the charged service was applied --></occurrence[x]>
 <performer>  <!-- 0..* Who performed charged service -->
  <function><!-- 0..1 CodeableConcept What type of performance was done --></function>
  <|
    </actor>

  <actor><!-- 1..1 Reference(CareTeam|Device|HealthcareService|Organization|
    Patient|Practitioner|PractitionerRole|RelatedPerson) Individual who was performing --></actor>
 </performer>
 <</performingOrganization>
 <</requestingOrganization>

 <performingOrganization><!-- 0..1 Reference(Organization) Organization providing the charged service --></performingOrganization>
 <requestingOrganization><!-- 0..1 Reference(Organization) Organization requesting the charged service --></requestingOrganization>

 <costCenter><!-- 0..1 Reference(Organization) Organization that has ownership of the (potential, future) revenue --></costCenter>
 <quantity><!-- 0..1 Quantity Quantity of which the charge item has been serviced --></quantity>
 <bodysite><!-- 0..* CodeableConcept Anatomical location, if relevant --></bodysite>
 <
 <</priceOverride>
 <

 <unitPriceComponent><!-- 0..1 MonetaryComponent Unit price overriding the associated rules --></unitPriceComponent>
 <totalPriceComponent><!-- 0..1 MonetaryComponent Total price overriding the associated rules --></totalPriceComponent>
 <overrideReason><!-- 0..1 CodeableConcept Reason for overriding the list price/factor --></overrideReason>

 <enterer><!-- 0..1 Reference(Device|Organization|Patient|Practitioner|
   PractitionerRole|RelatedPerson) Individual who was entering --></enterer>
 <enteredDate value="[dateTime]"/><!-- 0..1 Date the charge item was entered -->
 <reason><!-- 0..* CodeableConcept Why was the charged  service rendered? --></reason>
 <|
   |
   </service>
 <</product[x]>

 <service><!-- 0..* CodeableReference(DiagnosticReport|ImagingStudy|Immunization|
   MedicationAdministration|MedicationDispense|MedicationRequest|Observation|
   Procedure|ServiceRequest|SupplyDelivery) Which rendered service is being charged? --></service>

 <product><!-- 0..* CodeableReference(Device|Medication|Substance) Product charged --></product>

 <account><!-- 0..* Reference(Account) Account to place this charge --></account>
 <note><!-- 0..* Annotation Comments made about the ChargeItem --></note>
 <supportingInformation><!-- 0..* Reference(Any) Further information supporting this charge --></supportingInformation>
</ChargeItem>

JSON Template 

{doco
  "resourceType" : "ChargeItem",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Business Identifier for item
  "definitionUri" : ["<uri>"], // Defining information about the code of this charge item
  "

  "definitionCanonical" : ["<canonical(ChargeItemDefinition)>"], // Resource defining the code of this ChargeItem

  "status" : "<code>", // R!  planned | billable | not-billable | aborted | billed | entered-in-error | unknown
  "partOf" : [{ Reference(ChargeItem) }], // Part of referenced ChargeItem
  "code" : { CodeableConcept }, // R!  A code that identifies the charge, like a billing code
  "subject" : { Reference(Group|Patient) }, // R!  Individual service was done for/to
  "

  "encounter" : { Reference(Encounter) }, // Encounter associated with this ChargeItem

  // occurrence[x]: When the charged service was applied. One of these 3:
  "occurrenceDateTime" : "<dateTime>",
  "occurrencePeriod" : { Period },
  "occurrenceTiming" : { Timing },
  "performer" : [{ // Who performed charged service
    "function" : { CodeableConcept }, // What type of performance was done
    "|
    

    "actor" : { Reference(CareTeam|Device|HealthcareService|Organization|
    Patient|Practitioner|PractitionerRole|RelatedPerson) } // R!  Individual who was performing
  }],
  "
  "

  "performingOrganization" : { Reference(Organization) }, // Organization providing the charged service
  "requestingOrganization" : { Reference(Organization) }, // Organization requesting the charged service

