Release 4 4B

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8.24 Resource ChargeItem - Content

Patient Administration 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

This resource is referenced by itself and Invoice .

This resource implements the Event pattern.

8.24.3 8.24.4 Resource Content

Structure

Name Flags Card. Type Description & Constraints doco
. . 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 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

doco 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. 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] « Example set of codes that can be used for billing purposes. 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 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 Element [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. null (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. null (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 Element [0..1] « Reference ( Device | Medication | Substance )| CodeableConcept ; Example binding for product type. null (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. null (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 

<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>

 <subject><!-- 1..1 Reference(Group|Patient) Individual service was done for/to --></subject>

 <context><!-- 0..1 Reference(Encounter|EpisodeOfCare) Encounter / Episode associated with event --></context>
 <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|Organization|Patient|Practitioner|
    PractitionerRole|RelatedPerson) Individual who was performing --></actor>
 </performer>
 <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>
 <factorOverride value="[decimal]"/><!-- 0..1 Factor overriding the associated rules -->
 <priceOverride><!-- 0..1 Money Price overriding the associated rules --></priceOverride>
 <overrideReason value="[string]"/><!-- 0..1 Reason for overriding the list price/factor -->
 <|
   </enterer>

 <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><!-- 0..* Reference(DiagnosticReport|ImagingStudy|Immunization|
   MedicationAdministration|MedicationDispense|Observation|Procedure|
   SupplyDelivery) Which rendered service is being charged? --></service>
 <product[x]><!-- 0..1 Reference(Device|Medication|Substance)|CodeableConcept Product charged --></product[x]>
 <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

  "context" : { Reference(Encounter|EpisodeOfCare) }, // Encounter / Episode associated with event
  // 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|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
  "factorOverride" : <decimal>, // Factor overriding the associated rules
  "priceOverride" : { Money }, // Price overriding the associated rules
  "overrideReason" : "<string>", // 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" : [{ Reference(DiagnosticReport|ImagingStudy|Immunization|
   MedicationAdministration|MedicationDispense|Observation|Procedure|
   SupplyDelivery) }], // Which rendered service is being charged?
  // product[x]: Product charged. One of these 2:
  "productReference" : { Reference(Device|Medication|Substance) },
  "productCodeableConcept" : { CodeableConcept },
  "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:

  fhir:ChargeItem.subject [ Reference(Group|Patient) ]; # 1..1 Individual service was done for/to

  fhir:ChargeItem.context [ Reference(Encounter|EpisodeOfCare) ]; # 0..1 Encounter / Episode associated with event
  # 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|Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) ]; # 1..1 Individual who was performing

  ], ...;
  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:ChargeItem.factorOverride [ decimal ]; # 0..1 Factor overriding the associated rules
  fhir:ChargeItem.priceOverride [ Money ]; # 0..1 Price overriding the associated rules
  fhir:ChargeItem.overrideReason [ string ]; # 0..1 Reason for overriding the list price/factor
  fhir:

  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:ChargeItem.service [ Reference(DiagnosticReport|ImagingStudy|Immunization|MedicationAdministration|
  MedicationDispense|Observation|Procedure|SupplyDelivery) ], ... ; # 0..* Which rendered service is being charged?
  # ChargeItem.product[x] : 0..1 Product charged. One of these 2
    fhir:ChargeItem.productReference [ Reference(Device|Medication|Substance) ]
    fhir:ChargeItem.productCodeableConcept [ CodeableConcept ]
  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 R3 R4

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 No Changes

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

Name Flags Card. Type Description & Constraints doco
. . 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 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

doco 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. 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] « Example set of codes that can be used for billing purposes. 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 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 Element [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. null (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. null (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 Element [0..1] « Reference ( Device | Medication | Substance )| CodeableConcept ; Example binding for product type. null (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. null (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 

<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>

 <subject><!-- 1..1 Reference(Group|Patient) Individual service was done for/to --></subject>

 <context><!-- 0..1 Reference(Encounter|EpisodeOfCare) Encounter / Episode associated with event --></context>
 <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|Organization|Patient|Practitioner|
    PractitionerRole|RelatedPerson) Individual who was performing --></actor>
 </performer>
 <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>
 <factorOverride value="[decimal]"/><!-- 0..1 Factor overriding the associated rules -->
 <priceOverride><!-- 0..1 Money Price overriding the associated rules --></priceOverride>
 <overrideReason value="[string]"/><!-- 0..1 Reason for overriding the list price/factor -->
 <|
   </enterer>

 <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><!-- 0..* Reference(DiagnosticReport|ImagingStudy|Immunization|
   MedicationAdministration|MedicationDispense|Observation|Procedure|
   SupplyDelivery) Which rendered service is being charged? --></service>
 <product[x]><!-- 0..1 Reference(Device|Medication|Substance)|CodeableConcept Product charged --></product[x]>
 <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

  "context" : { Reference(Encounter|EpisodeOfCare) }, // Encounter / Episode associated with event
  // 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|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
  "factorOverride" : <decimal>, // Factor overriding the associated rules
  "priceOverride" : { Money }, // Price overriding the associated rules
  "overrideReason" : "<string>", // 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" : [{ Reference(DiagnosticReport|ImagingStudy|Immunization|
   MedicationAdministration|MedicationDispense|Observation|Procedure|
   SupplyDelivery) }], // Which rendered service is being charged?
  // product[x]: Product charged. One of these 2:
  "productReference" : { Reference(Device|Medication|Substance) },
  "productCodeableConcept" : { CodeableConcept },
  "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:

  fhir:ChargeItem.subject [ Reference(Group|Patient) ]; # 1..1 Individual service was done for/to

  fhir:ChargeItem.context [ Reference(Encounter|EpisodeOfCare) ]; # 0..1 Encounter / Episode associated with event
  # 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|Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) ]; # 1..1 Individual who was performing

  ], ...;
  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:ChargeItem.factorOverride [ decimal ]; # 0..1 Factor overriding the associated rules
  fhir:ChargeItem.priceOverride [ Money ]; # 0..1 Price overriding the associated rules
  fhir:ChargeItem.overrideReason [ string ]; # 0..1 Reason for overriding the list price/factor
  fhir:

  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:ChargeItem.service [ Reference(DiagnosticReport|ImagingStudy|Immunization|MedicationAdministration|
  MedicationDispense|Observation|Procedure|SupplyDelivery) ], ... ; # 0..* Which rendered service is being charged?
  # ChargeItem.product[x] : 0..1 Product charged. One of these 2
    fhir:ChargeItem.productReference [ Reference(Device|Medication|Substance) ]
    fhir:ChargeItem.productCodeableConcept [ CodeableConcept ]
  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 3 4

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 No Changes

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 definitions: Master Definition XML + JSON , XML Schema / Schematron + JSON Schema , ShEx (for Turtle ) + see the extensions & the dependency analysis

8.24.3.1 8.24.4.1 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. Example ICD-10Codes
ChargeItem.product[x] Example binding for product type. Example FHIRDeviceTypes

8.24.4 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 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 )