Generated Narrative: StructureDefinition xealth-chargeitem Name Flags Card. Type Description & Constraints<img src="[binary]" alt="doco" style="background-color: inherit"/> ChargeItem <a style="padding-left: 3px; padding-right: 3px; border: 1px maroon solid; font-weight: bold; color: #301212; background-color: #fdf4f4;; padding-left: 3px; padding-right: 3px; border: 1px maroon solid; font-weight: bold; color: #301212; background-color: #fdf4f4;" href="http://hl7.org/fhir/R4/conformance-rules.html#constraints" title="This element has or is affected by constraints ( chargeitem-performer-with-ehr-order-id )">C 0..* ChargeItem Item containing charge code(s) associated with the provision of healthcare provider products Constraints: chargeitem-performer-with-ehr-order-id #xD; meta S 1..1 Meta Metadata about the resource #xD; profile S 1..1 canonical(StructureDefinition) Profiles this resource claims to conform to #xD; Slices for extension 0..* Extension Extension Slice: Unordered, Open by value:url #xD; extension:ehrOrderId 0..1 string The EHR's identifier for the order. URL: https://fhir.xealth.io/StructureDefinition/extension-ehr-order-id #xD; identifier S 0..* Identifier The EHR's identifier for the charge, assigned by Xealth. Not usable with GET/PATCH — use ChargeItem.id (a UUID) for those. #xD; status S 1..1 code billable = charge (POST); entered-in-error = total reversal / correction (PATCH). Drives the transaction intent together with the HTTP verb. Binding: Xealth ChargeItem Valid Status Value Set (required) #xD; code S 1..1 CodeableConcept The billable charge code (CPT/HCPCS, or Cerner CDM_SCHED/PROCCODE). #xD; coding S 1..* Coding Code defined by a terminology system #xD; system S 1..1 uri Identity of the terminology system #xD; code S 1..1 code Symbol in syntax defined by the system #xD; display S 1..1 string Representation defined by the system #xD; subject S 1..1 Reference(Patient) The patient this charge is for. Resolved via Xealth patient context. #xD; occurrence[x] S 1..1 Service date, with an optional end when expressed as a Period. #xD; <span title="Base StructureDefinition for dateTime Type: A date, date-time or partial date (e.g. just year or year + month). If hours and minutes are specified, a time zone SHALL be populated. The format is a union of the schema types gYear, gYearMonth, date and dateTime. Seconds must be provided due to schema type constraints but may be zero-filled and may be ignored. Dates SHALL be valid dates.">occurrenceDateTime dateTime #xD; occurrencePeriod Period #xD; performer S 0..* BackboneElement Who performed charged service #xD; function S 1..1 CodeableConcept The role this performer played: OP (ordering provider), PRF (performer), or VRF (verifier). Binding: Xealth ChargeItem Performer Function Value Set (required) #xD; actor S 1..1 Reference(Practitioner | PractitionerRole | Organization) The ordering provider. Use actor.identifier (e.g. NPI) + actor.display when no Practitioner resource is referenced. #xD; performingOrganization S 0..1 Reference(Organization) The partner organization that submitted this charge. Set by Xealth; used for partner attribution and ownership. #xD; quantity S 1..1 Quantity Units serviced. Required — sent explicitly rather than defaulted. #xD; value S 1..1 decimal Numerical value (with implicit precision) #xD; supportingInformation S 1..1 Reference(ServiceRequest) The Xealth order this ChargeItem is based on. Consumed server-side to resolve the order. #xD; <img src="[binary]" alt="doco" style="background-color: inherit"/> Documentation for this format
Defines Xealth constraints on ChargeItem for posting partner charges to a health system's billing system.
Item containing charge code(s) associated with the provision of healthcare provider products
The resource ChargeItem describes the provision of healthcare provider products for a certain patient, therefore referring not only to the product, but containing in addition details of the provision, like date, time, amounts and participating organizations and persons. Main Usage of the ChargeItem is to enable the billing process and internal cost allocation.
If the resource is contained in another resource, it SHALL NOT contain nested Resources
not(parent::f:contained and f:contained)
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()
not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))
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()
not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))
If a resource is contained in another resource, it SHALL NOT have a security label
When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time.
