Patient Cost Transparency Implementation Guide
2.0.1 - STU 2

Patient Cost Transparency Implementation Guide, published by HL7 International / Financial Management. This guide is not an authorized publication; it is the continuous build for version 2.0.1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-pct/ and changes regularly. See the Directory of published versions

## Resource Profile: PCT Good Faith Estimate Summary

Official URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-summary | Version: 2.0.1
Standards status: Trial-use | Maturity Level: 1 | Computable Name: PCTGFESummary
Other Identifiers: OID:2.16.840.1.113883.4.642.40.4.42.17

PCT Good Faith Estimate Summary is a profile for summarizing costs associated with a set of Good Faith Estimate Claims for a single Period of Care.

Usages:

- Use this Profile: PCT GFE Bundle
- Examples for this Profile: Claim/PCT-GFE-Summary-1 and Claim/PCT-GFE-Summary-MRI

You can also check for usages in the FHIR IG Statistics

Changes since version 1.1.0:

- New Content

### Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

- Key Elements Table
- Differential Table
- Snapshot Table
- Statistics/References
- All

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Claim |  | 0..* | Claim | Claim, Pre-determination or Pre-authorization
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:gfeDisclaimer | S | 0..* | string | Disclaimers the patient should be made aware of regarding the estimate, e.g. application of sliding scale for self-pay/uninsured patients URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer
extension:serviceDescription | S | 0..1 | string | Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type | Σ | 1..1 | CodeableConcept | Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTEstimateTypeSummaryCSTemporaryTrialUse
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: estimate-summary
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
use | Σ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. Required Pattern: predetermination
patient | Σ | 1..1 | Reference(US Core Patient Profile(7.0.0)) | The recipient of the products and services
billablePeriod | S Σ | 0..1 | Period | The full Period of Care for all services or products included in the estimate from the first event to the last event.
created | Σ | 1..1 | dateTime | Resource creation date
insurer | S Σ | 0..1 | Reference(PCT Organization) | Target
provider | Σ | 1..1 | Reference(Practitioner | PractitionerRole | Organization) | Party responsible for the claim
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:dataAbsentReason |  | 1..1 | (Complex) | unknown | asked | temp | notasked | masked | unsupported | astext | error URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "http://hl7.org/fhir/StructureDefinition/data-absent-reason"
value[x] |  | 1..1 | code | Value of extension Binding: DataAbsentReason (required) Required Pattern: not-applicable
priority | Σ | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (required)
Slices for careTeam | S | 0..* | BackboneElement | Members of the care team Slice: Unordered, Open by value:role
careTeam:All Slices |  |  |  | Content/Rules for all slices
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Order of care team
provider |  | 1..1 | Reference(PCT Practitioner | PCT Organization) | Practitioner or organization
role |  | 1..1 | CodeableConcept | Function within the team Binding: PCT Care Team Role Value Set (required)
qualification |  | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: US Core Provider Role (NUCC) (required)
careTeam:attending | S | 0..1 | BackboneElement | Members of the care team
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Order of care team
provider |  | 1..1 | Reference(PCT Practitioner) | Practitioner or organization
role |  | 1..1 | CodeableConcept | Function within the team Binding: PCT Care Team Role Value Set (required) Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
version |  | 1..1 | string | Version of the system - if relevant Fixed Value: 1.0.1
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: attending
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
qualification |  | 1..1 | CodeableConcept | Practitioner credential or specialization Binding: US Core Provider Role (NUCC) (required)
careTeam:operating | S | 0..2 | BackboneElement | Members of the care team
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Order of care team
provider |  | 1..1 | Reference(PCT Practitioner) | Practitioner or organization
role |  | 1..1 | CodeableConcept | Function within the team Binding: PCT Care Team Role Value Set (required) Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
version |  | 1..1 | string | Version of the system - if relevant Fixed Value: 1.0.1
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: operating
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
careTeam:rendering | S | 0..1 | BackboneElement | Members of the care team
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Order of care team
provider |  | 1..1 | Reference(PCT Practitioner) | Practitioner or organization
role |  | 1..1 | CodeableConcept | Function within the team Binding: PCT Care Team Role Value Set (required) Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
version |  | 1..1 | string | Version of the system - if relevant Fixed Value: 1.0.1
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: rendering
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
careTeam:referring | S | 0..1 | BackboneElement | Members of the care team
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Order of care team
provider |  | 1..1 | Reference(PCT Practitioner | PCT Organization) | Practitioner or organization
role |  | 1..1 | CodeableConcept | Function within the team Binding: PCT Care Team Role Value Set (required) Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
version |  | 1..1 | string | Version of the system - if relevant Fixed Value: 1.0.1
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: referring
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
Slices for diagnosis | S | 0..* | BackboneElement | Pertinent diagnosis information Slice: Unordered, Open by value:type
diagnosis:All Slices |  |  |  | Content/Rules for all slices
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Diagnosis instance identifier
diagnosis[x] |  | 1..1 |  | Nature of illness or problem Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
diagnosisCodeableConcept |  |  | CodeableConcept |
diagnosisReference |  |  | Reference(Condition) |
type | S | 0..* | CodeableConcept | Timing or nature of the diagnosis Binding: Diagnosis Type Codes (required)
diagnosis:principal | S | 0..1 | BackboneElement | Principal Diagnosis - Must Support means the information source SHALL be capable of populating and SHALL populate if available and permitted.
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Diagnosis instance identifier Required Pattern: 1
diagnosis[x] |  | 1..1 | CodeableConcept | Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type | S | 1..1 | CodeableConcept | Timing or nature of the diagnosis Binding: Diagnosis Type Codes (required) Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: principal
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
diagnosis:admitting | S | 0..1 | BackboneElement | Pertinent diagnosis information
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Diagnosis instance identifier
diagnosis[x] |  | 1..1 | CodeableConcept | Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type | S | 1..1 | CodeableConcept | Timing or nature of the diagnosis Binding: Diagnosis Type Codes (required) Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: admitting
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
diagnosis:patientReasonForVisit | S | 0..3 | BackboneElement | Pertinent diagnosis information
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Diagnosis instance identifier
diagnosis[x] |  | 1..1 | CodeableConcept | Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type | S | 1..1 | CodeableConcept | Timing or nature of the diagnosis Binding: Diagnosis Type Codes (required) Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: patientreasonforvisit
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
diagnosis:externalcauseofinjury | S | 0..12 | BackboneElement | Pertinent diagnosis information
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Diagnosis instance identifier
diagnosis[x] |  | 1..1 | CodeableConcept | Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type | S | 1..1 | CodeableConcept | Timing or nature of the diagnosis Binding: Diagnosis Type Codes (required) Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: externalcauseofinjury
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
diagnosis:other | S | 0..24 | BackboneElement | Pertinent diagnosis information
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Diagnosis instance identifier
diagnosis[x] | S | 1..1 | CodeableConcept | Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type | S | 1..1 | CodeableConcept | Timing or nature of the diagnosis Binding: Diagnosis Type Codes (required) Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: secondary
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
Slices for procedure | S | 0..* | BackboneElement | Clinical procedures performed Slice: Unordered, Open by value:type
procedure:All Slices |  |  |  | Content/Rules for all slices
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:serviceDescription |  | 1..1 | string | Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Procedure instance identifier
type | S | 0..* | CodeableConcept | Category of Procedure Binding: PCT Procedure Type Value Set (required)
procedure[x] |  | 1..1 |  | Specific clinical procedure Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.
procedureCodeableConcept |  |  | CodeableConcept |
procedureReference |  |  | Reference(Procedure) |
procedure:principal | S | 0..1 | BackboneElement | Principal clinical procedure performed
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:serviceDescription |  | 1..1 | string | Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Procedure instance identifier Required Pattern: 1
type | S | 1..1 | CodeableConcept | Category of Procedure Binding: PCT Procedure Type Value Set (required) Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: principal
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
procedure[x] |  | 1..1 | CodeableConcept | Specific clinical procedure Binding: ICD-10 Procedure Codes (required)
procedure:anesthesiaRelated | S | 0..2 | BackboneElement | Clinical procedures performed
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:serviceDescription |  | 1..1 | string | Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Procedure instance identifier
type | S | 1..1 | CodeableConcept | Category of Procedure Binding: PCT Procedure Type Value Set (required) Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: procedureRequiringAnesthesia
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
procedure[x] |  | 1..1 | CodeableConcept | Specific clinical procedure Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required)
procedure:other | S | 0..24 | BackboneElement | Clinical procedures performed
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:serviceDescription |  | 1..1 | string | Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Procedure instance identifier
type | S | 1..1 | CodeableConcept | Category of Procedure Binding: PCT Procedure Type Value Set (required) Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: other
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
procedure[x] |  | 1..1 | CodeableConcept | Specific clinical procedure Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required)
insurance | Σ | 1..* | BackboneElement | Patient insurance information
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence | Σ | 1..1 | positiveInt | Insurance instance identifier
focal | Σ | 1..1 | boolean | Coverage to be used for adjudication
coverage | Σ | 1..1 | Reference(PCT Coverage) | Insurance information
total |  | 1..1 | Money | Total GFE Charges
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Claim.status | Base | required | Financial Resource Status Codes | 📍4.0.1 | FHIR Std.
Claim.type | Base | extensible | Claim Type Codes | 📍4.0.1 | FHIR Std.
Claim.use | Base | required | Use | 📍4.0.1 | FHIR Std.
Claim.provider.extension:dataAbsentReason.​value[x] | Base | required | DataAbsentReason | 📦4.0.1 | FHIR Std.
Claim.priority | Base | required | Process Priority Codes | 📦4.0.1 | FHIR Std.
Claim.payee.type | Base | example | PayeeType | 📍4.0.1 | FHIR Std.
Claim.careTeam.role | Base | required | PCT Care Team Role Value Set | 📦2.0.1 | This IG
Claim.careTeam.qualification | Base | required | US Core Provider Role (NUCC) | 📦3.1.1 | US Core v3.1
Claim.careTeam:attending.​role | Base | required | PCT Care Team Role Value Set | 📦2.0.1 | This IG
Claim.careTeam:attending.​qualification | Base | required | US Core Provider Role (NUCC) | 📦3.1.1 | US Core v3.1
Claim.careTeam:operating.​role | Base | required | PCT Care Team Role Value Set | 📦2.0.1 | This IG
Claim.careTeam:rendering.​role | Base | required | PCT Care Team Role Value Set | 📦2.0.1 | This IG
Claim.careTeam:referring.​role | Base | required | PCT Care Team Role Value Set | 📦2.0.1 | This IG
Claim.supportingInfo.​category | Base | example | Claim Information Category Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis.diagnosis[x] | Base | example | ICD-10 Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis.type | Base | required | Diagnosis Type Codes | 📦1.0.0 | THO v6.5
Claim.diagnosis:principal.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.diagnosis:principal.​type | Base | required | Diagnosis Type Codes | 📦1.0.0 | THO v6.5
Claim.diagnosis:admitting.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.diagnosis:admitting.​type | Base | required | Diagnosis Type Codes | 📦1.0.0 | THO v6.5
Claim.diagnosis:patientReasonForVisit.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.diagnosis:patientReasonForVisit.​type | Base | required | Diagnosis Type Codes | 📦1.0.0 | THO v6.5
Claim.diagnosis:externalcauseofinjury.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.diagnosis:externalcauseofinjury.​type | Base | required | Diagnosis Type Codes | 📦1.0.0 | THO v6.5
Claim.diagnosis:other.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.diagnosis:other.​type | Base | required | Diagnosis Type Codes | 📦1.0.0 | THO v6.5
Claim.procedure.type | Base | required | PCT Procedure Type Value Set | 📦2.0.1 | This IG
Claim.procedure.procedure[x] | Base | example | ICD-10 Procedure Codes | 📍4.0.1 | FHIR Std.
Claim.procedure:principal.​type | Base | required | PCT Procedure Type Value Set | 📦2.0.1 | This IG
Claim.procedure:principal.​procedure[x] | Base | required | ICD-10 Procedure Codes | 📦2.0.1 | This IG
Claim.procedure:anesthesiaRelated.​type | Base | required | PCT Procedure Type Value Set | 📦2.0.1 | This IG
Claim.procedure:anesthesiaRelated.​procedure[x] | Base | required | PCT CMS HCPCS and AMA CPT Procedure Surgical Codes | 📦2.0.1 | This IG
Claim.procedure:other.​type | Base | required | PCT Procedure Type Value Set | 📦2.0.1 | This IG
Claim.procedure:other.​procedure[x] | Base | required | PCT CMS HCPCS and AMA CPT Procedure Surgical Codes | 📦2.0.1 | This IG
Claim.item.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Claim | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Claim | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | Claim | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | Claim | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Claim | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`