  "costCenter" : { Reference(Organization) }, // Organization that has ownership of the (potential, future) revenue
  "quantity" : { Quantity }, // Quantity of which the charge item has been serviced
  "bodysite" : [{ CodeableConcept }], // Anatomical location, if relevant
  "
  "
  "

  "unitPriceComponent" : { MonetaryComponent }, // Unit price overriding the associated rules
  "totalPriceComponent" : { MonetaryComponent }, // Total price overriding the associated rules
  "overrideReason" : { CodeableConcept }, // Reason for overriding the list price/factor

  "enterer" : { Reference(Device|Organization|Patient|Practitioner|
   PractitionerRole|RelatedPerson) }, // Individual who was entering
  "enteredDate" : "<dateTime>", // Date the charge item was entered
  "reason" : [{ CodeableConcept }], // Why was the charged  service rendered?
  "|
   |
   
  
  " },
  " },

  "service" : [{ CodeableReference(DiagnosticReport|ImagingStudy|Immunization|
   MedicationAdministration|MedicationDispense|MedicationRequest|Observation|
   Procedure|ServiceRequest|SupplyDelivery) }], // Which rendered service is being charged?

  "product" : [{ CodeableReference(Device|Medication|Substance) }], // Product charged

  "account" : [{ Reference(Account) }], // Account to place this charge
  "note" : [{ Annotation }], // Comments made about the ChargeItem
  "supportingInformation" : [{ Reference(Any) }] // Further information supporting this charge
}

Turtle Template 

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:ChargeItem;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:ChargeItem.identifier [ Identifier ], ... ; # 0..* Business Identifier for item
  fhir:ChargeItem.definitionUri [ uri ], ... ; # 0..* Defining information about the code of this charge item
  fhir:ChargeItem.definitionCanonical [ canonical(ChargeItemDefinition) ], ... ; # 0..* Resource defining the code of this ChargeItem
  fhir:ChargeItem.status [ code ]; # 1..1 planned | billable | not-billable | aborted | billed | entered-in-error | unknown
  fhir:ChargeItem.partOf [ Reference(ChargeItem) ], ... ; # 0..* Part of referenced ChargeItem
  fhir:ChargeItem.code [ CodeableConcept ]; # 1..1 A code that identifies the charge, like a billing code
  fhir:ChargeItem.subject [ Reference(Group|Patient) ]; # 1..1 Individual service was done for/to
  fhir:

  fhir:ChargeItem.encounter [ Reference(Encounter) ]; # 0..1 Encounter associated with this ChargeItem

  # ChargeItem.occurrence[x] : 0..1 When the charged service was applied. One of these 3
    fhir:ChargeItem.occurrenceDateTime [ dateTime ]
    fhir:ChargeItem.occurrencePeriod [ Period ]
    fhir:ChargeItem.occurrenceTiming [ Timing ]
  fhir:ChargeItem.performer [ # 0..* Who performed charged service
    fhir:ChargeItem.performer.function [ CodeableConcept ]; # 0..1 What type of performance was done
    fhir:

    fhir:ChargeItem.performer.actor [ Reference(CareTeam|Device|HealthcareService|Organization|Patient|Practitioner|
  PractitionerRole|RelatedPerson) ]; # 1..1 Individual who was performing
  ], ...;
  fhir:
  fhir:

  fhir:ChargeItem.performingOrganization [ Reference(Organization) ]; # 0..1 Organization providing the charged service
  fhir:ChargeItem.requestingOrganization [ Reference(Organization) ]; # 0..1 Organization requesting the charged service

  fhir:ChargeItem.costCenter [ Reference(Organization) ]; # 0..1 Organization that has ownership of the (potential, future) revenue
  fhir:ChargeItem.quantity [ Quantity ]; # 0..1 Quantity of which the charge item has been serviced
  fhir:ChargeItem.bodysite [ CodeableConcept ], ... ; # 0..* Anatomical location, if relevant
  fhir:
  fhir:
  fhir:

  fhir:ChargeItem.unitPriceComponent [ MonetaryComponent ]; # 0..1 Unit price overriding the associated rules
  fhir:ChargeItem.totalPriceComponent [ MonetaryComponent ]; # 0..1 Total price overriding the associated rules
  fhir:ChargeItem.overrideReason [ CodeableConcept ]; # 0..1 Reason for overriding the list price/factor

  fhir:ChargeItem.enterer [ Reference(Device|Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) ]; # 0..1 Individual who was entering
  fhir:ChargeItem.enteredDate [ dateTime ]; # 0..1 Date the charge item was entered
  fhir:ChargeItem.reason [ CodeableConcept ], ... ; # 0..* Why was the charged  service rendered?
  fhir:|
  
