Administrative Incubator
0.1.0 - International flag

Administrative Incubator, published by HL7 International / Patient Administration. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/admin-incubator/ and changes regularly. See the Directory of published versions

Resource: Charge Item

Official URL: http://hl7.org/fhir/StructureDefinition/ChargeItem Version: 0.1.0
Standards status: Trial-use Draft as of 2021-01-02 Maturity Level: 1 Computable Name: ChargeItem
Other Identifiers: OID:2.16.840.1.113883.4.642.5.1384

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.

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.

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).

Usages:

You can also check for usages in the FHIR IG Statistics

Formal Views of Resource Content

Description Differentials, Snapshots, and other representations.

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. ChargeItem 0..* 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(Charge Item Definition) Resource defining the code of this ChargeItem
... partOf 0..* Reference(Charge Item) Part of referenced ChargeItem
... code Σ 1..1 CodeableConcept A code that identifies the charge, like a billing code
Binding: ChargeItemCode (example): Example codes for billing purposes
... 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: ProcedurePerformerRoleCodes (example): Codes describing the types of functional roles performers can take on when performing events.
.... 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: SNOMEDCTBodyStructures (example): SNOMED CT Body site concepts
... 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 Description: (example): Local or regional codes covering why a price was overridden
... 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: ICD10Codes (example): ICD 10 diagnosis codes
... service 0..* CodeableReference(DiagnosticReport | ImagingStudy | Immunization | MedicationAdministration | MedicationDispense | MedicationRequest | Observation | Procedure | ServiceRequest) Which rendered service is being charged?
... product 0..* CodeableReference(Device | Medication | Substance) Product charged
Binding: DeviceType (example): Example binding for product type.
... account Σ 0..* Reference(Account) Account to place this charge
... note 0..* Annotation Comments made about the ChargeItem
... supportingInformation 0..* Reference(Resource) Further information supporting this charge

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
ChargeItem.status Base required Charge Item Status 📦6.0.0-ballot3 FHIR Std.
ChargeItem.code Base example Charge Item Code 📦6.0.0-ballot3 FHIR Std.
ChargeItem.performer.​function Base example Procedure Performer Role Codes 📦6.0.0-ballot3 FHIR Std.
ChargeItem.bodysite Base example SNOMED CT Body Structures 📦6.0.0-ballot3 FHIR Std.
ChargeItem.overrideReason Base example Not State Unknown
ChargeItem.reason Base example ICD-10 Codes 📦6.0.0-ballot3 FHIR Std.
ChargeItem.product Base example Device Type 📦6.0.0-ballot3 FHIR Std. 
​
<ChargeItem xmlns="http://hl7.org/fhir"> ​​doco
 ​<id value="[id]"/><!-- 0..1 ​* ​Logical id of this artifact  -->
 ​<meta><!-- ​I 0..1 ​* ​Metadata about the resource  --></meta>
 ​<implicitRules value="[uri]"/><!-- ​I 0..1 ​* ​A set of rules under which this content was created  -->
 ​<language value="[code]"/><!-- ​I 0..1 ​* Language of the resource content  -->
 ​<text><!-- ​I 0..1 ​* ​Text summary of the resource, for human interpretation  --></text>
 ​<contained><!-- 0..* ​* ​Contained, inline Resources  --></contained>
 ​<extension><!-- See Extensions  ​Additional content defined by implementations  --></extension>
 ​<modifierExtension><!-- ​I 0..* ​* ​Extensions that cannot be ignored  --></modifierExtension>
 <identifier><!-- 0..* ​* ​Business Identifier for item  --></identifier>
 <definitionUri value="[uri]"/><!-- 0..* ​* ​Defining information about the code of this charge item  -->
 <definitionCanonical value="[canonical]"/><!-- 0..* ​* ​Resource defining the code of this ChargeItem  -->
 <status value="[code]"/><!-- 1..1 ​* planned | billable | not-billable | aborted | billed | entered-in-error | unknown  -->
 <partOf><!-- 0..* ​* ​Part of referenced ChargeItem  --></partOf>
 <code><!-- 1..1 ​* A code that identifies the charge, like a billing code  --></code>
 <subject><!-- 1..1 ​* ​Individual service was done for/to  --></subject>
 <encounter><!-- 0..1 ​* ​Encounter associated with this ChargeItem  --></encounter>
 <occurrence[x]><!-- 0..1 dateTime|Period|Timing ​When the charged service was applied  --></occurrence[x]>
 <performer> ​I 0..* ​*  <!-- ​I 0..* Who performed charged service -->
  ​<id value="[id]"/><!-- 0..1 ​* ​Unique id for inter-element referencing   -->
  ​<extension><!-- See Extensions  ​Additional content defined by implementations   --></extension>
  ​<modifierExtension><!-- ​I 0..* ​* ​Extensions that cannot be ignored even if unrecognized   --></modifierExtension>
  <function><!-- 0..1 ​* What type of performance was done   --></function>
  <actor><!-- 1..1 ​* ​Individual who was performing   --></actor>
 </performer>
 <performingOrganization><!-- 0..1 ​* ​Organization providing the charged service  --></performingOrganization>
 <requestingOrganization><!-- 0..1 ​* ​Organization requesting the charged service  --></requestingOrganization>
 <costCenter><!-- 0..1 ​* ​Organization that has ownership of the (potential, future) revenue  --></costCenter>
 <quantity><!-- 0..1 ​* ​Quantity of which the charge item has been serviced  --></quantity>
 <bodysite><!-- 0..* ​* Anatomical location, if relevant  --></bodysite>
 <unitPriceComponent><!-- 0..1 ​* ​Unit price overriding the associated rules  --></unitPriceComponent>
 <totalPriceComponent><!-- 0..1 ​* ​Total price overriding the associated rules  --></totalPriceComponent>
 <overrideReason><!-- 0..1 ​* ​Reason for overriding the list price/factor  --></overrideReason>
 <enterer><!-- 0..1 ​* ​Individual who was entering  --></enterer>
 <enteredDate value="[dateTime]"/><!-- 0..1 ​* ​Date the charge item was entered  -->
 <reason><!-- 0..* ​* Why was the charged  service rendered?  --></reason>
 <service><!-- 0..* ​* ​Which rendered service is being charged?  --></service>
 <product><!-- 0..* ​* Product charged  --></product>
 <account><!-- 0..* ​* ​Account to place this charge  --></account>
 <note><!-- 0..* ​* ​Comments made about the ChargeItem  --></note>
 <supportingInformation><!-- 0..* ​* ​Further information supporting this charge  --></supportingInformation>
</ChargeItem>