This structure is derived from Claim

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Claim |  |  | Claim |
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:gfeDisclaimer | S | 0..* | string | Disclaimers the patient should be made aware of regarding the estimate, e.g. application of sliding scale for self-pay/uninsured patients URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer
extension:serviceDescription | S | 0..1 | string | Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
type |  | 1..1 | CodeableConcept | Category or discipline Required Pattern: At least the following
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTEstimateTypeSummaryCSTemporaryTrialUse
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: estimate-summary
subType |  | 0..0 |  | More granular claim type
use |  | 1..1 | code | claim | preauthorization | predetermination Required Pattern: predetermination
patient |  | 1..1 | Reference(US Core Patient Profile(7.0.0)) | The recipient of the products and services
billablePeriod | S | 0..1 | Period | The full Period of Care for all services or products included in the estimate from the first event to the last event.
enterer |  | 0..0 |  | Author of the claim
insurer | S | 0..1 | Reference(PCT Organization) | Target
provider |  |  |  |
extension |  | 1..* | Extension | Extension
Slices for extension |  |  |  | Content/Rules for all slices
extension:dataAbsentReason |  | 1..1 | (Complex) | unknown | asked | temp | notasked | masked | unsupported | astext | error URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
value[x] |  | 1..1 | code | Value of extension Required Pattern: not-applicable
reference |  | 0..0 |  | Literal reference, Relative, internal or absolute URL
type |  | 0..0 |  | Type the reference refers to (e.g. "Patient")
identifier |  | 0..0 |  | Logical reference, when literal reference is not known
display |  | 0..0 |  | Text alternative for the resource
priority |  | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (required)
fundsReserve |  | 0..0 |  | For whom to reserve funds
prescription |  | 0..0 |  | Prescription authorizing services and products
originalPrescription |  | 0..0 |  | Original prescription if superseded by fulfiller
payee |  | 0..0 |  | Recipient of benefits payable
referral |  | 0..0 |  | Treatment referral
facility |  | 0..0 |  | Servicing facility
Slices for careTeam | S | 0..* | BackboneElement | Members of the care team Slice: Unordered, Open by value:role
careTeam:All Slices |  |  |  | Content/Rules for all slices
provider |  | 1..1 | Reference(PCT Practitioner | PCT Organization) | Practitioner or organization
role |  | 1..1 | CodeableConcept | Function within the team Binding: PCT Care Team Role Value Set (required)
qualification |  | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: US Core Provider Role (NUCC) (required)
careTeam:attending | S | 0..1 | BackboneElement | Members of the care team
provider |  | 1..1 | Reference(PCT Practitioner) | Practitioner or organization
role |  | 1..1 | CodeableConcept | Function within the team Required Pattern: At least the following
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
version |  | 1..1 | string | Version of the system - if relevant Fixed Value: 1.0.1
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: attending
qualification |  | 1..1 | CodeableConcept | Practitioner credential or specialization
careTeam:operating | S | 0..2 | BackboneElement | Members of the care team
provider |  | 1..1 | Reference(PCT Practitioner) | Practitioner or organization
role |  | 1..1 | CodeableConcept | Function within the team Required Pattern: At least the following
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
version |  | 1..1 | string | Version of the system - if relevant Fixed Value: 1.0.1
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: operating
careTeam:rendering | S | 0..1 | BackboneElement | Members of the care team
provider |  | 1..1 | Reference(PCT Practitioner) | Practitioner or organization
role |  | 1..1 | CodeableConcept | Function within the team Required Pattern: At least the following
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
version |  | 1..1 | string | Version of the system - if relevant Fixed Value: 1.0.1
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: rendering
careTeam:referring | S | 0..1 | BackboneElement | Members of the care team
role |  | 1..1 | CodeableConcept | Function within the team Required Pattern: At least the following
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
version |  | 1..1 | string | Version of the system - if relevant Fixed Value: 1.0.1
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: referring
supportingInfo |  | 0..0 |  | Supporting information
Slices for diagnosis | S | 0..* | BackboneElement | Pertinent diagnosis information Slice: Unordered, Open by value:type
diagnosis:All Slices |  |  |  | Content/Rules for all slices
type | S | 0..* | CodeableConcept | Timing or nature of the diagnosis Binding: Diagnosis Type Codes (required)
diagnosis:principal | S | 0..1 | BackboneElement | Principal Diagnosis - Must Support means the information source SHALL be capable of populating and SHALL populate if available and permitted.
sequence |  | 1..1 | positiveInt | Diagnosis instance identifier Required Pattern: 1
diagnosis[x] |  | 1..1 | CodeableConcept | Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type |  | 1..1 | CodeableConcept | Timing or nature of the diagnosis Required Pattern: At least the following
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: principal
diagnosis:admitting | S | 0..1 | BackboneElement | Pertinent diagnosis information
diagnosis[x] |  | 1..1 | CodeableConcept | Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type |  | 1..1 | CodeableConcept | Timing or nature of the diagnosis Required Pattern: At least the following
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: admitting
diagnosis:patientReasonForVisit | S | 0..3 | BackboneElement | Pertinent diagnosis information
diagnosis[x] |  | 1..1 | CodeableConcept | Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type |  | 1..1 | CodeableConcept | Timing or nature of the diagnosis Required Pattern: At least the following
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: patientreasonforvisit
diagnosis:externalcauseofinjury | S | 0..12 | BackboneElement | Pertinent diagnosis information
diagnosis[x] |  | 1..1 | CodeableConcept | Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type |  | 1..1 | CodeableConcept | Timing or nature of the diagnosis Required Pattern: At least the following
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: externalcauseofinjury
diagnosis:other | S | 0..24 | BackboneElement | Pertinent diagnosis information
diagnosis[x] | S | 1..1 | CodeableConcept | Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type |  | 1..1 | CodeableConcept | Timing or nature of the diagnosis Required Pattern: At least the following
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: secondary
Slices for procedure | S | 0..* | BackboneElement | Clinical procedures performed Slice: Unordered, Open by value:type
procedure:All Slices |  |  |  | Content/Rules for all slices
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:serviceDescription |  | 1..1 | string | Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
type | S | 0..* | CodeableConcept | Category of Procedure Binding: PCT Procedure Type Value Set (required)
procedure:principal | S | 0..1 | BackboneElement | Principal clinical procedure performed
Slices for extension |  |  |  | Content/Rules for all slices
extension:serviceDescription |  | 1..1 | string | Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
sequence |  | 1..1 | positiveInt | Procedure instance identifier Required Pattern: 1
type |  | 1..1 | CodeableConcept | Category of Procedure Required Pattern: At least the following
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: principal
procedure[x] |  | 1..1 | CodeableConcept | Specific clinical procedure Binding: ICD-10 Procedure Codes (required)
procedure:anesthesiaRelated | S | 0..2 | BackboneElement | Clinical procedures performed
Slices for extension |  |  |  | Content/Rules for all slices
extension:serviceDescription |  | 1..1 | string | Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
type |  | 1..1 | CodeableConcept | Category of Procedure Required Pattern: At least the following
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: procedureRequiringAnesthesia
procedure[x] |  | 1..1 | CodeableConcept | Specific clinical procedure Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required)
procedure:other | S | 0..24 | BackboneElement | Clinical procedures performed
Slices for extension |  |  |  | Content/Rules for all slices
extension:serviceDescription |  | 1..1 | string | Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
type |  | 1..1 | CodeableConcept | Category of Procedure Required Pattern: At least the following
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: other
procedure[x] |  | 1..1 | CodeableConcept | Specific clinical procedure Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required)
insurance |  |  |  |
coverage |  | 1..1 | Reference(PCT Coverage) | Insurance information
preAuthRef |  | 0..0 |  | Prior authorization reference number
accident |  |  |  |
location[x] |  | 0..1 | Address | Where the event occurred
country |  | 0..1 | string | Country (e.g. can be ISO 3166 2 or 3 letter code) Binding: Iso3166-1-2 (required)
item |  | 0..0 |  | Product or service provided
total |  | 1..1 | Money | Total GFE Charges
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
Claim.priority | Base | required | Process Priority Codes | 📦4.0.1 | FHIR Std.
Claim.careTeam.role | Base | required | PCT Care Team Role Value Set | 📦2.0.1 | This IG
Claim.careTeam.qualification | Base | required | US Core Provider Role (NUCC) | 📦3.1.1 | US Core v3.1
Claim.diagnosis.type | Base | required | Diagnosis Type Codes | 📦1.0.0 | THO v6.5
Claim.diagnosis:principal.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.diagnosis:admitting.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.diagnosis:patientReasonForVisit.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.diagnosis:externalcauseofinjury.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.diagnosis:other.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.procedure.type | Base | required | PCT Procedure Type Value Set | 📦2.0.1 | This IG
Claim.procedure:principal.​procedure[x] | Base | required | ICD-10 Procedure Codes | 📦2.0.1 | This IG
Claim.procedure:anesthesiaRelated.​procedure[x] | Base | required | PCT CMS HCPCS and AMA CPT Procedure Surgical Codes | 📦2.0.1 | This IG
Claim.procedure:other.​procedure[x] | Base | required | PCT CMS HCPCS and AMA CPT Procedure Surgical Codes | 📦2.0.1 | This IG
Claim.accident.location[x].​country | Base | required | Iso 3166 Part 1: 2 Letter Codes | 📦4.0.1 | FHIR Std.

