FHIR Release 3 (STU) 4

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Patient Administration Work Group Maturity Level : 0   Draft Trial Use Security Category : Patient Compartments : Device , Encounter , Patient , Practitioner , RelatedPerson

Detailed Descriptions for the elements in the ChargeItem resource.

ChargeItem
Element Id ChargeItem
Definition

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.

Control Cardinality 1..1 0..*
Type DomainResource
ChargeItem.identifier
Element Id ChargeItem.identifier
Definition

Identifiers assigned to this event performer or other systems.

Note This is a business identifer, identifier, not a resource identifier (see discussion )
Control Cardinality 0..1 0..*
Type Identifier
Requirements

Allows identification of the charge Item as it is known by various participating systems and in a way that remains consistent across servers.

Summary true
ChargeItem.definition ChargeItem.definitionUri
Element Id ChargeItem.definitionUri
Definition

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

Control Cardinality 0..*
Type uri
Summary false
ChargeItem.definitionCanonical
Comments Element Id ChargeItem.definitionCanonical
Definition

Target Resource is yet to be defined as a container that holds information about list prices and References the source of pricing information, rules applicable to of application for the charge item code. Once defined, change type back to Reference(Definition Type). code this ChargeItem uses.

Cardinality 0..*
Type canonical ( ChargeItemDefinition )
Summary false
ChargeItem.status
Element Id ChargeItem.status
Definition

The current state of the ChargeItem.

Control Cardinality 1..1
Terminology Binding ChargeItemStatus ( Required )
Type code
Is Modifier true (Reason: This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid)
Summary true
Comments

Unknown does not represent "other" "other" - one of the defined statuses must apply. Unknown is used when the authoring system is not sure what the current status is.

This element is labeled as a modifier because the status contains the code entered-in-error that marks the charge item as not currently valid.

ChargeItem.partOf
Element Id ChargeItem.partOf
Definition

ChargeItems can be grouped to larger ChargeItems covering the whole set.

Control Cardinality 0..*
Type Reference ( ChargeItem )
Requirements

E.g. Drug administration as part of a procedure, procedure as part of observation, etc.

Alternate Names container
Summary false
ChargeItem.code
Element Id ChargeItem.code
Definition

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

Control Cardinality 1..1
Terminology Binding ChargeItemCode ( Example )
Type CodeableConcept
Alternate Names type
Summary true
ChargeItem.subject
Element Id ChargeItem.subject
Definition

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

Control Cardinality 1..1
Type Reference ( Patient | Group )
Requirements

Links the event to the Patient context.

Alternate Names patient
Summary true
ChargeItem.context
Element Id ChargeItem.context
Definition

The encounter or episode of care that establishes the context for this event.

Control Cardinality 0..1
Type Reference ( Encounter | EpisodeOfCare )
Requirements

Links the request to the Encounter context.

Alternate Names encounter
Summary true
ChargeItem.occurrence[x]
Element Id ChargeItem.occurrence[x]
Definition

Date/time(s) or duration when the charged service was applied.

Control Cardinality 0..1
Type dateTime | Period | Timing
[x] Note See Choice of Data Types for further information about how to use [x]
Alternate Names timing
Summary true
Comments

The list of types may be constrained as appropriate for the type of charge item.

ChargeItem.participant ChargeItem.performer
Element Id ChargeItem.performer
Definition

Indicates who or what performed or participated in the charged service.

Control Cardinality 0..*
Summary false
ChargeItem.participant.role ChargeItem.performer.function
Element Id ChargeItem.performer.function
Definition

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

Control Cardinality 0..1
Terminology Binding Procedure Performer Role Codes ( Example )
Type CodeableConcept
Summary false
ChargeItem.participant.actor ChargeItem.performer.actor
Element Id ChargeItem.performer.actor
Definition

The device, practitioner, etc. who performed or participated in the service.

Control Cardinality 1..1
Type Reference ( Practitioner | PractitionerRole | Organization | CareTeam | Patient | Device | RelatedPerson )
Summary false
ChargeItem.performingOrganization
Element Id ChargeItem.performingOrganization
Definition

The organization requesting the service.

Control Cardinality 0..1
Type Reference ( Organization )
Summary false
Comments

Practitioners and Devices can be associated with multiple organizations. It has to be made clear, on behalf of which Organization the services have been rendered.

ChargeItem.requestingOrganization
Element Id ChargeItem.requestingOrganization
Definition

The organization performing the service.

Control Cardinality 0..1
Type Reference ( Organization )
Summary false
Comments

The rendered Service may might not be associated with a Request. It has to be made clear, ob This property indicates which Organization's Request, Organization requested the services have been to be rendered. (In many cases, this may just be the Department associated with the Encounter.location).