​
{​​doco
  "resourceType" : "ChargeItem",
  "id" : "<id>", // 0..1 ​Logical id of this artifact
  "meta" : { Meta }, // ​I 0..1 ​Metadata about the resource
  "implicitRules" : "<uri>", // ​I 0..1 ​A set of rules under which this content was created
  "language" : "<code>", // ​I 0..1 Language of the resource content
  "text" : { Narrative }, // ​I 0..1 ​Text summary of the resource, for human interpretation
  "contained" : [{ ​Resource }], // 0..* ​Contained, inline Resources
  (Extensions - see JSON page)
  (Modifier Extensions - see JSON page)
  "identifier" : [{ Identifier }], // 0..* ​Business Identifier for item
  "definitionUri" : ["<uri>"], // 0..* ​Defining information about the code of this charge item
  "definitionCanonical" : ["<canonical(ChargeItemDefinition)>"], // 0..* ​Resource defining the code of this ChargeItem
  "status" : "<code>", // 1..1 planned | billable | not-billable | aborted | billed | entered-in-error | unknown
  "partOf" : [{ Reference(ChargeItem) }], // 0..* ​Part of referenced ChargeItem
  "code" : { CodeableConcept }, // 1..1 A code that identifies the charge, like a billing code
  "subject" : { Reference(Group|Patient) }, // 1..1 ​Individual service was done for/to
  "encounter" : { Reference(Encounter) }, // 0..1 ​Encounter associated with this ChargeItem
  // occurrence[x]: When the charged service was applied. One of these 3:
  "occurrencedateTime" : "<dateTime>",
  "occurrencePeriod" : { Period },
  "occurrenceTiming" : { Timing },
  "performer" : [{ BackboneElement }], // ​I 0..* ​Who performed charged service
    "id" : "<id>", // 0..1 ​Unique id for inter-element referencing
  (Extensions - see JSON page)
  (Modifier Extensions - see JSON page)
    "function" : { CodeableConcept }, // 0..1 What type of performance was done
    "actor" : { Reference(CareTeam|Device|HealthcareService|Organization|
    Patient|Practitioner|PractitionerRole|RelatedPerson) } // 1..1 ​Individual who was performing
  }
  "performingOrganization" : { Reference(Organization) }, // 0..1 ​Organization providing the charged service
  "requestingOrganization" : { Reference(Organization) }, // 0..1 ​Organization requesting the charged service
  "costCenter" : { Reference(Organization) }, // 0..1 ​Organization that has ownership of the (potential, future) revenue
  "quantity" : { Quantity }, // 0..1 ​Quantity of which the charge item has been serviced
  "bodysite" : [{ CodeableConcept }], // 0..* Anatomical location, if relevant
  "unitPriceComponent" : { MonetaryComponent }, // 0..1 ​Unit price overriding the associated rules
  "totalPriceComponent" : { MonetaryComponent }, // 0..1 ​Total price overriding the associated rules
  "overrideReason" : { CodeableConcept }, // 0..1 ​Reason for overriding the list price/factor
  "enterer" : { Reference(Device|Organization|Patient|Practitioner|
   PractitionerRole|RelatedPerson) }, // 0..1 ​Individual who was entering
  "enteredDate" : "<dateTime>", // 0..1 ​Date the charge item was entered
  "reason" : [{ CodeableReference(Condition|DiagnosticReport|
   ImmunizationRecommendation|Observation|Procedure) }], // 0..* Why was the charged  service rendered?
  "service" : [{ CodeableReference(DiagnosticReport|ImagingStudy|Immunization|
   MedicationAdministration|MedicationDispense|MedicationRequest|Observation|
   Procedure|ServiceRequest) }], // 0..* ​Which rendered service is being charged?
  "product" : [{ CodeableReference(Device|Medication|Substance) }], // 0..* Product charged
  "account" : [{ Reference(Account) }], // 0..* ​Account to place this charge
  "note" : [{ Annotation }], // 0..* ​Comments made about the ChargeItem
  "supportingInformation" : [{ Reference(Resource) }] // 0..* ​Further information supporting this charge
}