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Claim |  | 0..* | Claim | Claim, Pre-determination or Pre-authorization
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:gfeDisclaimer | S | 0..* | string | Disclaimers the patient should be made aware of regarding the estimate, e.g. application of sliding scale for self-pay/uninsured patients URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer
extension:serviceDescription | S | 0..1 | string | Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier |  | 0..* | Identifier | Business Identifier for claim
status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type | Σ | 1..1 | CodeableConcept | Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTEstimateTypeSummaryCSTemporaryTrialUse
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: estimate-summary
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
use | Σ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. Required Pattern: predetermination
patient | Σ | 1..1 | Reference(US Core Patient Profile(7.0.0)) | The recipient of the products and services
billablePeriod | S Σ | 0..1 | Period | The full Period of Care for all services or products included in the estimate from the first event to the last event.
created | Σ | 1..1 | dateTime | Resource creation date
insurer | S Σ | 0..1 | Reference(PCT Organization) | Target
provider | Σ | 1..1 | Reference(Practitioner | PractitionerRole | Organization) | Party responsible for the claim
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:dataAbsentReason |  | 1..1 | (Complex) | unknown | asked | temp | notasked | masked | unsupported | astext | error URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
id |  | 0..1 | id | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "http://hl7.org/fhir/StructureDefinition/data-absent-reason"
value[x] |  | 1..1 | code | Value of extension Binding: DataAbsentReason (required) Required Pattern: not-applicable
priority | Σ | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (required)
related |  | 0..* | BackboneElement | Prior or corollary claims
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
claim |  | 0..1 | Reference(Claim) | Reference to the related claim
relationship |  | 0..1 | CodeableConcept | How the reference claim is related Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.
reference |  | 0..1 | Identifier | File or case reference
Slices for careTeam | S | 0..* | BackboneElement | Members of the care team Slice: Unordered, Open by value:role
careTeam:All Slices |  |  |  | Content/Rules for all slices
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Order of care team
provider |  | 1..1 | Reference(PCT Practitioner | PCT Organization) | Practitioner or organization
responsible |  | 0..1 | boolean | Indicator of the lead practitioner
role |  | 1..1 | CodeableConcept | Function within the team Binding: PCT Care Team Role Value Set (required)
qualification |  | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: US Core Provider Role (NUCC) (required)
careTeam:attending | S | 0..1 | BackboneElement | Members of the care team
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Order of care team
provider |  | 1..1 | Reference(PCT Practitioner) | Practitioner or organization
responsible |  | 0..1 | boolean | Indicator of the lead practitioner
role |  | 1..1 | CodeableConcept | Function within the team Binding: PCT Care Team Role Value Set (required) Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
version |  | 1..1 | string | Version of the system - if relevant Fixed Value: 1.0.1
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: attending
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
qualification |  | 1..1 | CodeableConcept | Practitioner credential or specialization Binding: US Core Provider Role (NUCC) (required)
careTeam:operating | S | 0..2 | BackboneElement | Members of the care team
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Order of care team
provider |  | 1..1 | Reference(PCT Practitioner) | Practitioner or organization
responsible |  | 0..1 | boolean | Indicator of the lead practitioner
role |  | 1..1 | CodeableConcept | Function within the team Binding: PCT Care Team Role Value Set (required) Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
version |  | 1..1 | string | Version of the system - if relevant Fixed Value: 1.0.1
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: operating
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
qualification |  | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: US Core Provider Role (NUCC) (required)
careTeam:rendering | S | 0..1 | BackboneElement | Members of the care team
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Order of care team
provider |  | 1..1 | Reference(PCT Practitioner) | Practitioner or organization
responsible |  | 0..1 | boolean | Indicator of the lead practitioner
role |  | 1..1 | CodeableConcept | Function within the team Binding: PCT Care Team Role Value Set (required) Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
version |  | 1..1 | string | Version of the system - if relevant Fixed Value: 1.0.1
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: rendering
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
qualification |  | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: US Core Provider Role (NUCC) (required)
careTeam:referring | S | 0..1 | BackboneElement | Members of the care team
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Order of care team
provider |  | 1..1 | Reference(PCT Practitioner | PCT Organization) | Practitioner or organization
responsible |  | 0..1 | boolean | Indicator of the lead practitioner
role |  | 1..1 | CodeableConcept | Function within the team Binding: PCT Care Team Role Value Set (required) Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
version |  | 1..1 | string | Version of the system - if relevant Fixed Value: 1.0.1
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: referring
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
qualification |  | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: US Core Provider Role (NUCC) (required)
Slices for diagnosis | S | 0..* | BackboneElement | Pertinent diagnosis information Slice: Unordered, Open by value:type
diagnosis:All Slices |  |  |  | Content/Rules for all slices
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Diagnosis instance identifier
diagnosis[x] |  | 1..1 |  | Nature of illness or problem Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
diagnosisCodeableConcept |  |  | CodeableConcept |
diagnosisReference |  |  | Reference(Condition) |
type | S | 0..* | CodeableConcept | Timing or nature of the diagnosis Binding: Diagnosis Type Codes (required)
onAdmission |  | 0..1 | CodeableConcept | Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
packageCode |  | 0..1 | CodeableConcept | Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
diagnosis:principal | S | 0..1 | BackboneElement | Principal Diagnosis - Must Support means the information source SHALL be capable of populating and SHALL populate if available and permitted.
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Diagnosis instance identifier Required Pattern: 1
diagnosis[x] |  | 1..1 | CodeableConcept | Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type | S | 1..1 | CodeableConcept | Timing or nature of the diagnosis Binding: Diagnosis Type Codes (required) Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: principal
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
onAdmission |  | 0..1 | CodeableConcept | Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
packageCode |  | 0..1 | CodeableConcept | Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
diagnosis:admitting | S | 0..1 | BackboneElement | Pertinent diagnosis information
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Diagnosis instance identifier
diagnosis[x] |  | 1..1 | CodeableConcept | Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type | S | 1..1 | CodeableConcept | Timing or nature of the diagnosis Binding: Diagnosis Type Codes (required) Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: admitting
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
onAdmission |  | 0..1 | CodeableConcept | Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
packageCode |  | 0..1 | CodeableConcept | Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
diagnosis:patientReasonForVisit | S | 0..3 | BackboneElement | Pertinent diagnosis information
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Diagnosis instance identifier
diagnosis[x] |  | 1..1 | CodeableConcept | Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type | S | 1..1 | CodeableConcept | Timing or nature of the diagnosis Binding: Diagnosis Type Codes (required) Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: patientreasonforvisit
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
onAdmission |  | 0..1 | CodeableConcept | Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
packageCode |  | 0..1 | CodeableConcept | Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
diagnosis:externalcauseofinjury | S | 0..12 | BackboneElement | Pertinent diagnosis information
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Diagnosis instance identifier
diagnosis[x] |  | 1..1 | CodeableConcept | Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type | S | 1..1 | CodeableConcept | Timing or nature of the diagnosis Binding: Diagnosis Type Codes (required) Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: externalcauseofinjury
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
onAdmission |  | 0..1 | CodeableConcept | Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
packageCode |  | 0..1 | CodeableConcept | Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
diagnosis:other | S | 0..24 | BackboneElement | Pertinent diagnosis information
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Diagnosis instance identifier
diagnosis[x] | S | 1..1 | CodeableConcept | Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type | S | 1..1 | CodeableConcept | Timing or nature of the diagnosis Binding: Diagnosis Type Codes (required) Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: secondary
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
onAdmission |  | 0..1 | CodeableConcept | Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
packageCode |  | 0..1 | CodeableConcept | Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
Slices for procedure | S | 0..* | BackboneElement | Clinical procedures performed Slice: Unordered, Open by value:type
procedure:All Slices |  |  |  | Content/Rules for all slices
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:serviceDescription |  | 1..1 | string | Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Procedure instance identifier
type | S | 0..* | CodeableConcept | Category of Procedure Binding: PCT Procedure Type Value Set (required)
date |  | 0..1 | dateTime | When the procedure was performed
procedure[x] |  | 1..1 |  | Specific clinical procedure Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.
procedureCodeableConcept |  |  | CodeableConcept |
procedureReference |  |  | Reference(Procedure) |
udi |  | 0..* | Reference(Device) | Unique device identifier
procedure:principal | S | 0..1 | BackboneElement | Principal clinical procedure performed
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:serviceDescription |  | 1..1 | string | Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Procedure instance identifier Required Pattern: 1
type | S | 1..1 | CodeableConcept | Category of Procedure Binding: PCT Procedure Type Value Set (required) Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: principal
