ChargeItem

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.

Schema

Elements

Name	Required	Type	Description
identifier		Identifier[]	Business Identifier for item Details Identifiers assigned to this event performer or other systems.
definitionUri		uri[]	Defining information about the code of this charge item Details References the (external) source of pricing information, rules of application for the code this ChargeItem uses.
definitionCanonical		canonical[]	Resource defining the code of this ChargeItem Details References the source of pricing information, rules of application for the code this ChargeItem uses.
status	✓	code	planned | billable | not-billable | aborted | billed | entered-in-error | unknown Details The current state of the ChargeItem. 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.
partOf		Reference<ChargeItem>[]	Part of referenced ChargeItem Details ChargeItems can be grouped to larger ChargeItems covering the whole set.
code	✓	CodeableConcept	A code that identifies the charge, like a billing code Details A code that identifies the charge, like a billing code.
subject	✓	Reference<Patient | Group>	Individual service was done for/to Details The individual or set of individuals the action is being or was performed on.
context		Reference<Encounter | EpisodeOfCare>	Encounter / Episode associated with event Details The encounter or episode of care that establishes the context for this event.
occurrence[x]		dateTime, Period, Timing	When the charged service was applied Details 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.
performer		ChargeItemPerformer[]	Who performed charged service Details Indicates who or what performed or participated in the charged service.
id		string	Unique id for inter-element referencing Details Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
extension		Extension[]	Additional content defined by implementations Details 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.
modifierExtension		Extension[]	Extensions that cannot be ignored even if unrecognized Details 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). 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.
function		CodeableConcept	What type of performance was done Details Describes the type of performance or participation(e.g. primary surgeon, anesthesiologiest, etc.).
actor	✓	Reference< Practitioner | PractitionerRole | Organization | CareTeam | Patient | Device | RelatedPerson >	Individual who was performing Details The device, practitioner, etc. who performed or participated in the service.
performingOrganization		Reference<Organization>	Organization providing the charged service Details 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.
requestingOrganization		Reference<Organization>	Organization requesting the charged service Details 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).
costCenter		Reference<Organization>	Organization that has ownership of the (potential, future) revenue Details 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.
quantity		Quantity	Quantity of which the charge item has been serviced Details 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.
bodysite		CodeableConcept[]	Anatomical location, if relevant Details 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](extension-bodysite.html). May be a summary code, or a reference to a very precise definition of the location, or both.
factorOverride		decimal	Factor overriding the associated rules Details 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.
priceOverride		Money	Price overriding the associated rules Details 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.
overrideReason		string	Reason for overriding the list price/factor Details 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.
enterer		Reference< Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson >	Individual who was entering Details The device, practitioner, etc. who entered the charge item. The enterer is also the person considered responsible for factor/price overrides if applicable.
enteredDate		dateTime	Date the charge item was entered Details Date the charge item was entered. The actual date when the service associated with the charge has been rendered is captured in occurrence[x].
reason		CodeableConcept[]	Why was the charged service rendered? Details 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.
service		Reference< DiagnosticReport | ImagingStudy | Immunization | MedicationAdministration | MedicationDispense | Observation | Procedure | SupplyDelivery >[]	Which rendered service is being charged? Details Indicated the rendered service that caused this charge.
product[x]		Reference< Device | Medication | Substance >, CodeableConcept	Product charged Details Identifies the device, food, drug or other product being charged either by type code or reference to an instance.
account		Reference<Account>[]	Account to place this charge Details 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.
note		Annotation[]	Comments made about the ChargeItem Details Comments made about the event by the performer, subject or other participants.
supportingInformation		Reference<Resource>[]	Further information supporting this charge Details Further information supporting this charge.

