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8.29 Resource ChargeItemDefinition - Content

Patient Administration icon Work GroupMaturity Level: 1 Trial UseSecurity Category: Business Compartments: No defined compartments

The ChargeItemDefinition resource provides the properties that apply to the (billing) codes necessary to calculate costs and prices. The properties may differ largely depending on type and realm, therefore this resource gives only a rough structure and requires profiling for each type of billing code system.

8.29.1 Scope and Usage

The ChargeItemDefinition holds all relevant billing information pertaining to a billing code or a product.

Many billing systems have rules associated with the code which may define whether a billing code is applicable in a specific context or whether certain billing details (surcharges, discounts) apply. ChargeItemDefinitions may also be used to hold pricing information pertaining to only one specific instance of a product (e.g. Device, Medication or Substance) which may be a requirement for custom made devices or medications or other products where prices vary by instance. Rules for applicability may include

  • a billing code is only applicable in an outpatient setting
  • a surcharge that applies only to services provided outside regular business hours
  • a discount that applies only to patients up to the age of 14
  • a billing code that may only be charged once per Encounter
  • a billing code that can only be charged in combination with another code from the same billing system

A billing engine will apply the ChargeItemDefinitions to all ChargeItems within a specific Account in order to select all billable items an acquire the pricing details to create an Invoice. However, ChargeItems may be validated against a ChargeItemDefinition at any point in time, using the $apply-Operation

8.29.2 Boundaries and Relationships

While the ChargeItem resource represents the occurrence of a billing code (for services rendered or products supplied to a specific patient), the ChargeItemDefinition represents the properties and rules that a billing engine needs to determine the pricing and applicability of a billing code in the context of a specific setting.

Billing Codes may be defined in a CodeSystem Resource, however, each of these codes - if it is used in a financial context - can have a large number of business rules and properties associated with it, that lay outside the scope of CodeSystem and may change in time independently from the underlying Code's validity period. Even though CodeSystem can associate a concept with any number of additional properties, such a construct would be very hard to maintain. This is why the ChargItemDefinition has been introduced. It allows to maintain the attributes of each billing code independently and has a wider scope to also include business rules.

In most use cases, billing codes will be both defined as semantical concepts in a CodeSystem and as a financial artifact in ChargeItemDefinition.

ChargeItemDefinitions that pertain to codes from the same CodeSystem may be aggregated using the Catalog profile for Composition.

Resources representing products that can be sold or billed (Device, Medication, Substance...), do not specify financial details for the product instance. Most of the time, such products are not billed seperately but are a part of a generic billing code that covers both the product and the service rendered. In some occasions however, product prices may vary depending on type or manufactuer or even on instance (e.g. custom made products). For these cases, ChargeItemDefinitions may be created to specify the financial details for a product kind, type or instance.

8.29.3 References to this Resource

8.29.4 Resource Content

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. ChargeItemDefinition TU DomainResource Definition of properties and rules about how the price and the applicability of a ChargeItem can be determined
+ Warning: Name should be usable as an identifier for the module by machine processing applications such as code generation

Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
Interfaces Implemented: MetadataResource
... url ΣC 0..1 uri Canonical identifier for this charge item definition, represented as a URI (globally unique)
+ Warning: URL should not contain | or # - these characters make processing canonical references problematic
... identifier Σ 0..* Identifier Additional identifier for the charge item definition

... version Σ 0..1 string Business version of the charge item definition
... versionAlgorithm[x] Σ 0..1 How to compare versions
Binding: Version Algorithm (Extensible)
.... versionAlgorithmString string
.... versionAlgorithmCoding Coding
... name ΣC 0..1 string Name for this charge item definition (computer friendly)
... title ΣT 0..1 string Name for this charge item definition (human friendly)
... derivedFromUri Σ 0..* uri Underlying externally-defined charge item definition

... partOf Σ 0..* canonical(ChargeItemDefinition) A larger definition of which this particular definition is a component or step

... replaces Σ 0..* canonical(ChargeItemDefinition) Completed or terminated request(s) whose function is taken by this new request

... status ?!Σ 1..1 code draft | active | retired | unknown
Binding: PublicationStatus (Required)
... experimental Σ 0..1 boolean For testing only - never for real usage
... date Σ 0..1 dateTime Date last changed
... account Σ 0..* Reference(Account) Candidate account(s) for charge items

... publisher ΣT 0..1 string Name of the publisher/steward (organization or individual)
... contact Σ 0..* ContactDetail Contact details for the publisher

... description ΣT 0..1 markdown Natural language description of the charge item definition
... useContext Σ 0..* UsageContext The context that the content is intended to support