  # . One of these 2
    fhir:) ]
    fhir: ]

  fhir:ChargeItem.service [ CodeableReference(DiagnosticReport|ImagingStudy|Immunization|MedicationAdministration|
  MedicationDispense|MedicationRequest|Observation|Procedure|ServiceRequest|
  SupplyDelivery) ], ... ; # 0..* Which rendered service is being charged?

  fhir:ChargeItem.product [ CodeableReference(Device|Medication|Substance) ], ... ; # 0..* Product charged

  fhir:ChargeItem.account [ Reference(Account) ], ... ; # 0..* Account to place this charge
  fhir:ChargeItem.note [ Annotation ], ... ; # 0..* Comments made about the ChargeItem
  fhir:ChargeItem.supportingInformation [ Reference(Any) ], ... ; # 0..* Further information supporting this charge
]

Changes since Release 4

ChargeItem
ChargeItem.encounter
  • No Changes Added Element
ChargeItem.performer.actor
  • Type Reference: Added Target Type HealthcareService
  • Type Reference: Added Target Type HealthcareService
ChargeItem.unitPriceComponent
  • Added Element
ChargeItem.totalPriceComponent
  • Added Element
ChargeItem.overrideReason
  • Type changed from string to CodeableConcept
  • Type changed from string to CodeableConcept
ChargeItem.service
  • Type changed from Reference(DiagnosticReport | ImagingStudy | Immunization | MedicationAdministration | MedicationDispense | Observation | Procedure | SupplyDelivery) to CodeableReference
  • Type changed from Reference(DiagnosticReport | ImagingStudy | Immunization | MedicationAdministration | MedicationDispense | Observation | Procedure | SupplyDelivery) to CodeableReference
ChargeItem.product
  • Added Element
ChargeItem.context
  • deleted
ChargeItem.factorOverride
  • deleted
ChargeItem.priceOverride
  • deleted
ChargeItem.product[x]
  • deleted

See the Full Difference for further information

This analysis is available as XML or JSON .

Conversions between R3 and R4 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 Additional definitions: Master Definition XML + JSON , XML Schema / Schematron + JSON Schema , ShEx (for Turtle ) + see the extensions , the spreadsheet version & the dependency analysis

8.24.4.1 Terminology Bindings

ChargeItem.product[x]
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

This example value set defines the set of codes that can be used to indicate a role of a procedure performer.

Example ProcedurePerformerRoleCodes
ChargeItem.bodysite

This value set includes all codes from SNOMED CT icon where concept is-a 442083009 (Anatomical or acquired body site (body structure)).

Example SNOMEDCTBodyStructures
ChargeItem.reason

This value set includes sample ICD-10 codes.

Example ICD-10Codes ICD10Codes (a valid code from ICD-10 icon )
ChargeItem.product

Codes used to identify medical devices. Includes concepts from SNOMED CT (http://www.snomed.org/) where concept is-a 49062001 (Device) and is provided as a suggestive example.

Example FHIRDeviceTypes DeviceType

8.24.5 Search Parameters

Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

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 encounter reference Encounter / Episode associated with event ChargeItem.context ChargeItem.encounter
( 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 ChargeItem.totalPriceComponent.factor
identifier token Business Identifier for item ChargeItem.identifier
occurrence date When the charged service was applied ChargeItem.occurrence ChargeItem.occurrence.as(dateTime) | ChargeItem.occurrence.as(Period) | ChargeItem.occurrence.as(Timing)
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 , HealthcareService , 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 ChargeItem.totalPriceComponent.amount
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 ) ChargeItem.service.reference
subject reference Individual service was done for/to ChargeItem.subject
( Group , Patient )