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
date |  | 0..1 | dateTime | When the procedure was performed
procedure[x] |  | 1..1 | CodeableConcept | Specific clinical procedure Binding: ICD-10 Procedure Codes (required)
udi |  | 0..* | Reference(Device) | Unique device identifier
procedure:anesthesiaRelated | S | 0..2 | BackboneElement | Clinical procedures performed
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:serviceDescription |  | 1..1 | string | Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Procedure instance identifier
type | S | 1..1 | CodeableConcept | Category of Procedure Binding: PCT Procedure Type Value Set (required) Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: procedureRequiringAnesthesia
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
date |  | 0..1 | dateTime | When the procedure was performed
procedure[x] |  | 1..1 | CodeableConcept | Specific clinical procedure Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required)
udi |  | 0..* | Reference(Device) | Unique device identifier
procedure:other | S | 0..24 | BackboneElement | Clinical procedures performed
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:serviceDescription |  | 1..1 | string | Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Procedure instance identifier
type | S | 1..1 | CodeableConcept | Category of Procedure Binding: PCT Procedure Type Value Set (required) Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: other
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
date |  | 0..1 | dateTime | When the procedure was performed
procedure[x] |  | 1..1 | CodeableConcept | Specific clinical procedure Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required)
udi |  | 0..* | Reference(Device) | Unique device identifier
insurance | Σ | 1..* | BackboneElement | Patient insurance information
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence | Σ | 1..1 | positiveInt | Insurance instance identifier
focal | Σ | 1..1 | boolean | Coverage to be used for adjudication
identifier |  | 0..1 | Identifier | Pre-assigned Claim number
coverage | Σ | 1..1 | Reference(PCT Coverage) | Insurance information
businessArrangement |  | 0..1 | string | Additional provider contract number
claimResponse |  | 0..1 | Reference(ClaimResponse) | Adjudication results
accident |  | 0..1 | BackboneElement | Details of the event
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
date |  | 1..1 | date | When the incident occurred
type |  | 0..1 | CodeableConcept | The nature of the accident Binding: ActIncidentCode (3.0.0) (extensible): Type of accident: work place, auto, etc.
location[x] |  | 0..1 | Address | Where the event occurred
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
use | ?!Σ | 0..1 | code | home | work | temp | old | billing - purpose of this address Binding: AddressUse (required): The use of an address. Example General: home
type | Σ | 0..1 | code | postal | physical | both Binding: AddressType (required): The type of an address (physical / postal). Example General: both
text | Σ | 0..1 | string | Text representation of the address Example General: 137 Nowhere Street, Erewhon 9132
line | Σ | 0..* | string | Street name, number, direction & P.O. Box etc. This repeating element order: The order in which lines should appear in an address label Example General: 137 Nowhere Street
city | Σ | 0..1 | string | Name of city, town etc. Example General: Erewhon
district | Σ | 0..1 | string | District name (aka county) Example General: Madison
state | Σ | 0..1 | string | Sub-unit of country (abbreviations ok)
postalCode | Σ | 0..1 | string | Postal code for area Example General: 9132
country | Σ | 0..1 | string | Country (e.g. can be ISO 3166 2 or 3 letter code) Binding: Iso3166-1-2 (required)
period | Σ | 0..1 | Period | Time period when address was/is in use Example General: {"start":"2010-03-23","end":"2010-07-01"}
total |  | 1..1 | Money | Total GFE Charges
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Claim.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std.
Claim.status | Base | required | Financial Resource Status Codes | 📍4.0.1 | FHIR Std.
Claim.type | Base | extensible | Claim Type Codes | 📍4.0.1 | FHIR Std.
Claim.use | Base | required | Use | 📍4.0.1 | FHIR Std.
Claim.provider.extension:dataAbsentReason.​value[x] | Base | required | DataAbsentReason | 📦4.0.1 | FHIR Std.
Claim.priority | Base | required | Process Priority Codes | 📦4.0.1 | FHIR Std.
Claim.related.relationship | Base | example | Example Related Claim Relationship Codes | 📍4.0.1 | FHIR Std.
Claim.payee.type | Base | example | PayeeType | 📍4.0.1 | FHIR Std.
Claim.careTeam.role | Base | required | PCT Care Team Role Value Set | 📦2.0.1 | This IG
Claim.careTeam.qualification | Base | required | US Core Provider Role (NUCC) | 📦3.1.1 | US Core v3.1
Claim.careTeam:attending.​role | Base | required | PCT Care Team Role Value Set | 📦2.0.1 | This IG
Claim.careTeam:attending.​qualification | Base | required | US Core Provider Role (NUCC) | 📦3.1.1 | US Core v3.1
Claim.careTeam:operating.​role | Base | required | PCT Care Team Role Value Set | 📦2.0.1 | This IG
Claim.careTeam:operating.​qualification | Base | required | US Core Provider Role (NUCC) | 📦3.1.1 | US Core v3.1
Claim.careTeam:rendering.​role | Base | required | PCT Care Team Role Value Set | 📦2.0.1 | This IG
Claim.careTeam:rendering.​qualification | Base | required | US Core Provider Role (NUCC) | 📦3.1.1 | US Core v3.1
Claim.careTeam:referring.​role | Base | required | PCT Care Team Role Value Set | 📦2.0.1 | This IG
Claim.careTeam:referring.​qualification | Base | required | US Core Provider Role (NUCC) | 📦3.1.1 | US Core v3.1
Claim.supportingInfo.​category | Base | example | Claim Information Category Codes | 📍4.0.1 | FHIR Std.
Claim.supportingInfo.​code | Base | example | Exception Codes | 📍4.0.1 | FHIR Std.
Claim.supportingInfo.​reason | Base | example | Missing Tooth Reason Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis.diagnosis[x] | Base | example | ICD-10 Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis.type | Base | required | Diagnosis Type Codes | 📦1.0.0 | THO v6.5
Claim.diagnosis.onAdmission | Base | example | Example Diagnosis on Admission Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis.packageCode | Base | example | Example Diagnosis Related Group Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis:principal.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.diagnosis:principal.​type | Base | required | Diagnosis Type Codes | 📦1.0.0 | THO v6.5
Claim.diagnosis:principal.​onAdmission | Base | example | Example Diagnosis on Admission Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis:principal.​packageCode | Base | example | Example Diagnosis Related Group Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis:admitting.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.diagnosis:admitting.​type | Base | required | Diagnosis Type Codes | 📦1.0.0 | THO v6.5
Claim.diagnosis:admitting.​onAdmission | Base | example | Example Diagnosis on Admission Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis:admitting.​packageCode | Base | example | Example Diagnosis Related Group Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis:patientReasonForVisit.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.diagnosis:patientReasonForVisit.​type | Base | required | Diagnosis Type Codes | 📦1.0.0 | THO v6.5
Claim.diagnosis:patientReasonForVisit.​onAdmission | Base | example | Example Diagnosis on Admission Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis:patientReasonForVisit.​packageCode | Base | example | Example Diagnosis Related Group Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis:externalcauseofinjury.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.diagnosis:externalcauseofinjury.​type | Base | required | Diagnosis Type Codes | 📦1.0.0 | THO v6.5
Claim.diagnosis:externalcauseofinjury.​onAdmission | Base | example | Example Diagnosis on Admission Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis:externalcauseofinjury.​packageCode | Base | example | Example Diagnosis Related Group Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis:other.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.diagnosis:other.​type | Base | required | Diagnosis Type Codes | 📦1.0.0 | THO v6.5
Claim.diagnosis:other.​onAdmission | Base | example | Example Diagnosis on Admission Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis:other.​packageCode | Base | example | Example Diagnosis Related Group Codes | 📍4.0.1 | FHIR Std.
Claim.procedure.type | Base | required | PCT Procedure Type Value Set | 📦2.0.1 | This IG
Claim.procedure.procedure[x] | Base | example | ICD-10 Procedure Codes | 📍4.0.1 | FHIR Std.
Claim.procedure:principal.​type | Base | required | PCT Procedure Type Value Set | 📦2.0.1 | This IG
Claim.procedure:principal.​procedure[x] | Base | required | ICD-10 Procedure Codes | 📦2.0.1 | This IG
Claim.procedure:anesthesiaRelated.​type | Base | required | PCT Procedure Type Value Set | 📦2.0.1 | This IG
Claim.procedure:anesthesiaRelated.​procedure[x] | Base | required | PCT CMS HCPCS and AMA CPT Procedure Surgical Codes | 📦2.0.1 | This IG
Claim.procedure:other.​type | Base | required | PCT Procedure Type Value Set | 📦2.0.1 | This IG
Claim.procedure:other.​procedure[x] | Base | required | PCT CMS HCPCS and AMA CPT Procedure Surgical Codes | 📦2.0.1 | This IG
Claim.accident.type | Base | extensible | ActIncidentCode | 📍3.0.0 | THO v6.5
Claim.accident.location[x].​use | Base | required | AddressUse | 📍4.0.1 | FHIR Std.
Claim.accident.location[x].​type | Base | required | AddressType | 📍4.0.1 | FHIR Std.
Claim.accident.location[x].​country | Base | required | Iso 3166 Part 1: 2 Letter Codes | 📦4.0.1 | FHIR Std.
Claim.item.revenue | Base | example | Example Revenue Center Codes | 📍4.0.1 | FHIR Std.
Claim.item.category | Base | example | Benefit Category Codes | 📍4.0.1 | FHIR Std.
Claim.item.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item.modifier | Base | example | Modifier type Codes | 📍4.0.1 | FHIR Std.
Claim.item.programCode | Base | example | Example Program Reason Codes | 📍4.0.1 | FHIR Std.
Claim.item.location[x] | Base | example | Example Service Place Codes | 📍4.0.1 | FHIR Std.
Claim.item.bodySite | Base | example | Oral Site Codes | 📍4.0.1 | FHIR Std.
Claim.item.subSite | Base | example | Surface Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.revenue | Base | example | Example Revenue Center Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.category | Base | example | Benefit Category Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.modifier | Base | example | Modifier type Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.programCode | Base | example | Example Program Reason Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.subDetail.​revenue | Base | example | Example Revenue Center Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.subDetail.​category | Base | example | Benefit Category Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.subDetail.​productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.subDetail.​modifier | Base | example | Modifier type Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.subDetail.​programCode | Base | example | Example Program Reason Codes | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Claim | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Claim | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | Claim | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | Claim | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Claim | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`