A resource should have narrative for robust management
If an ordering provider (performer.function = OP) is present, then the ehr-order-id extension must be present.
performer.function.coding.where(system = 'http://terminology.hl7.org/CodeSystem/v2-0912' and code = 'OP').exists() implies extension.exists(url = 'https://fhir.xealth.io/StructureDefinition/extension-ehr-order-id')
The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Extensions are always sliced by (at least) url
Additional content defined by implementations
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Must have either extensions or value[x], not both
exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted.
The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.
When the resource last changed - e.g. when the version changed.
This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a [read](http://hl7.org/fhir/R4/http.html#read) interaction.
Identifies where the resource comes from
A uri that identifies the source system of the resource. This provides a minimal amount of [Provenance](http://hl7.org/fhir/R4/provenance.html#) information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc.
In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used. This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.
Profiles this resource claims to conform to
A list of profiles (references to [StructureDefinition](http://hl7.org/fhir/R4/structuredefinition.html#) resources) that this resource claims to conform to. The URL is a reference to [StructureDefinition.url](http://hl7.org/fhir/R4/structuredefinition-definitions.html#StructureDefinition.url).
It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.
Security Labels applied to this resource
Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.
The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.
Security Labels from the Healthcare Privacy and Security Classification System.
Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.
The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.
Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
A set of rules under which this content was created
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
The base language in which the resource is written.
Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).
Text summary of the resource, for human interpretation
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
The EHR's identifier for the charge, assigned by Xealth. Not usable with GET/PATCH — use ChargeItem.id (a UUID) for those.
Identifiers assigned to this event performer or other systems.
Allows identification of the charge Item as it is known by various participating systems and in a way that remains consistent across servers.
Defining information about the code of this charge item
References the (external) source of pricing information, rules of application for the code this ChargeItem uses.
Resource defining the code of this ChargeItem
References the source of pricing information, rules of application for the code this ChargeItem uses.
billable = charge (POST); entered-in-error = total reversal / correction (PATCH). Drives the transaction intent together with the HTTP verb.
Unknown does not represent "other" - one of the defined statuses must apply. Unknown is used when the authoring system is not sure what the current status is. This element is labeled as a modifier because the status contains the code entered-in-error that marks the charge item as not currently valid.
This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
ChargeItems can be grouped to larger ChargeItems covering the whole set.
E.g. Drug administration as part of a procedure, procedure as part of observation, etc.
The billable charge code (CPT/HCPCS, or Cerner CDM_SCHED/PROCCODE).
A code that identifies the charge, like a billing code.
Recognized by Xealth and mapped to the health system's standard code systems by default: CPT (system http://www.ama-assn.org/go/cpt), HCPCS (system http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets), Cerner CDM_SCHED (system https://fhir.xealth.io/CodeSystem/cerner-cdm-sched), and Cerner PROCCODE (system https://fhir.xealth.io/CodeSystem/cerner-proccode). Any other code system requires Xealth mapping configuration before it can be recognized and mapped.
Example set of codes that can be used for billing purposes.
A reference to a code defined by a terminology system.
Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.
Allows for alternative encodings within a code system, and translations to other code systems.
fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
The identification of the code system that defines the meaning of the symbol in the code.
The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.
Need to be unambiguous about the source of the definition of the symbol.
fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem
The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.
Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.
fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion
A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).
Need to refer to a particular code in the system.
fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code
A representation of the meaning of the code in the system, following the rules of the system.
Need to be able to carry a human-readable meaning of the code for readers that do not know the system.
C*E.2 - but note this is not well followed
fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName
If this coding was chosen directly by the user
Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.
This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.
fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]
Plain text representation of the concept
A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
Very often the text is the same as a displayName of one of the codings.
The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.
C*E.9. But note many systems use C*E.2 for this
fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText
The patient this charge is for. Resolved via Xealth patient context.
The individual or set of individuals the action is being or was performed on.
Encounter / Episode associated with event
The encounter or episode of care that establishes the context for this event.
Links the request to the Encounter context.
.inboundRelationship(typeCode=COMP].source[classCode<=PCPR, moodCode=EVN]
Service date, with an optional end when expressed as a Period.
Date/time(s) or duration when the charged service was applied.
The list of types may be constrained as appropriate for the type of charge item.
Indicates who or what performed or participated in the charged service.