... jurisdiction ΣXD 0..* CodeableConcept Intended jurisdiction for charge item definition (if applicable)
Binding: Jurisdiction ValueSet (Extensible)

... purpose T 0..1 markdown Why this charge item definition is defined
... copyright T 0..1 markdown Use and/or publishing restrictions
... copyrightLabel T 0..1 string Copyright holder and year(s)
... approvalDate 0..1 date When the charge item definition was approved by publisher
... lastReviewDate 0..1 date When the charge item definition was last reviewed by the publisher
... code Σ 0..1 CodeableConcept Billing code or product type this definition applies to
Binding: Charge Item Code (Example)
... instance 0..* Reference(Medication | Substance | Device | DeviceDefinition | ActivityDefinition | PlanDefinition | HealthcareService) Instances this definition applies to

... applicability 0..* BackboneElement Whether or not the billing code is applicable

.... condition 0..1 Expression Boolean-valued expression
.... effectivePeriod Σ 0..1 Period When the charge item definition is expected to be used
.... relatedArtifact 0..1 RelatedArtifact Reference to / quotation of the external source of the group of properties
... propertyGroup 0..* BackboneElement Group of properties which are applicable under the same conditions

.... applicability 0..* see applicability Conditions under which the priceComponent is applicable

.... priceComponent 0..* MonetaryComponent Components of total line item price


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) , the spreadsheet version & the dependency analysis

8.29.4.1 Terminology Bindings

Path ValueSet Type Documentation
ChargeItemDefinition.versionAlgorithm[x] VersionAlgorithm Extensible

Indicates the mechanism used to compare versions to determine which is more current.
ChargeItemDefinition.status PublicationStatus Required

The lifecycle status of an artifact.
ChargeItemDefinition.jurisdiction JurisdictionValueSet Extensible

This value set defines a base set of codes for country, country subdivision and region for indicating where a resource is intended to be used.

Note: The codes for countries and country subdivisions are taken from ISO 3166 icon while the codes for "supra-national" regions are from UN Standard country or area codes for statistical use (M49) icon.
ChargeItemDefinition.code ChargeItemCode Example

Example set of codes that can be used for billing purposes.

8.29.4.2 Constraints

UniqueKeyLevelLocationDescriptionExpression
img cnl-0Warning (base)Name should be usable as an identifier for the module by machine processing applications such as code generationname.exists() implies name.matches('^[A-Z]([A-Za-z0-9_]){1,254}$')
img cnl-1Warning ChargeItemDefinition.urlURL should not contain | or # - these characters make processing canonical references problematicexists() implies matches('^[^|# ]+$')



8.29.5 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 Candidate account for charge items ChargeItemDefinition.account
(Account)
context token A use context assigned to the charge item definition (ChargeItemDefinition.useContext.value.ofType(CodeableConcept)) 30 Resources
context-quantity quantity A quantity- or range-valued use context assigned to the charge item definition (ChargeItemDefinition.useContext.value.ofType(Quantity)) | (ChargeItemDefinition.useContext.value.ofType(Range)) 30 Resources
context-type token A type of use context assigned to the charge item definition ChargeItemDefinition.useContext.code 30 Resources
context-type-quantity composite A use context type and quantity- or range-based value assigned to the charge item definition On ChargeItemDefinition.useContext:
  context-type: code
  context-quantity: value.ofType(Quantity) | value.ofType(Range)		 30 Resources
context-type-value composite A use context type and value assigned to the charge item definition On ChargeItemDefinition.useContext:
  context-type: code
  context: value.ofType(CodeableConcept)		 30 Resources
date date The charge item definition publication date ChargeItemDefinition.date 31 Resources
description string The description of the charge item definition ChargeItemDefinition.description 29 Resources
effective date The time during which the charge item definition is intended to be in use ChargeItemDefinition.applicability.effectivePeriod 12 Resources
identifier token External identifier for the charge item definition ChargeItemDefinition.identifier 35 Resources
jurisdiction token Intended jurisdiction for the charge item definition ChargeItemDefinition.jurisdiction 27 Resources
publisher string Name of the publisher of the charge item definition ChargeItemDefinition.publisher 31 Resources
status token The current status of the charge item definition ChargeItemDefinition.status 35 Resources
title string The human-friendly name of the charge item definition ChargeItemDefinition.title 28 Resources
url uri The uri that identifies the charge item definition ChargeItemDefinition.url 34 Resources
version token The business version of the charge item definition ChargeItemDefinition.version 32 Resources