This structure is derived from Claim

Summary

Mandatory: 3 elements(15 nested mandatory elements)
Must-Support: 22 elements
Prohibited: 15 elements

Structures

This structure refers to these other structures:

- US Core Patient Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient|7.0.0)
- PCT Organization (http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization)
- PCT Practitioner (http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-practitioner)
- PCT Coverage (http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-coverage)

Extensions

This structure refers to these extensions:

- http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer
- http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
- http://hl7.org/fhir/StructureDefinition/data-absent-reason|5.2.0

Slices

This structure defines the following Slices:

- The element 1 is sliced based on the value of Claim.careTeam
- The element 1 is sliced based on the value of Claim.diagnosis
- The element 1 is sliced based on the value of Claim.procedure

Maturity: 1

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Claim |  | 0..* | Claim | Claim, Pre-determination or Pre-authorization
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:gfeDisclaimer | S | 0..* | string | Disclaimers the patient should be made aware of regarding the estimate, e.g. application of sliding scale for self-pay/uninsured patients URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer
extension:serviceDescription | S | 0..1 | string | Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type | Σ | 1..1 | CodeableConcept | Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTEstimateTypeSummaryCSTemporaryTrialUse
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: estimate-summary
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
use | Σ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. Required Pattern: predetermination
patient | Σ | 1..1 | Reference(US Core Patient Profile(7.0.0)) | The recipient of the products and services
billablePeriod | S Σ | 0..1 | Period | The full Period of Care for all services or products included in the estimate from the first event to the last event.
created | Σ | 1..1 | dateTime | Resource creation date
insurer | S Σ | 0..1 | Reference(PCT Organization) | Target
provider | Σ | 1..1 | Reference(Practitioner | PractitionerRole | Organization) | Party responsible for the claim
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:dataAbsentReason |  | 1..1 | (Complex) | unknown | asked | temp | notasked | masked | unsupported | astext | error URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "http://hl7.org/fhir/StructureDefinition/data-absent-reason"
value[x] |  | 1..1 | code | Value of extension Binding: DataAbsentReason (required) Required Pattern: not-applicable
priority | Σ | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (required)
Slices for careTeam | S | 0..* | BackboneElement | Members of the care team Slice: Unordered, Open by value:role
careTeam:All Slices |  |  |  | Content/Rules for all slices
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Order of care team
provider |  | 1..1 | Reference(PCT Practitioner | PCT Organization) | Practitioner or organization
role |  | 1..1 | CodeableConcept | Function within the team Binding: PCT Care Team Role Value Set (required)
qualification |  | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: US Core Provider Role (NUCC) (required)
careTeam:attending | S | 0..1 | BackboneElement | Members of the care team
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Order of care team
provider |  | 1..1 | Reference(PCT Practitioner) | Practitioner or organization
role |  | 1..1 | CodeableConcept | Function within the team Binding: PCT Care Team Role Value Set (required) Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
version |  | 1..1 | string | Version of the system - if relevant Fixed Value: 1.0.1
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: attending
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
qualification |  | 1..1 | CodeableConcept | Practitioner credential or specialization Binding: US Core Provider Role (NUCC) (required)
careTeam:operating | S | 0..2 | BackboneElement | Members of the care team
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Order of care team
provider |  | 1..1 | Reference(PCT Practitioner) | Practitioner or organization
role |  | 1..1 | CodeableConcept | Function within the team Binding: PCT Care Team Role Value Set (required) Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
version |  | 1..1 | string | Version of the system - if relevant Fixed Value: 1.0.1
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: operating
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
careTeam:rendering | S | 0..1 | BackboneElement | Members of the care team
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Order of care team
provider |  | 1..1 | Reference(PCT Practitioner) | Practitioner or organization
role |  | 1..1 | CodeableConcept | Function within the team Binding: PCT Care Team Role Value Set (required) Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
version |  | 1..1 | string | Version of the system - if relevant Fixed Value: 1.0.1
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: rendering
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
careTeam:referring | S | 0..1 | BackboneElement | Members of the care team
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Order of care team
provider |  | 1..1 | Reference(PCT Practitioner | PCT Organization) | Practitioner or organization
role |  | 1..1 | CodeableConcept | Function within the team Binding: PCT Care Team Role Value Set (required) Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
version |  | 1..1 | string | Version of the system - if relevant Fixed Value: 1.0.1
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: referring
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
Slices for diagnosis | S | 0..* | BackboneElement | Pertinent diagnosis information Slice: Unordered, Open by value:type
diagnosis:All Slices |  |  |  | Content/Rules for all slices
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Diagnosis instance identifier
diagnosis[x] |  | 1..1 |  | Nature of illness or problem Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
diagnosisCodeableConcept |  |  | CodeableConcept |
diagnosisReference |  |  | Reference(Condition) |
type | S | 0..* | CodeableConcept | Timing or nature of the diagnosis Binding: Diagnosis Type Codes (required)
diagnosis:principal | S | 0..1 | BackboneElement | Principal Diagnosis - Must Support means the information source SHALL be capable of populating and SHALL populate if available and permitted.
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Diagnosis instance identifier Required Pattern: 1
diagnosis[x] |  | 1..1 | CodeableConcept | Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type | S | 1..1 | CodeableConcept | Timing or nature of the diagnosis Binding: Diagnosis Type Codes (required) Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: principal
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
diagnosis:admitting | S | 0..1 | BackboneElement | Pertinent diagnosis information
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Diagnosis instance identifier
diagnosis[x] |  | 1..1 | CodeableConcept | Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type | S | 1..1 | CodeableConcept | Timing or nature of the diagnosis Binding: Diagnosis Type Codes (required) Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: admitting
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
diagnosis:patientReasonForVisit | S | 0..3 | BackboneElement | Pertinent diagnosis information
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Diagnosis instance identifier
diagnosis[x] |  | 1..1 | CodeableConcept | Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type | S | 1..1 | CodeableConcept | Timing or nature of the diagnosis Binding: Diagnosis Type Codes (required) Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: patientreasonforvisit
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
diagnosis:externalcauseofinjury | S | 0..12 | BackboneElement | Pertinent diagnosis information
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Diagnosis instance identifier
diagnosis[x] |  | 1..1 | CodeableConcept | Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type | S | 1..1 | CodeableConcept | Timing or nature of the diagnosis Binding: Diagnosis Type Codes (required) Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: externalcauseofinjury
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
diagnosis:other | S | 0..24 | BackboneElement | Pertinent diagnosis information
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Diagnosis instance identifier
diagnosis[x] | S | 1..1 | CodeableConcept | Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type | S | 1..1 | CodeableConcept | Timing or nature of the diagnosis Binding: Diagnosis Type Codes (required) Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: secondary
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
Slices for procedure | S | 0..* | BackboneElement | Clinical procedures performed Slice: Unordered, Open by value:type
procedure:All Slices |  |  |  | Content/Rules for all slices
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:serviceDescription |  | 1..1 | string | Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Procedure instance identifier
type | S | 0..* | CodeableConcept | Category of Procedure Binding: PCT Procedure Type Value Set (required)
procedure[x] |  | 1..1 |  | Specific clinical procedure Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.
procedureCodeableConcept |  |  | CodeableConcept |
procedureReference |  |  | Reference(Procedure) |
procedure:principal | S | 0..1 | BackboneElement | Principal clinical procedure performed
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:serviceDescription |  | 1..1 | string | Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Procedure instance identifier Required Pattern: 1
type | S | 1..1 | CodeableConcept | Category of Procedure Binding: PCT Procedure Type Value Set (required) Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: principal
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
procedure[x] |  | 1..1 | CodeableConcept | Specific clinical procedure Binding: ICD-10 Procedure Codes (required)
procedure:anesthesiaRelated | S | 0..2 | BackboneElement | Clinical procedures performed
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:serviceDescription |  | 1..1 | string | Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Procedure instance identifier
type | S | 1..1 | CodeableConcept | Category of Procedure Binding: PCT Procedure Type Value Set (required) Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: procedureRequiringAnesthesia
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
procedure[x] |  | 1..1 | CodeableConcept | Specific clinical procedure Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required)
procedure:other | S | 0..24 | BackboneElement | Clinical procedures performed
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:serviceDescription |  | 1..1 | string | Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Procedure instance identifier
type | S | 1..1 | CodeableConcept | Category of Procedure Binding: PCT Procedure Type Value Set (required) Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: other
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
procedure[x] |  | 1..1 | CodeableConcept | Specific clinical procedure Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required)
insurance | Σ | 1..* | BackboneElement | Patient insurance information
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence | Σ | 1..1 | positiveInt | Insurance instance identifier
focal | Σ | 1..1 | boolean | Coverage to be used for adjudication
coverage | Σ | 1..1 | Reference(PCT Coverage) | Insurance information
total |  | 1..1 | Money | Total GFE Charges
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Claim.status | Base | required | Financial Resource Status Codes | 📍4.0.1 | FHIR Std.
Claim.type | Base | extensible | Claim Type Codes | 📍4.0.1 | FHIR Std.
Claim.use | Base | required | Use | 📍4.0.1 | FHIR Std.
Claim.provider.extension:dataAbsentReason.​value[x] | Base | required | DataAbsentReason | 📦4.0.1 | FHIR Std.
Claim.priority | Base | required | Process Priority Codes | 📦4.0.1 | FHIR Std.
Claim.payee.type | Base | example | PayeeType | 📍4.0.1 | FHIR Std.
Claim.careTeam.role | Base | required | PCT Care Team Role Value Set | 📦2.0.1 | This IG
Claim.careTeam.qualification | Base | required | US Core Provider Role (NUCC) | 📦3.1.1 | US Core v3.1
Claim.careTeam:attending.​role | Base | required | PCT Care Team Role Value Set | 📦2.0.1 | This IG
Claim.careTeam:attending.​qualification | Base | required | US Core Provider Role (NUCC) | 📦3.1.1 | US Core v3.1
Claim.careTeam:operating.​role | Base | required | PCT Care Team Role Value Set | 📦2.0.1 | This IG
Claim.careTeam:rendering.​role | Base | required | PCT Care Team Role Value Set | 📦2.0.1 | This IG
Claim.careTeam:referring.​role | Base | required | PCT Care Team Role Value Set | 📦2.0.1 | This IG
Claim.supportingInfo.​category | Base | example | Claim Information Category Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis.diagnosis[x] | Base | example | ICD-10 Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis.type | Base | required | Diagnosis Type Codes | 📦1.0.0 | THO v6.5
Claim.diagnosis:principal.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.diagnosis:principal.​type | Base | required | Diagnosis Type Codes | 📦1.0.0 | THO v6.5
Claim.diagnosis:admitting.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.diagnosis:admitting.​type | Base | required | Diagnosis Type Codes | 📦1.0.0 | THO v6.5
Claim.diagnosis:patientReasonForVisit.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.diagnosis:patientReasonForVisit.​type | Base | required | Diagnosis Type Codes | 📦1.0.0 | THO v6.5
Claim.diagnosis:externalcauseofinjury.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.diagnosis:externalcauseofinjury.​type | Base | required | Diagnosis Type Codes | 📦1.0.0 | THO v6.5
Claim.diagnosis:other.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.diagnosis:other.​type | Base | required | Diagnosis Type Codes | 📦1.0.0 | THO v6.5
Claim.procedure.type | Base | required | PCT Procedure Type Value Set | 📦2.0.1 | This IG
Claim.procedure.procedure[x] | Base | example | ICD-10 Procedure Codes | 📍4.0.1 | FHIR Std.
Claim.procedure:principal.​type | Base | required | PCT Procedure Type Value Set | 📦2.0.1 | This IG
Claim.procedure:principal.​procedure[x] | Base | required | ICD-10 Procedure Codes | 📦2.0.1 | This IG
Claim.procedure:anesthesiaRelated.​type | Base | required | PCT Procedure Type Value Set | 📦2.0.1 | This IG
Claim.procedure:anesthesiaRelated.​procedure[x] | Base | required | PCT CMS HCPCS and AMA CPT Procedure Surgical Codes | 📦2.0.1 | This IG
Claim.procedure:other.​type | Base | required | PCT Procedure Type Value Set | 📦2.0.1 | This IG
Claim.procedure:other.​procedure[x] | Base | required | PCT CMS HCPCS and AMA CPT Procedure Surgical Codes | 📦2.0.1 | This IG
Claim.item.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Claim | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Claim | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | Claim | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | Claim | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Claim | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`

