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8.28 Resource ChargeItem - Content

Patient Administration icon Work GroupMaturity Level: 1 Trial UseSecurity Category: Patient Compartments: Device, Encounter, Group, 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.

8.28.1 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.

8.28.2 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).

8.28.3 References to this Resource

8.28.4 Resource Content

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. 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
Binding: Charge Item Code (Example)
... subject Σ 1..1 Reference(Patient | Group) Individual service was done for/to
... encounter Σ 0..1 Reference(Encounter) Encounter associated with 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
Binding: 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
Binding: SNOMED CT Body Structures (Example)

... unitPriceComponent 0..1 MonetaryComponent Unit price overriding the associated rules
... totalPriceComponent 0..1 MonetaryComponent Total price overriding the associated rules
... overrideReason 0..1 CodeableConcept Reason for overriding the list price/factor
Binding: override-reason (Example)
... 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..* CodeableReference(Condition | DiagnosticReport | Observation | ImmunizationRecommendation | Procedure) Why was the charged service rendered?
Binding: ICD-10 Codes (Example)

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

... product 0..* CodeableReference(Device | Medication | Substance) Product charged
Binding: 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

 

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

8.28.4.1 Terminology Bindings

Path ValueSet Type Documentation
ChargeItem.status ChargeItemStatus Required

Codes identifying the lifecycle stage of a ChargeItem.
ChargeItem.code ChargeItemCode Example

Example set of codes that can be used for billing purposes.
ChargeItem.performer.function ProcedurePerformerRoleCodes Example

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

This value set includes all codes from SNOMED CT icon where concept is-a 442083009 (Anatomical or acquired body site (body structure)).
ChargeItem.overrideReason Example
ChargeItem.reason ICD10Codes (a valid code from ICD-10 icon) Example

This value set includes sample ICD-10 codes.
ChargeItem.product DeviceType Example

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.



8.28.5 Search Parameters

Search parameters for this resource. See also the full list of search parameters for this resource, and check the Extensions registry for search parameters on extensions related to 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 21 Resources
encounter reference Encounter associated with event ChargeItem.encounter
(Encounter)		 29 Resources
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.totalPriceComponent.factor
identifier token Business Identifier for item ChargeItem.identifier 65 Resources
occurrence date When the charged service was applied ChargeItem.occurrence.ofType(dateTime) | ChargeItem.occurrence.ofType(Period) | ChargeItem.occurrence.ofType(Timing)
patient reference Individual service was done for/to ChargeItem.subject.where(resolve() is Patient)
(Patient)		 65 Resources
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.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.reference
status token Is this charge item active ChargeItem.status
subject reference Individual service was done for/to ChargeItem.subject
(Group, Patient)