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


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

  fhir:id [ id ] ; # 0..1 Logical id of this artifact
  fhir:meta [ Meta ] ; # 0..1 ​I Metadata about the resource
  fhir:implicitRules [ uri ] ; # 0..1 ​I A set of rules under which this content was created
  fhir:language [ code ] ; # 0..1 ​I Language of the resource content
  fhir:text [ Narrative ] ; # 0..1 ​I Text summary of the resource, for human interpretation
  fhir:contained  ( [ Resource ] ... ) ; # 0..* Contained, inline Resources
  fhir:extension  ( [ Extension ] ... ) ; # 0..* ​I Additional content defined by implementations
  fhir:modifierExtension  ( [ Extension ] ... ) ; # 0..* ​I Extensions that cannot be ignored
  fhir:identifier  ( [ Identifier ] ... ) ; # 0..* Business Identifier for item
  fhir:definitionUri  ( [ uri ] ... ) ; # 0..* Defining information about the code of this charge item
  fhir:definitionCanonical  ( [ canonical(ChargeItemDefinition) ] ... ) ; # 0..* Resource defining the code of this ChargeItem
  fhir:status [ code ] ; # 1..1 planned | billable | not-billable | aborted | billed | entered-in-error | unknown
  fhir:partOf  ( [ Reference(ChargeItem) ] ... ) ; # 0..* Part of referenced ChargeItem
  fhir:code [ CodeableConcept ] ; # 1..1 A code that identifies the charge, like a billing code
  fhir:subject [ Reference(Group|Patient) ] ; # 1..1 Individual service was done for/to
  fhir:encounter [ Reference(Encounter) ] ; # 0..1 Encounter associated with this ChargeItem
  # occurrence[x] : 0..1 When the charged service was applied. One of these 3
    fhir:occurrence [  a fhir:dateTime ; dateTime ]
    fhir:occurrence [  a fhir:Period ; Period ]
    fhir:occurrence [  a fhir:Timing ; Timing ]
  fhir:performer  ( [ BackboneElement ] ... ) ; # 0..* ​I Who performed charged service
  fhir:performingOrganization [ Reference(Organization) ] ; # 0..1 Organization providing the charged service
  fhir:requestingOrganization [ Reference(Organization) ] ; # 0..1 Organization requesting the charged service
  fhir:costCenter [ Reference(Organization) ] ; # 0..1 Organization that has ownership of the (potential, future) revenue
  fhir:quantity [ Quantity ] ; # 0..1 Quantity of which the charge item has been serviced
  fhir:bodysite  ( [ CodeableConcept ] ... ) ; # 0..* Anatomical location, if relevant
  fhir:unitPriceComponent [ MonetaryComponent ] ; # 0..1 Unit price overriding the associated rules
  fhir:totalPriceComponent [ MonetaryComponent ] ; # 0..1 Total price overriding the associated rules
  fhir:overrideReason [ CodeableConcept ] ; # 0..1 Reason for overriding the list price/factor
  fhir:enterer [ Reference(Device|Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) ] ; # 0..1 Individual who was entering
  fhir:enteredDate [ dateTime ] ; # 0..1 Date the charge item was entered
  fhir:reason  ( [ CodeableReference(Condition|DiagnosticReport|ImmunizationRecommendation|Observation|Procedure) ] ... ) ; # 0..* Why was the charged  service rendered?
  fhir:service  ( [ CodeableReference(DiagnosticReport|ImagingStudy|Immunization|MedicationAdministration|
  MedicationDispense|MedicationRequest|Observation|Procedure|ServiceRequest) ] ... ) ; # 0..* Which rendered service is being charged?
  fhir:product  ( [ CodeableReference(Device|Medication|Substance) ] ... ) ; # 0..* Product charged
  fhir:account  ( [ Reference(Account) ] ... ) ; # 0..* Account to place this charge
  fhir:note  ( [ Annotation ] ... ) ; # 0..* Comments made about the ChargeItem
  fhir:supportingInformation  ( [ Reference(Resource) ] ... ) ; # 0..* Further information supporting this charge
]