Differential View

This structure is derived from Claim

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Claim |  |  | Claim |
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:gfeDisclaimer | S | 0..* | string | Disclaimers the patient should be made aware of regarding the estimate, e.g. application of sliding scale for self-pay/uninsured patients URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer
extension:serviceDescription | S | 0..1 | string | Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
type |  | 1..1 | CodeableConcept | Category or discipline Required Pattern: At least the following
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTEstimateTypeSummaryCSTemporaryTrialUse
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: estimate-summary
subType |  | 0..0 |  | More granular claim type
use |  | 1..1 | code | claim | preauthorization | predetermination Required Pattern: predetermination
patient |  | 1..1 | Reference(US Core Patient Profile(7.0.0)) | The recipient of the products and services
billablePeriod | S | 0..1 | Period | The full Period of Care for all services or products included in the estimate from the first event to the last event.
enterer |  | 0..0 |  | Author of the claim
insurer | S | 0..1 | Reference(PCT Organization) | Target
provider |  |  |  |
extension |  | 1..* | Extension | Extension
Slices for extension |  |  |  | Content/Rules for all slices
extension:dataAbsentReason |  | 1..1 | (Complex) | unknown | asked | temp | notasked | masked | unsupported | astext | error URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
value[x] |  | 1..1 | code | Value of extension Required Pattern: not-applicable
reference |  | 0..0 |  | Literal reference, Relative, internal or absolute URL
type |  | 0..0 |  | Type the reference refers to (e.g. "Patient")
identifier |  | 0..0 |  | Logical reference, when literal reference is not known
display |  | 0..0 |  | Text alternative for the resource
priority |  | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (required)
fundsReserve |  | 0..0 |  | For whom to reserve funds
prescription |  | 0..0 |  | Prescription authorizing services and products
originalPrescription |  | 0..0 |  | Original prescription if superseded by fulfiller
payee |  | 0..0 |  | Recipient of benefits payable
referral |  | 0..0 |  | Treatment referral
facility |  | 0..0 |  | Servicing facility
Slices for careTeam | S | 0..* | BackboneElement | Members of the care team Slice: Unordered, Open by value:role
careTeam:All Slices |  |  |  | Content/Rules for all slices
provider |  | 1..1 | Reference(PCT Practitioner | PCT Organization) | Practitioner or organization
role |  | 1..1 | CodeableConcept | Function within the team Binding: PCT Care Team Role Value Set (required)
qualification |  | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: US Core Provider Role (NUCC) (required)
careTeam:attending | S | 0..1 | BackboneElement | Members of the care team
provider |  | 1..1 | Reference(PCT Practitioner) | Practitioner or organization
role |  | 1..1 | CodeableConcept | Function within the team Required Pattern: At least the following
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
version |  | 1..1 | string | Version of the system - if relevant Fixed Value: 1.0.1
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: attending
qualification |  | 1..1 | CodeableConcept | Practitioner credential or specialization
careTeam:operating | S | 0..2 | BackboneElement | Members of the care team
provider |  | 1..1 | Reference(PCT Practitioner) | Practitioner or organization
role |  | 1..1 | CodeableConcept | Function within the team Required Pattern: At least the following
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
version |  | 1..1 | string | Version of the system - if relevant Fixed Value: 1.0.1
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: operating
careTeam:rendering | S | 0..1 | BackboneElement | Members of the care team
provider |  | 1..1 | Reference(PCT Practitioner) | Practitioner or organization
role |  | 1..1 | CodeableConcept | Function within the team Required Pattern: At least the following
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
version |  | 1..1 | string | Version of the system - if relevant Fixed Value: 1.0.1
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: rendering
careTeam:referring | S | 0..1 | BackboneElement | Members of the care team
role |  | 1..1 | CodeableConcept | Function within the team Required Pattern: At least the following
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
version |  | 1..1 | string | Version of the system - if relevant Fixed Value: 1.0.1
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: referring
supportingInfo |  | 0..0 |  | Supporting information
Slices for diagnosis | S | 0..* | BackboneElement | Pertinent diagnosis information Slice: Unordered, Open by value:type
diagnosis:All Slices |  |  |  | Content/Rules for all slices
type | S | 0..* | CodeableConcept | Timing or nature of the diagnosis Binding: Diagnosis Type Codes (required)
diagnosis:principal | S | 0..1 | BackboneElement | Principal Diagnosis - Must Support means the information source SHALL be capable of populating and SHALL populate if available and permitted.
sequence |  | 1..1 | positiveInt | Diagnosis instance identifier Required Pattern: 1
diagnosis[x] |  | 1..1 | CodeableConcept | Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type |  | 1..1 | CodeableConcept | Timing or nature of the diagnosis Required Pattern: At least the following
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: principal
diagnosis:admitting | S | 0..1 | BackboneElement | Pertinent diagnosis information
diagnosis[x] |  | 1..1 | CodeableConcept | Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type |  | 1..1 | CodeableConcept | Timing or nature of the diagnosis Required Pattern: At least the following
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: admitting
diagnosis:patientReasonForVisit | S | 0..3 | BackboneElement | Pertinent diagnosis information
diagnosis[x] |  | 1..1 | CodeableConcept | Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type |  | 1..1 | CodeableConcept | Timing or nature of the diagnosis Required Pattern: At least the following
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: patientreasonforvisit
diagnosis:externalcauseofinjury | S | 0..12 | BackboneElement | Pertinent diagnosis information
diagnosis[x] |  | 1..1 | CodeableConcept | Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type |  | 1..1 | CodeableConcept | Timing or nature of the diagnosis Required Pattern: At least the following
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: externalcauseofinjury
diagnosis:other | S | 0..24 | BackboneElement | Pertinent diagnosis information
diagnosis[x] | S | 1..1 | CodeableConcept | Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type |  | 1..1 | CodeableConcept | Timing or nature of the diagnosis Required Pattern: At least the following
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: secondary
Slices for procedure | S | 0..* | BackboneElement | Clinical procedures performed Slice: Unordered, Open by value:type
procedure:All Slices |  |  |  | Content/Rules for all slices
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:serviceDescription |  | 1..1 | string | Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
type | S | 0..* | CodeableConcept | Category of Procedure Binding: PCT Procedure Type Value Set (required)
procedure:principal | S | 0..1 | BackboneElement | Principal clinical procedure performed
Slices for extension |  |  |  | Content/Rules for all slices
extension:serviceDescription |  | 1..1 | string | Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
sequence |  | 1..1 | positiveInt | Procedure instance identifier Required Pattern: 1
type |  | 1..1 | CodeableConcept | Category of Procedure Required Pattern: At least the following
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: principal
procedure[x] |  | 1..1 | CodeableConcept | Specific clinical procedure Binding: ICD-10 Procedure Codes (required)
procedure:anesthesiaRelated | S | 0..2 | BackboneElement | Clinical procedures performed
Slices for extension |  |  |  | Content/Rules for all slices
extension:serviceDescription |  | 1..1 | string | Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
type |  | 1..1 | CodeableConcept | Category of Procedure Required Pattern: At least the following
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: procedureRequiringAnesthesia
procedure[x] |  | 1..1 | CodeableConcept | Specific clinical procedure Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required)
procedure:other | S | 0..24 | BackboneElement | Clinical procedures performed
Slices for extension |  |  |  | Content/Rules for all slices
extension:serviceDescription |  | 1..1 | string | Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
type |  | 1..1 | CodeableConcept | Category of Procedure Required Pattern: At least the following
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: other
procedure[x] |  | 1..1 | CodeableConcept | Specific clinical procedure Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required)
insurance |  |  |  |
coverage |  | 1..1 | Reference(PCT Coverage) | Insurance information
preAuthRef |  | 0..0 |  | Prior authorization reference number
accident |  |  |  |
location[x] |  | 0..1 | Address | Where the event occurred
country |  | 0..1 | string | Country (e.g. can be ISO 3166 2 or 3 letter code) Binding: Iso3166-1-2 (required)
item |  | 0..0 |  | Product or service provided
total |  | 1..1 | Money | Total GFE Charges
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
Claim.priority | Base | required | Process Priority Codes | 📦4.0.1 | FHIR Std.
Claim.careTeam.role | Base | required | PCT Care Team Role Value Set | 📦2.0.1 | This IG
Claim.careTeam.qualification | Base | required | US Core Provider Role (NUCC) | 📦3.1.1 | US Core v3.1
Claim.diagnosis.type | Base | required | Diagnosis Type Codes | 📦1.0.0 | THO v6.5
Claim.diagnosis:principal.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.diagnosis:admitting.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.diagnosis:patientReasonForVisit.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.diagnosis:externalcauseofinjury.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.diagnosis:other.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.procedure.type | Base | required | PCT Procedure Type Value Set | 📦2.0.1 | This IG
Claim.procedure:principal.​procedure[x] | Base | required | ICD-10 Procedure Codes | 📦2.0.1 | This IG
Claim.procedure:anesthesiaRelated.​procedure[x] | Base | required | PCT CMS HCPCS and AMA CPT Procedure Surgical Codes | 📦2.0.1 | This IG
Claim.procedure:other.​procedure[x] | Base | required | PCT CMS HCPCS and AMA CPT Procedure Surgical Codes | 📦2.0.1 | This IG
Claim.accident.location[x].​country | Base | required | Iso 3166 Part 1: 2 Letter Codes | 📦4.0.1 | FHIR Std.

