Da Vinci Payer Data Exchange
2.1.1 - STU 2.1

Da Vinci Payer Data Exchange, published by HL7 International / Financial Management. This guide is not an authorized publication; it is the continuous build for version 2.1.1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-epdx/ and changes regularly. See the Directory of published versions

## US Core Procedure

Page standards status: Informative

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The US Core 3.1.1 Procedure or US Core 6.1.0 Procedure SHALL be used to record a member's health events.

The essential fields (Must Support or Cardinality greater than 0..*) to be provided in the US Core 3.1.1 Procedure or US Core 6.1.0 Procedure are:

R4 Element | Name | Cardinality | Type
--- | --- | --- | ---
Procedure.status | status | 1..1 | code
Procedure.code | code | 1..1 | CodeableConcept
Procedure.subject | subject | 1..1 | Reference(US Core Patient Profile)
Procedure.performed[x] | performed[x] | 1..1 |

Table Definition

#### Health Plan Mapping Assistance

A collaboration of Health Plan experts has performed an evaluation of claims information and developed a mapping of data for Members to the US Core Procedure profile. This is shown below as an assistance to implementers:

US Core Element | Must Support | Cardinality | CARIN-BB Element | CPCDS Element Mapping or Implementer Note
--- | --- | --- | --- | ---
Procedure.meta.lastUpdated |  | 0..1 | ExplanationOfBenefit.meta.lastUpdated | [{"163":"EOB Last Updated Date"}]
Procedure.identifier |  | 0..* | ExplanationOfBenefit.identifier + ExplanationOfBenefit.item.id | [{"35":"Payer claim unique identifier"}]. Note: Assign Payer System URI for Unique Claim Id in Procedure.identifier.system. Set Claim Id in Procedure.identifier.value. Add line item.id from EOB to identify multiple procedures on an EOB
Procedure.status | S | 1..1 |  | Note: Note: EOB Status 0f [active | cancelled | draft | entered-in-error] = [completed|not-done|unknown|entered-in-error]
Procedure.code | S | 1..1 | ExplanationOfBenefit.procedure.procedure | [{"24, 26, 146":"ICD Procedure Code"}, {"40":"Procedure Code - CPT / HCPCS"}, {"41":"Procedure Code Modifier - CPT / HCPCS"}]
Procedure.subject | S | 1..1 | ExplanationOfBenefit.patient | [{"Ref (1), Ref (109)":"Member id, Patient account number"}, {"Ref (191)":"Unique Member ID"}, {"Ref (110)":"Medical record number"}]
Procedure.performed[x] | S | 1..1 |  | Note: Enter Procedure.performedPeriod or Procedure.performedDateTime (next field below)
Procedure.performedDateTime |  |  | ExplanationOfBenefit.procedure.date, ExplanationOfBenefit.item.serviced.servicedPeriod, ExplanationOfBenefit.item.serviced.servicedDate | [{"25, 27":"Procedure date"}, {"90, 119":"Service from date, Service to date"}]
Procedure.performedPeriod |  |  | ExplanationOfBenefit.procedure.date, ExplanationOfBenefit.item.serviced.servicedPeriod, ExplanationOfBenefit.item.serviced.servicedDate | [{"25, 27":"Procedure date"}, {"90, 119":"Service from date, Service to date"}]
Procedure.location |  | 0..1 | ExplanationOfBenefit.item.location. locationCodeableConcept, ExplanationOfBenefit.item.supportingInfo.location. locationCodeableConcept | [{"46":"Place of service code"}, {"97, 170, 176":"Service Facility NPI (if available), Name, Address"}]
Procedure.reasonCode |  | 0..* | ExplanationOfBenefit.diagnosis.diagnosis | [{“22, 23”:”Diagnosis Code”}]

Table Definition

Note: Procedure records should only be created from ExplanationOfBenefit or CPCDS resources for items that are clinical procedures. Medications, facility charges and supplies should not be created as prodcudure records.

#### Example Procedure Resource

An example mapping of a Procedure resource for a medical implant is presented below:

###

###

    {
      "resourceType" : "Procedure",
      "id" : "defib-implant",
      "meta" : {
        "profile" : [
          "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure"
        ]
      },
      "text" : {
        "status" : "generated",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">Generated Narrative with Detailsid: defib-implantmeta: identifier: urn:uuid:b2a737f2-2fdb-49c1-b097-dac173d07affstatus: completedcode: Insertion or replacement of permanent implantable defibrillator system with transvenous lead(s), single or dual chamber <span style=\"background: LightGoldenRodYellow\">(Details : {http://www.ama-assn.org/go/cpt code '33249' = '33249)</span>subject: <a href=\"Patient-example.html\">Generated Summary: id: example; Medical Record Number = 1032702 (USUAL); active; Amy V. Shaw ; ph: 555-555-5555(HOME), amy.shaw@example.com; gender: female; birthDate: Feb 20, 2007</a>performed: Mar 26, 2019, 7:55:26 PM --> Mar 26, 2019, 8:25:26 PMPerformers<table class=\"grid\">-Actor*<a href=\"Practitioner-practitioner-1.html\">Generated Summary: id: practitioner-1; 9941339108, 25456; Ronald Bone </a></table>FocalDevices<table class=\"grid\">-Manipulated*<a href=\"Device-udi-2.html\">Generated Summary: id: udi-2; status: active; manufacturer: ACME Biomedical; expirationDate: Jan 1, 2022, 12:00:00 AM; lotNumber: M320; serialNumber: AC221; modelNumber: 1.0; <span title=\"Codes: {http://snomed.info/sct 19257004}\">Implant</span></a></table></div>"
      },
      "identifier" : [
        {
          "system" : "urn:ietf:rfc:3986",
          "value" : "urn:uuid:b2a737f2-2fdb-49c1-b097-dac173d07aff"
        }
      ],
      "status" : "completed",
      "code" : {
        "coding" : [
          {
            "system" : "http://www.ama-assn.org/go/cpt",
            "code" : "33249"
          }
        ],
        "text" : "Insertion or replacement of permanent implantable defibrillator system with transvenous lead(s), single or dual chamber"
      },
      "subject" : {
        "reference" : "Patient/example"
      },
      "performedPeriod" : {
        "start" : "2019-03-26T12:55:26-07:00",
        "end" : "2019-03-26T13:25:26-07:00"
      },
      "performer" : [
        {
          "actor" : {
            "reference" : "Practitioner/practitioner-1"
          }
        }
      ],
      "focalDevice" : [
        {
          "manipulated" : {
            "reference" : "Device/udi-2"
          }
        }
      ]
    }

Refer to the US Core Additional examples of the US Core 3.1.1 or US Core 6.1.0 Implementation Guide for further examples of completed Procedure Profiles.

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