Differential View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. ChargeItem 0..* 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(Charge Item Definition) Resource defining the code of this ChargeItem
... partOf 0..* Reference(Charge Item) Part of referenced ChargeItem
... code Σ 1..1 CodeableConcept A code that identifies the charge, like a billing code
Binding: ChargeItemCode (example): Example codes for billing purposes
... 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: ProcedurePerformerRoleCodes (example): Codes describing the types of functional roles performers can take on when performing events.
.... 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: SNOMEDCTBodyStructures (example): SNOMED CT Body site concepts
... 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 Description: (example): Local or regional codes covering why a price was overridden
... 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: ICD10Codes (example): ICD 10 diagnosis codes
... service 0..* CodeableReference(DiagnosticReport | ImagingStudy | Immunization | MedicationAdministration | MedicationDispense | MedicationRequest | Observation | Procedure | ServiceRequest) Which rendered service is being charged?
... product 0..* CodeableReference(Device | Medication | Substance) Product charged
Binding: DeviceType (example): Example binding for product type.
... account Σ 0..* Reference(Account) Account to place this charge
... note 0..* Annotation Comments made about the ChargeItem
... supportingInformation 0..* Reference(Resource) Further information supporting this charge

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
ChargeItem.status Base required Charge Item Status 📦6.0.0-ballot3 FHIR Std.
ChargeItem.code Base example Charge Item Code 📦6.0.0-ballot3 FHIR Std.
ChargeItem.performer.​function Base example Procedure Performer Role Codes 📦6.0.0-ballot3 FHIR Std.
ChargeItem.bodysite Base example SNOMED CT Body Structures 📦6.0.0-ballot3 FHIR Std.
ChargeItem.overrideReason Base example Not State Unknown
ChargeItem.reason Base example ICD-10 Codes 📦6.0.0-ballot3 FHIR Std.
ChargeItem.product Base example Device Type 📦6.0.0-ballot3 FHIR Std.

 

Other representations of resource: CSV, Excel

Notes:


Name Type Description Expression
account reference

Account to place this charge

 ChargeItem.account
code token

A code that identifies the charge, like a billing code

 ChargeItem.code
encounter reference

Encounter associated with event

 ChargeItem.encounter
entered-date date

Date the charge item was entered

 ChargeItem.enteredDate
enterer reference

Individual who was entering

 ChargeItem.enterer
factor-override number

Factor overriding the associated rules

 ChargeItem.totalPriceComponent.factor
identifier token

Business Identifier for item

 ChargeItem.identifier
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)
performer-actor reference

Individual who was performing

 ChargeItem.performer.actor
performer-function token

What type of performance was done

 ChargeItem.performer.function
performing-organization reference

Organization providing the charged service

 ChargeItem.performingOrganization
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
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