Extensions that cannot be ignored even if unrecognized
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
The role this performer played: OP (ordering provider), PRF (performer), or VRF (verifier).
Describes the type of performance or participation(e.g. primary surgeon, anesthesiologiest, etc.).
The ordering provider. Use actor.identifier (e.g. NPI) + actor.display when no Practitioner resource is referenced.
The device, practitioner, etc. who performed or participated in the service.
The partner organization that submitted this charge. Set by Xealth; used for partner attribution and ownership.
The organization requesting the service.
Practitioners and Devices can be associated with multiple organizations. It has to be made clear, on behalf of which Organization the services have been rendered.
Organization requesting the charged service
The organization performing the service.
The rendered Service might not be associated with a Request. This property indicates which Organization requested the services to be rendered. (In many cases, this may just be the Department associated with the Encounter.location).
Organization that has ownership of the (potential, future) revenue
The financial cost center permits the tracking of charge attribution.
The costCenter could either be given as a reference to an Organization(Role) resource or as the identifier of the cost center determined by Reference.identifier.value and Reference.identifier.system, depending on use case requirements.
Units serviced. Required — sent explicitly rather than defaulted.
Quantity of which the charge item has been serviced.
In many cases this may just be a value, if the underlying units are implicit in the definition of the charge item code.
Numerical value (with implicit precision)
The value of the measured amount. The value includes an implicit precision in the presentation of the value.
The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).
Precision is handled implicitly in almost all cases of measurement.
PQ.value, CO.value, MO.value, IVL.high or IVL.low depending on the value
< | <= | >= | > - how to understand the value
How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.
Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.
If there is no comparator, then there is no modification of the value
This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
How the Quantity should be understood and represented.
There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.
The identification of the system that provides the coded form of the unit.
Need to know the system that defines the coded form of the unit.
CO.codeSystem, PQ.translation.codeSystem
A computer processable form of the unit in some unit representation system.
The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.
Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.
PQ.code, MO.currency, PQ.translation.code
The anatomical location where the related service has been applied.
Only used if not implicit in code found in Condition.code. If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension [bodySite](http://hl7.org/fhir/R4/extension-bodysite.html). May be a summary code, or a reference to a very precise definition of the location, or both.
Codes describing anatomical locations. May include laterality.
Factor overriding the factor determined by the rules associated with the code.
There is no reason to carry the factor in the instance of a ChargeItem unless special circumstances require a manual override. The factors are usually defined by a set of rules in a back catalogue of the billing codes (see ChargeItem.definition). Derived profiles may require a ChargeItem.overrideReason to be provided if either factor or price are manually overridden.
Total price of the charge overriding the list price associated with the code.
There is no reason to carry the price in the instance of a ChargeItem unless circumstances require a manual override. The list prices or are usually defined in a back catalogue of the billing codes (see ChargeItem.definition). Derived profiles may require a ChargeItem.overrideReason to be provided if either factor or price are manually overridden.
Reason for overriding the list price/factor
If the list price or the rule-based factor associated with the code is overridden, this attribute can capture a text to indicate the reason for this action.
Derived Profiles may choose to add invariants requiring this field to be populated if either priceOverride or factorOverride have been filled.
The device, practitioner, etc. who entered the charge item.
The enterer is also the person considered responsible for factor/price overrides if applicable.
The actual date when the service associated with the charge has been rendered is captured in occurrence[x].
Describes why the event occurred in coded or textual form.
If the application of the charge item requires a reason to be given, it can be captured here. Textual reasons can be captured using reasonCode.text.
Which rendered service is being charged?
Indicated the rendered service that caused this charge.
Identifies the device, food, drug or other product being charged either by type code or reference to an instance.
Account into which this ChargeItems belongs.
Systems posting the ChargeItems might not always be able to determine, which accounts the Items need to be places into. It is up to the postprocessing Financial System to apply internal rules to decide based on the Encounter/EpisodeOfCare/Patient/Coverage context and the type of ChargeItem, which Account is appropriate.
Comments made about the event by the performer, subject or other participants.
.inboundRelationship(typeCode=SUBJ].source[classCode=ANNGEN, moodCode=EVN].value[xsi:type=ST]
The Xealth order this ChargeItem is based on. Consumed server-side to resolve the order.
Further information supporting this charge.