Release 4B

This page is part of the FHIR Specification (v4.3.0: R4B - STU). This is a downloaded version of the specification. For a full list of available versions, see the Directory of published versions

8.25 Resource ChargeItemDefinition - Content

Patient Administration Work GroupMaturity Level: 0 Trial UseSecurity Category: Business Compartments: Not linked to any defined compartments

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

8.25.1 Scope and Usage

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

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

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

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

8.25.2 Boundaries and Relationships

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

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

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

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

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

8.25.3 References

This resource is referenced by ChargeItem and itself.

This resource does not implement any patterns.

8.25.4 Resource Content

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. ChargeItemDefinition TUDomainResourceDefinition of properties and rules about how the price and the applicability of a ChargeItem can be determined
+ Warning: Name should be usable as an identifier for the module by machine processing applications such as code generation
Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... url Σ1..1uriCanonical identifier for this charge item definition, represented as a URI (globally unique)
... identifier Σ0..*IdentifierAdditional identifier for the charge item definition
... version Σ0..1stringBusiness version of the charge item definition
... derivedFromUri Σ0..*uriUnderlying externally-defined charge item definition
... partOf Σ0..*canonical(ChargeItemDefinition)A larger definition of which this particular definition is a component or step
... replaces Σ0..*canonical(ChargeItemDefinition)Completed or terminated request(s) whose function is taken by this new request
... status ?!Σ1..1codedraft | active | retired | unknown
PublicationStatus (Required)
... experimental Σ0..1booleanFor testing purposes, not real usage
... date Σ0..1dateTimeDate last changed
... publisher Σ0..1stringName of the publisher (organization or individual)
... contact Σ0..*ContactDetailContact details for the publisher
... description Σ0..1markdownNatural language description of the charge item definition
... useContext Σ0..*UsageContextThe context that the content is intended to support
... jurisdiction Σ0..*CodeableConceptIntended jurisdiction for charge item definition (if applicable)
Jurisdiction (Extensible)
... copyright 0..1markdownUse and/or publishing restrictions
... approvalDate 0..1dateWhen the charge item definition was approved by publisher
... lastReviewDate 0..1dateWhen the charge item definition was last reviewed
... effectivePeriod Σ0..1PeriodWhen the charge item definition is expected to be used
... code Σ0..1CodeableConceptBilling codes or product types this definition applies to
ChargeItemCode (Example)
... instance 0..*Reference(Medication | Substance | Device)Instances this definition applies to
... applicability 0..*BackboneElementWhether or not the billing code is applicable
.... description 0..1stringNatural language description of the condition
.... language 0..1stringLanguage of the expression
.... expression 0..1stringBoolean-valued expression
... propertyGroup 0..*BackboneElementGroup of properties which are applicable under the same conditions
.... applicability 0..*see applicabilityConditions under which the priceComponent is applicable
.... priceComponent 0..*BackboneElementComponents of total line item price
..... type 1..1codebase | surcharge | deduction | discount | tax | informational
InvoicePriceComponentType (Required)
..... code 0..1CodeableConceptCode identifying the specific component
..... factor 0..1decimalFactor used for calculating this component
..... amount 0..1MoneyMonetary amount associated with this component

doco Documentation for this format

 

See the Profiles & Extensions and the alternate definitions: Master Definition XML + JSON, XML Schema/Schematron + JSON Schema, ShEx (for Turtle) + see the extensions & the dependency analysis

8.25.4.1 Terminology Bindings

PathDefinitionTypeReference
ChargeItemDefinition.status RequiredPublicationStatus
ChargeItemDefinition.jurisdiction ExtensibleJurisdiction ValueSet
ChargeItemDefinition.code ExampleChargeItemCode
ChargeItemDefinition.propertyGroup.priceComponent.type RequiredInvoicePriceComponentType

8.25.4.2 Constraints

idLevelLocationDescriptionExpression
cid-0Warning (base)Name should be usable as an identifier for the module by machine processing applications such as code generationname.exists() implies name.matches('[A-Z]([A-Za-z0-9_]){0,254}')

8.25.5 Search Parameters

Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

NameTypeDescriptionExpressionIn Common
contexttokenA use context assigned to the charge item definition(ChargeItemDefinition.useContext.value as CodeableConcept)
context-quantityquantityA quantity- or range-valued use context assigned to the charge item definition(ChargeItemDefinition.useContext.value as Quantity) | (ChargeItemDefinition.useContext.value as Range)
context-typetokenA type of use context assigned to the charge item definitionChargeItemDefinition.useContext.code
context-type-quantitycompositeA use context type and quantity- or range-based value assigned to the charge item definitionOn ChargeItemDefinition.useContext:
  context-type: code
  context-quantity: value.as(Quantity) | value.as(Range)
context-type-valuecompositeA use context type and value assigned to the charge item definitionOn ChargeItemDefinition.useContext:
  context-type: code
  context: value.as(CodeableConcept)
datedateThe charge item definition publication dateChargeItemDefinition.date
descriptionstringThe description of the charge item definitionChargeItemDefinition.description
effectivedateThe time during which the charge item definition is intended to be in useChargeItemDefinition.effectivePeriod
identifiertokenExternal identifier for the charge item definitionChargeItemDefinition.identifier
jurisdictiontokenIntended jurisdiction for the charge item definitionChargeItemDefinition.jurisdiction
publisherstringName of the publisher of the charge item definitionChargeItemDefinition.publisher
statustokenThe current status of the charge item definitionChargeItemDefinition.status
titlestringThe human-friendly name of the charge item definitionChargeItemDefinition.title
urluriThe uri that identifies the charge item definitionChargeItemDefinition.url
versiontokenThe business version of the charge item definitionChargeItemDefinition.version