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.

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.

An Extension

Indian GST goods (HSN) or services (SAC) classification code for a billing item or charge line.

Default GST rate class for a billing item (nil, exempt, or standard slabs).

Operational billing category for catalog items (consultation, lab, bed-day, etc.).

Department attribution for a charge (HealthcareService or Location org-unit).

Reference to the schedule-of-charges version used to price a ChargeItem or catalog entry.

Line-level GST tax breakdown for audit (taxable value, CGST/SGST or IGST, rate, HSN/SAC).

Accommodation class on a rate row, payer contract, package, or posted charge. Occupied class on a Location is Location.type with this CodeSystem, not this extension.

Integer generation of the rate schedule that priced this ChargeItem. Absent when the price came from the ChargeItemDefinition projection rather than the rate store.

Integer generation of the payer contract that priced this line, or the published generation on the Contract header.

seq of the winning contract_discount_rule when a discount-matrix row priced the line rather than a negotiated rate row.

Human-readable why-this-price, from the shared matcher plus entitlement.

Per-unit professional component of the charged price, snapshotted onto the ChargeItem. A payout share is taken of this figure; it is not a practitioner contract. Dropped when a biller overrides the unit price.

Per-unit facility component of the charged price, snapshotted onto the ChargeItem.

How the unit price was derived (contract row, discounted SOR, package, cash, …).

Who pays for the resolved line (payer or patient).

Payer-claimable amount on the line after discounts and entitlement. Cash/self-pay is 0.

Nested deduction basis on every ChargeItem affected by entitlement or a room-rent cap, so the claim and the patient bill can each explain themselves. Nested urls match HIS (policy, actualBedRate, …).

True when this ChargeItem was absorbed by a package case.

Winning package_inclusion.seq on a posted ChargeItem.

Allocator outcome on the line (included, overflow-chargeable, …).

Pending or decided package exception (unclassifiable / bucket breach / pre-auth). Nested urls match HIS (status, kind, reason, decision, decidedBy, decidedAt).

One manual adjustment, carrying the quantity, price and reason it replaced. Repeats because overrideReason holds only the latest edit.

Why and when a ChargeItem was voided (status aborted). A void is not an adjustment: amounts stay as they were.

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.

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.

References the (external) source of pricing information, rules of application for the code this ChargeItem uses.

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.

Codes identifying the lifecycle stage of a ChargeItem.

A code that identifies the charge, like a billing code.

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.

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.

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.

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.

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.

The individual or set of individuals the action is being or was performed on.

Links the event to the Patient context.

The encounter or episode of care that establishes the context for this event.

Links the request to the Encounter context.

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.

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.

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.

The device, practitioner, etc. who performed or participated in the service.

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.

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).

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 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.

Identifies the device, food, drug or other product being charged either by type code or reference to an instance.

Example binding for product type.

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.

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.

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.

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).

A human language.

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.

An Extension

Indian GST goods (HSN) or services (SAC) classification code for a billing item or charge line.

Default GST rate class for a billing item (nil, exempt, or standard slabs).

Operational billing category for catalog items (consultation, lab, bed-day, etc.).

Department attribution for a charge (HealthcareService or Location org-unit).

Reference to the schedule-of-charges version used to price a ChargeItem or catalog entry.

Line-level GST tax breakdown for audit (taxable value, CGST/SGST or IGST, rate, HSN/SAC).

Accommodation class on a rate row, payer contract, package, or posted charge. Occupied class on a Location is Location.type with this CodeSystem, not this extension.

Integer generation of the rate schedule that priced this ChargeItem. Absent when the price came from the ChargeItemDefinition projection rather than the rate store.

Integer generation of the payer contract that priced this line, or the published generation on the Contract header.

seq of the winning contract_discount_rule when a discount-matrix row priced the line rather than a negotiated rate row.

Human-readable why-this-price, from the shared matcher plus entitlement.

Per-unit professional component of the charged price, snapshotted onto the ChargeItem. A payout share is taken of this figure; it is not a practitioner contract. Dropped when a biller overrides the unit price.

Per-unit facility component of the charged price, snapshotted onto the ChargeItem.

How the unit price was derived (contract row, discounted SOR, package, cash, …).

Who pays for the resolved line (payer or patient).

Payer-claimable amount on the line after discounts and entitlement. Cash/self-pay is 0.

Nested deduction basis on every ChargeItem affected by entitlement or a room-rent cap, so the claim and the patient bill can each explain themselves. Nested urls match HIS (policy, actualBedRate, …).

True when this ChargeItem was absorbed by a package case.

Winning package_inclusion.seq on a posted ChargeItem.

Allocator outcome on the line (included, overflow-chargeable, …).

Pending or decided package exception (unclassifiable / bucket breach / pre-auth). Nested urls match HIS (status, kind, reason, decision, decidedBy, decidedAt).

One manual adjustment, carrying the quantity, price and reason it replaced. Repeats because overrideReason holds only the latest edit.

Why and when a ChargeItem was voided (status aborted). A void is not an adjustment: amounts stay as they were.

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.

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.

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.

References the (external) source of pricing information, rules of application for the code this ChargeItem uses.

References the source of pricing information, rules of application for the code this ChargeItem uses.

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.

Codes identifying the lifecycle stage of a ChargeItem.

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.

A code that identifies the charge, like a billing code.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

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.

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.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

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.

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.

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.

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.

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.

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.

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.

The individual or set of individuals the action is being or was performed on.

Links the event to the Patient context.

The encounter or episode of care that establishes the context for this event.

Links the request to the Encounter context.

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.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

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.

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.

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.

Describes the type of performance or participation(e.g. primary surgeon, anesthesiologiest, etc.).

Codes describing the types of functional roles performers can take on when performing events.

The device, practitioner, etc. who performed or participated in the service.

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.

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).

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 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.

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. 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.

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.

Date the charge item was entered.

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.

Example binding for reason.

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.

Example binding for product type.

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.

Further information supporting this charge.