Snapshot View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Claim |  | 0..* | Claim | Claim, Pre-determination or Pre-authorization
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:gfeDisclaimer | S | 0..* | string | Disclaimers the patient should be made aware of regarding the estimate, e.g. application of sliding scale for self-pay/uninsured patients URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer
extension:serviceDescription | S | 0..1 | string | Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier |  | 0..* | Identifier | Business Identifier for claim
status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type | Σ | 1..1 | CodeableConcept | Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim. Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTEstimateTypeSummaryCSTemporaryTrialUse
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: estimate-summary
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
use | Σ | 1..1 | code | claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim. Required Pattern: predetermination
patient | Σ | 1..1 | Reference(US Core Patient Profile(7.0.0)) | The recipient of the products and services
billablePeriod | S Σ | 0..1 | Period | The full Period of Care for all services or products included in the estimate from the first event to the last event.
created | Σ | 1..1 | dateTime | Resource creation date
insurer | S Σ | 0..1 | Reference(PCT Organization) | Target
provider | Σ | 1..1 | Reference(Practitioner | PractitionerRole | Organization) | Party responsible for the claim
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:dataAbsentReason |  | 1..1 | (Complex) | unknown | asked | temp | notasked | masked | unsupported | astext | error URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason
id |  | 0..1 | id | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "http://hl7.org/fhir/StructureDefinition/data-absent-reason"
value[x] |  | 1..1 | code | Value of extension Binding: DataAbsentReason (required) Required Pattern: not-applicable
priority | Σ | 1..1 | CodeableConcept | Desired processing ugency Binding: ProcessPriorityCodes (required)
related |  | 0..* | BackboneElement | Prior or corollary claims
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
claim |  | 0..1 | Reference(Claim) | Reference to the related claim
relationship |  | 0..1 | CodeableConcept | How the reference claim is related Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.
reference |  | 0..1 | Identifier | File or case reference
Slices for careTeam | S | 0..* | BackboneElement | Members of the care team Slice: Unordered, Open by value:role
careTeam:All Slices |  |  |  | Content/Rules for all slices
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Order of care team
provider |  | 1..1 | Reference(PCT Practitioner | PCT Organization) | Practitioner or organization
responsible |  | 0..1 | boolean | Indicator of the lead practitioner
role |  | 1..1 | CodeableConcept | Function within the team Binding: PCT Care Team Role Value Set (required)
qualification |  | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: US Core Provider Role (NUCC) (required)
careTeam:attending | S | 0..1 | BackboneElement | Members of the care team
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Order of care team
provider |  | 1..1 | Reference(PCT Practitioner) | Practitioner or organization
responsible |  | 0..1 | boolean | Indicator of the lead practitioner
role |  | 1..1 | CodeableConcept | Function within the team Binding: PCT Care Team Role Value Set (required) Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
version |  | 1..1 | string | Version of the system - if relevant Fixed Value: 1.0.1
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: attending
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
qualification |  | 1..1 | CodeableConcept | Practitioner credential or specialization Binding: US Core Provider Role (NUCC) (required)
careTeam:operating | S | 0..2 | BackboneElement | Members of the care team
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Order of care team
provider |  | 1..1 | Reference(PCT Practitioner) | Practitioner or organization
responsible |  | 0..1 | boolean | Indicator of the lead practitioner
role |  | 1..1 | CodeableConcept | Function within the team Binding: PCT Care Team Role Value Set (required) Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
version |  | 1..1 | string | Version of the system - if relevant Fixed Value: 1.0.1
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: operating
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
qualification |  | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: US Core Provider Role (NUCC) (required)
careTeam:rendering | S | 0..1 | BackboneElement | Members of the care team
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Order of care team
provider |  | 1..1 | Reference(PCT Practitioner) | Practitioner or organization
responsible |  | 0..1 | boolean | Indicator of the lead practitioner
role |  | 1..1 | CodeableConcept | Function within the team Binding: PCT Care Team Role Value Set (required) Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
version |  | 1..1 | string | Version of the system - if relevant Fixed Value: 1.0.1
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: rendering
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
qualification |  | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: US Core Provider Role (NUCC) (required)
careTeam:referring | S | 0..1 | BackboneElement | Members of the care team
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Order of care team
provider |  | 1..1 | Reference(PCT Practitioner | PCT Organization) | Practitioner or organization
responsible |  | 0..1 | boolean | Indicator of the lead practitioner
role |  | 1..1 | CodeableConcept | Function within the team Binding: PCT Care Team Role Value Set (required) Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/claimcareteamrole
version |  | 1..1 | string | Version of the system - if relevant Fixed Value: 1.0.1
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: referring
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
qualification |  | 0..1 | CodeableConcept | Practitioner credential or specialization Binding: US Core Provider Role (NUCC) (required)
Slices for diagnosis | S | 0..* | BackboneElement | Pertinent diagnosis information Slice: Unordered, Open by value:type
diagnosis:All Slices |  |  |  | Content/Rules for all slices
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Diagnosis instance identifier
diagnosis[x] |  | 1..1 |  | Nature of illness or problem Binding: ICD-10Codes (example): Example ICD10 Diagnostic codes.
diagnosisCodeableConcept |  |  | CodeableConcept |
diagnosisReference |  |  | Reference(Condition) |
type | S | 0..* | CodeableConcept | Timing or nature of the diagnosis Binding: Diagnosis Type Codes (required)
onAdmission |  | 0..1 | CodeableConcept | Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
packageCode |  | 0..1 | CodeableConcept | Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
diagnosis:principal | S | 0..1 | BackboneElement | Principal Diagnosis - Must Support means the information source SHALL be capable of populating and SHALL populate if available and permitted.
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Diagnosis instance identifier Required Pattern: 1
diagnosis[x] |  | 1..1 | CodeableConcept | Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type | S | 1..1 | CodeableConcept | Timing or nature of the diagnosis Binding: Diagnosis Type Codes (required) Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: principal
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
onAdmission |  | 0..1 | CodeableConcept | Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
packageCode |  | 0..1 | CodeableConcept | Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
diagnosis:admitting | S | 0..1 | BackboneElement | Pertinent diagnosis information
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Diagnosis instance identifier
diagnosis[x] |  | 1..1 | CodeableConcept | Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type | S | 1..1 | CodeableConcept | Timing or nature of the diagnosis Binding: Diagnosis Type Codes (required) Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: admitting
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
onAdmission |  | 0..1 | CodeableConcept | Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
packageCode |  | 0..1 | CodeableConcept | Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
diagnosis:patientReasonForVisit | S | 0..3 | BackboneElement | Pertinent diagnosis information
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Diagnosis instance identifier
diagnosis[x] |  | 1..1 | CodeableConcept | Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type | S | 1..1 | CodeableConcept | Timing or nature of the diagnosis Binding: Diagnosis Type Codes (required) Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: patientreasonforvisit
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
onAdmission |  | 0..1 | CodeableConcept | Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
packageCode |  | 0..1 | CodeableConcept | Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
diagnosis:externalcauseofinjury | S | 0..12 | BackboneElement | Pertinent diagnosis information
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Diagnosis instance identifier
diagnosis[x] |  | 1..1 | CodeableConcept | Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type | S | 1..1 | CodeableConcept | Timing or nature of the diagnosis Binding: Diagnosis Type Codes (required) Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: externalcauseofinjury
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
onAdmission |  | 0..1 | CodeableConcept | Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
packageCode |  | 0..1 | CodeableConcept | Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
diagnosis:other | S | 0..24 | BackboneElement | Pertinent diagnosis information
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Diagnosis instance identifier
diagnosis[x] | S | 1..1 | CodeableConcept | Nature of illness or problem Binding: PCT ICD-10 Diagnostic Codes (required)
type | S | 1..1 | CodeableConcept | Timing or nature of the diagnosis Binding: Diagnosis Type Codes (required) Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/diagnosistype
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: secondary
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
onAdmission |  | 0..1 | CodeableConcept | Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
packageCode |  | 0..1 | CodeableConcept | Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
Slices for procedure | S | 0..* | BackboneElement | Clinical procedures performed Slice: Unordered, Open by value:type
procedure:All Slices |  |  |  | Content/Rules for all slices
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:serviceDescription |  | 1..1 | string | Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Procedure instance identifier
type | S | 0..* | CodeableConcept | Category of Procedure Binding: PCT Procedure Type Value Set (required)
date |  | 0..1 | dateTime | When the procedure was performed
procedure[x] |  | 1..1 |  | Specific clinical procedure Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.
procedureCodeableConcept |  |  | CodeableConcept |
procedureReference |  |  | Reference(Procedure) |
udi |  | 0..* | Reference(Device) | Unique device identifier
procedure:principal | S | 0..1 | BackboneElement | Principal clinical procedure performed
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:serviceDescription |  | 1..1 | string | Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Procedure instance identifier Required Pattern: 1
type | S | 1..1 | CodeableConcept | Category of Procedure Binding: PCT Procedure Type Value Set (required) Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: principal
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
date |  | 0..1 | dateTime | When the procedure was performed
procedure[x] |  | 1..1 | CodeableConcept | Specific clinical procedure Binding: ICD-10 Procedure Codes (required)
udi |  | 0..* | Reference(Device) | Unique device identifier
procedure:anesthesiaRelated | S | 0..2 | BackboneElement | Clinical procedures performed