Search Parameters

Name	Type	Description	Expression
account	reference	Account to place this charge	ChargeItem.account
code	token	A code that identifies the charge, like a billing code	ChargeItem.code
context	reference	Encounter / Episode associated with event	ChargeItem.context
entered-date	date	Date the charge item was entered	ChargeItem.enteredDate
enterer	reference	Individual who was entering	ChargeItem.enterer
factor-override	number	Factor overriding the associated rules	ChargeItem.factorOverride
identifier	token	Business Identifier for item	ChargeItem.identifier
occurrence	date	When the charged service was applied	ChargeItem.occurrence
patient	reference	Individual service was done for/to	ChargeItem.subject.where(resolve() is Patient)
performer-actor	reference	Individual who was performing	ChargeItem.performer.actor
performer-function	token	What type of performance was done	ChargeItem.performer.function
performing-organization	reference	Organization providing the charged service	ChargeItem.performingOrganization
price-override	quantity	Price overriding the associated rules	ChargeItem.priceOverride
quantity	quantity	Quantity of which the charge item has been serviced	ChargeItem.quantity
requesting-organization	reference	Organization requesting the charged service	ChargeItem.requestingOrganization
service	reference	Which rendered service is being charged?	ChargeItem.service
subject	reference	Individual service was done for/to	ChargeItem.subject

Inherited Elements

Name	Required	Type	Description
id		string	Logical id of this artifact Details 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.
meta		Meta	Metadata about the resource Details 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.
implicitRules		uri	A set of rules under which this content was created Details 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.
language		code	Language of the resource content Details 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		Narrative	Text summary of the resource, for human interpretation Details 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.
contained		Resource[]	Contained, inline Resources Details 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.
extension		Extension[]	Additional content defined by implementations Details May be used to represent additional information that is not part of the basic definition of the resource. 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.
modifierExtension		Extension[]	Extensions that cannot be ignored Details 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). 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.

Usage

Tracking Financial information is vital in Patient Administration and Finance systems in most Healthcare Organizations. The resource ChargeItem describes the charge for provision of healthcare provider products for a certain patient, therefore referring not only to the product, but containing in addition details of the provision, like date, time, amounts and participating organizations and persons. Main Usage of the ChargeItem is to enable the billing process and internal cost allocation. They are created as soon as the products are planned or provisioned, references to Encounters and/or Accounts can be maintained in a later process step.

The target of ChargeItem.definition may provide information on the Charge code such as pricing and inclusion/exclusion rules as well as factors that apply under certain conditions. In many cases however this information may have been drawn from sources outside of FHIR depending on the distribution format of the code catalogue. The ChargeItem assumes that such information is either implicitly known by the communicating systems or explicitly shared through the ChargeItem.definition. Therefore explicit pricing information is not shared within the ChargeItem resource. Also, the systems posting the ChargeItems are not expected to apply the rules associated with the charge codes as they may not know the whole context of the patient/encounter to evaluate such rules. It lies within the responsibility of a billing engine, to collect the ChargeItems in the context of an Account or Encounter at a certain point in time (e.g. discharge of the patient) and to evaluate the associated rules resulting in some of the ChargeItems to be set to the status "not billable" in case the rules exclude them from being billed, or to create financial transactions according to base price and factors. Additional references to Encounter/EpisodeOfCare, Patient/Group and Services provide further context to help billing systems determine the appropriate account and establish the clinical/financial context to evaluate the rules associated with the charge codes.

Relationships

This resource is not an actual financial transaction (such as an item on an invoice or any concise monetary amount being transferred from one Account to another) but is the base administrative data that may be used by a billing engine to create the financial transactions based on rules, factors and base prices associated with the charge code.

Unlike the Financial Transaction the ChargeItem primarily describes the provision, whereas the Financial Transaction documents cash flow. Therefore, the Financial Transaction results from ChargeItems created via the subsequent billing- or cost allocation process.

The actual financial transaction resulting from the evaluation of these rules against the clinical and financial context may be represented in formats appropriate to the financial realm. These are considered out of scope for the FHIR Standard, as they are not specific to the healthcare domain. The FHIR Claim resource does contain line items, and this ChargeItem resource provides the source material for the billing engine to create the items on the claim (which may be different due to business rules).

Referenced By

• Invoice