ChargeItem.costCenter
Element Id ChargeItem.costCenter
Definition

The financial cost center permits the tracking of charge attribution.

Cardinality 0..1
Type Reference ( Organization )
Summary false
Comments

The costCenter could either be given as a reference to an Organization(Role) resource or as the identifier of the cost center determined by Reference.identifier.value and Reference.identifier.system, depending on use case requirements.

ChargeItem.quantity
Element Id ChargeItem.quantity
Definition

Quantity of which the charge item has been serviced.

Control Cardinality 0..1
Type Quantity
Summary true
Comments

In many cases this may just be a value, if the underlying units are implicit in the definition of the charge item code.

ChargeItem.bodysite
Element Id ChargeItem.bodysite
Definition

The anatomical location where the related service has been applied.

Control Cardinality 0..*
Terminology Binding SNOMED CT Body Structures ( Example )
Type CodeableConcept
Summary true
Comments

Only used if not implicit in code found in Condition.code. If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension body-site-instance bodySite . May be a summary code, or a reference to a very precise definition of the location, or both.

ChargeItem.factorOverride
Element Id ChargeItem.factorOverride
Definition

Factor overriding the factor determined by the rules associated with the code.

Control Cardinality 0..1
Type decimal
Summary false
Comments

There is no reason to carry the factor in the instance of a ChargeItem unless special circumstances require a manual override. The factors are usually defined by a set of rules in a back catalogue of the billing codes (see ChargeItem.definition). Derived profiles may require a ChargeItem.overrideReason to be provided if either factor or price are manually overriden. overridden.

ChargeItem.priceOverride
Element Id ChargeItem.priceOverride
Definition

Total price of the charge overriding the list price associated with the code.

Control Cardinality 0..1
Type Money
Summary false
Comments

There is no reason to carry the price in the instance of a ChargeItem unless circumstances require a manual override. The list prices or are usually defined in a back catalogue of the billing codes (see ChargeItem.definition). Derived profiles may require a ChargeItem.overrideReason to be provided if either factor or price are manually overriden. overridden.

ChargeItem.overrideReason
Element Id ChargeItem.overrideReason
Definition

If the list price or the rule based rule-based factor associated with the code is overridden, this attribute can capture a text to indicate the reason for this action.

Control Cardinality 0..1
Type string
Summary false
Comments

Derived Profiles may chose choose to add invariants requiring this field to be populated if either priceOverride or factorOverride have been filled.

ChargeItem.enterer
Element Id ChargeItem.enterer
Definition

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

Control Cardinality 0..1
Type Reference ( Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson )
Summary true
Comments

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

ChargeItem.enteredDate
Element Id ChargeItem.enteredDate
Definition

Date the charge item was entered.

Control Cardinality 0..1
Type dateTime
Summary true
Comments

The actual date when the service associated with the charge has been rendered is captured in occurrence[x].

ChargeItem.reason
Element Id ChargeItem.reason
Definition

Describes why the event occurred in coded or textual form.

Control Cardinality 0..*
Terminology Binding ICD-10 Codes ( Example )
Type CodeableConcept
Summary false
Comments

If the application of the charge item requires a reason to be given, it can be captured here. Textual reasons can be captured using reasonCode.text.

ChargeItem.service
Element Id ChargeItem.service
Definition

Indicated the rendered service that caused this charge.

Control Cardinality 0..*
Type Reference ( DiagnosticReport | ImagingStudy | Immunization | MedicationAdministration | MedicationDispense | Observation | Procedure | SupplyDelivery )
Summary false
ChargeItem.product[x]
Element Id ChargeItem.product[x]
Definition

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

Cardinality 0..1
Terminology Binding FHIR Device Types ( Example )
Type Reference ( Device | Medication | Substance )| CodeableConcept
[x] Note See Choice of Data Types for further information about how to use [x]
Summary false
ChargeItem.account
Element Id ChargeItem.account
Definition

Account into which this ChargeItems belongs.

Control Cardinality 0..*
Type Reference ( Account )
Summary true
Comments

Systems posting the ChargeItems may might not always be able to determine, which accounts the Items need to be places into. It is up to the potprocessing postprocessing Financial System to apply internal rules to decide based on the Encounter/EpisodeOfCare/Patient/Coverage context and the type of ChargeItem, which Account is appropriate.

ChargeItem.note
Element Id ChargeItem.note
Definition

Comments made about the event by the performer, subject or other participants.

Control Cardinality 0..*
Type Annotation
Summary false
ChargeItem.supportingInformation
Element Id ChargeItem.supportingInformation
Definition

Further information supporting the this charge.

Control Cardinality 0..*
Type Reference ( Any )
Summary false