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:serviceDescription |  | 1..1 | string | Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Procedure instance identifier
type | S | 1..1 | CodeableConcept | Category of Procedure Binding: PCT Procedure Type Value Set (required) Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: procedureRequiringAnesthesia
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
date |  | 0..1 | dateTime | When the procedure was performed
procedure[x] |  | 1..1 | CodeableConcept | Specific clinical procedure Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required)
udi |  | 0..* | Reference(Device) | Unique device identifier
procedure:other | S | 0..24 | BackboneElement | Clinical procedures performed
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:serviceDescription |  | 1..1 | string | Service Description URL: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence |  | 1..1 | positiveInt | Procedure instance identifier
type | S | 1..1 | CodeableConcept | Category of Procedure Binding: PCT Procedure Type Value Set (required) Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: other
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
date |  | 0..1 | dateTime | When the procedure was performed
procedure[x] |  | 1..1 | CodeableConcept | Specific clinical procedure Binding: PCT CMS HCPCS and AMA CPT Procedure Surgical Codes (required)
udi |  | 0..* | Reference(Device) | Unique device identifier
insurance | Σ | 1..* | BackboneElement | Patient insurance information
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
sequence | Σ | 1..1 | positiveInt | Insurance instance identifier
focal | Σ | 1..1 | boolean | Coverage to be used for adjudication
identifier |  | 0..1 | Identifier | Pre-assigned Claim number
coverage | Σ | 1..1 | Reference(PCT Coverage) | Insurance information
businessArrangement |  | 0..1 | string | Additional provider contract number
claimResponse |  | 0..1 | Reference(ClaimResponse) | Adjudication results
accident |  | 0..1 | BackboneElement | Details of the event
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
date |  | 1..1 | date | When the incident occurred
type |  | 0..1 | CodeableConcept | The nature of the accident Binding: ActIncidentCode (3.0.0) (extensible): Type of accident: work place, auto, etc.
location[x] |  | 0..1 | Address | Where the event occurred
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
use | ?!Σ | 0..1 | code | home | work | temp | old | billing - purpose of this address Binding: AddressUse (required): The use of an address. Example General: home
type | Σ | 0..1 | code | postal | physical | both Binding: AddressType (required): The type of an address (physical / postal). Example General: both
text | Σ | 0..1 | string | Text representation of the address Example General: 137 Nowhere Street, Erewhon 9132
line | Σ | 0..* | string | Street name, number, direction & P.O. Box etc. This repeating element order: The order in which lines should appear in an address label Example General: 137 Nowhere Street
city | Σ | 0..1 | string | Name of city, town etc. Example General: Erewhon
district | Σ | 0..1 | string | District name (aka county) Example General: Madison
state | Σ | 0..1 | string | Sub-unit of country (abbreviations ok)
postalCode | Σ | 0..1 | string | Postal code for area Example General: 9132
country | Σ | 0..1 | string | Country (e.g. can be ISO 3166 2 or 3 letter code) Binding: Iso3166-1-2 (required)
period | Σ | 0..1 | Period | Time period when address was/is in use Example General: {"start":"2010-03-23","end":"2010-07-01"}
total |  | 1..1 | Money | Total GFE Charges
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Claim.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std.
Claim.status | Base | required | Financial Resource Status Codes | 📍4.0.1 | FHIR Std.
Claim.type | Base | extensible | Claim Type Codes | 📍4.0.1 | FHIR Std.
Claim.use | Base | required | Use | 📍4.0.1 | FHIR Std.
Claim.provider.extension:dataAbsentReason.​value[x] | Base | required | DataAbsentReason | 📦4.0.1 | FHIR Std.
Claim.priority | Base | required | Process Priority Codes | 📦4.0.1 | FHIR Std.
Claim.related.relationship | Base | example | Example Related Claim Relationship Codes | 📍4.0.1 | FHIR Std.
Claim.payee.type | Base | example | PayeeType | 📍4.0.1 | FHIR Std.
Claim.careTeam.role | Base | required | PCT Care Team Role Value Set | 📦2.0.1 | This IG
Claim.careTeam.qualification | Base | required | US Core Provider Role (NUCC) | 📦3.1.1 | US Core v3.1
Claim.careTeam:attending.​role | Base | required | PCT Care Team Role Value Set | 📦2.0.1 | This IG
Claim.careTeam:attending.​qualification | Base | required | US Core Provider Role (NUCC) | 📦3.1.1 | US Core v3.1
Claim.careTeam:operating.​role | Base | required | PCT Care Team Role Value Set | 📦2.0.1 | This IG
Claim.careTeam:operating.​qualification | Base | required | US Core Provider Role (NUCC) | 📦3.1.1 | US Core v3.1
Claim.careTeam:rendering.​role | Base | required | PCT Care Team Role Value Set | 📦2.0.1 | This IG
Claim.careTeam:rendering.​qualification | Base | required | US Core Provider Role (NUCC) | 📦3.1.1 | US Core v3.1
Claim.careTeam:referring.​role | Base | required | PCT Care Team Role Value Set | 📦2.0.1 | This IG
Claim.careTeam:referring.​qualification | Base | required | US Core Provider Role (NUCC) | 📦3.1.1 | US Core v3.1
Claim.supportingInfo.​category | Base | example | Claim Information Category Codes | 📍4.0.1 | FHIR Std.
Claim.supportingInfo.​code | Base | example | Exception Codes | 📍4.0.1 | FHIR Std.
Claim.supportingInfo.​reason | Base | example | Missing Tooth Reason Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis.diagnosis[x] | Base | example | ICD-10 Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis.type | Base | required | Diagnosis Type Codes | 📦1.0.0 | THO v6.5
Claim.diagnosis.onAdmission | Base | example | Example Diagnosis on Admission Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis.packageCode | Base | example | Example Diagnosis Related Group Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis:principal.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.diagnosis:principal.​type | Base | required | Diagnosis Type Codes | 📦1.0.0 | THO v6.5
Claim.diagnosis:principal.​onAdmission | Base | example | Example Diagnosis on Admission Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis:principal.​packageCode | Base | example | Example Diagnosis Related Group Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis:admitting.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.diagnosis:admitting.​type | Base | required | Diagnosis Type Codes | 📦1.0.0 | THO v6.5
Claim.diagnosis:admitting.​onAdmission | Base | example | Example Diagnosis on Admission Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis:admitting.​packageCode | Base | example | Example Diagnosis Related Group Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis:patientReasonForVisit.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.diagnosis:patientReasonForVisit.​type | Base | required | Diagnosis Type Codes | 📦1.0.0 | THO v6.5
Claim.diagnosis:patientReasonForVisit.​onAdmission | Base | example | Example Diagnosis on Admission Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis:patientReasonForVisit.​packageCode | Base | example | Example Diagnosis Related Group Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis:externalcauseofinjury.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.diagnosis:externalcauseofinjury.​type | Base | required | Diagnosis Type Codes | 📦1.0.0 | THO v6.5
Claim.diagnosis:externalcauseofinjury.​onAdmission | Base | example | Example Diagnosis on Admission Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis:externalcauseofinjury.​packageCode | Base | example | Example Diagnosis Related Group Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis:other.​diagnosis[x] | Base | required | PCT ICD-10 Diagnostic Codes | 📦2.0.1 | This IG
Claim.diagnosis:other.​type | Base | required | Diagnosis Type Codes | 📦1.0.0 | THO v6.5
Claim.diagnosis:other.​onAdmission | Base | example | Example Diagnosis on Admission Codes | 📍4.0.1 | FHIR Std.
Claim.diagnosis:other.​packageCode | Base | example | Example Diagnosis Related Group Codes | 📍4.0.1 | FHIR Std.
Claim.procedure.type | Base | required | PCT Procedure Type Value Set | 📦2.0.1 | This IG
Claim.procedure.procedure[x] | Base | example | ICD-10 Procedure Codes | 📍4.0.1 | FHIR Std.
Claim.procedure:principal.​type | Base | required | PCT Procedure Type Value Set | 📦2.0.1 | This IG
Claim.procedure:principal.​procedure[x] | Base | required | ICD-10 Procedure Codes | 📦2.0.1 | This IG
Claim.procedure:anesthesiaRelated.​type | Base | required | PCT Procedure Type Value Set | 📦2.0.1 | This IG
Claim.procedure:anesthesiaRelated.​procedure[x] | Base | required | PCT CMS HCPCS and AMA CPT Procedure Surgical Codes | 📦2.0.1 | This IG
Claim.procedure:other.​type | Base | required | PCT Procedure Type Value Set | 📦2.0.1 | This IG
Claim.procedure:other.​procedure[x] | Base | required | PCT CMS HCPCS and AMA CPT Procedure Surgical Codes | 📦2.0.1 | This IG
Claim.accident.type | Base | extensible | ActIncidentCode | 📍3.0.0 | THO v6.5
Claim.accident.location[x].​use | Base | required | AddressUse | 📍4.0.1 | FHIR Std.
Claim.accident.location[x].​type | Base | required | AddressType | 📍4.0.1 | FHIR Std.
Claim.accident.location[x].​country | Base | required | Iso 3166 Part 1: 2 Letter Codes | 📦4.0.1 | FHIR Std.
Claim.item.revenue | Base | example | Example Revenue Center Codes | 📍4.0.1 | FHIR Std.
Claim.item.category | Base | example | Benefit Category Codes | 📍4.0.1 | FHIR Std.
Claim.item.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item.modifier | Base | example | Modifier type Codes | 📍4.0.1 | FHIR Std.
Claim.item.programCode | Base | example | Example Program Reason Codes | 📍4.0.1 | FHIR Std.
Claim.item.location[x] | Base | example | Example Service Place Codes | 📍4.0.1 | FHIR Std.
Claim.item.bodySite | Base | example | Oral Site Codes | 📍4.0.1 | FHIR Std.
Claim.item.subSite | Base | example | Surface Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.revenue | Base | example | Example Revenue Center Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.category | Base | example | Benefit Category Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.modifier | Base | example | Modifier type Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.programCode | Base | example | Example Program Reason Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.subDetail.​revenue | Base | example | Example Revenue Center Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.subDetail.​category | Base | example | Benefit Category Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.subDetail.​productOrService | Base | example | USCLS Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.subDetail.​modifier | Base | example | Modifier type Codes | 📍4.0.1 | FHIR Std.
Claim.item.detail.subDetail.​programCode | Base | example | Example Program Reason Codes | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | Claim | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Claim | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | Claim | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | Claim | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Claim | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`

This structure is derived from Claim

Summary

Mandatory: 3 elements(15 nested mandatory elements)
Must-Support: 22 elements
Prohibited: 15 elements

Structures

This structure refers to these other structures:

- US Core Patient Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient|7.0.0)
- PCT Organization (http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization)
- PCT Practitioner (http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-practitioner)
- PCT Coverage (http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-coverage)

Extensions

This structure refers to these extensions:

- http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer
- http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
- http://hl7.org/fhir/StructureDefinition/data-absent-reason|5.2.0

Slices

This structure defines the following Slices:

- The element 1 is sliced based on the value of Claim.careTeam
- The element 1 is sliced based on the value of Claim.diagnosis
- The element 1 is sliced based on the value of Claim.procedure

Maturity: 1

Other representations of profile: CSV, Excel, Schematron