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  1. FHIR Specification Feedback
  2. FHIR-33144

Procedure code shouldn't reference eob.item.productOrService

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    • Icon: Change Request Change Request
    • Resolution: Persuasive with Modification
    • Icon: Medium Medium
    • US Da Vinci PDex (FHIR)
    • current
    • Financial Mgmt
    • PdexServerCapabilityStatement [deprecated]
    • (NA)
    • 4.3.26.0.1
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      A note was added to the Health Plan Mapping Assistance section:

      "Note: Procedure records should only be created from ExplanationOfBenefit or CPCDS resources for items that are clinical procedures. Medications, facility charges and supplies should not be created as Procedure records."

       

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      A note was added to the Health Plan Mapping Assistance section: "Note: Procedure records should only be created from ExplanationOfBenefit or CPCDS resources for items that are clinical procedures. Medications, facility charges and supplies should not be created as Procedure records."  
    • Bob Dieterle / Chris Johnson: 12-0-1
    • Clarification
    • Non-substantive
    • Yes
    • 1.0.0

    Description

      Procedure resources are supposed to be clinical procedures.

      Procedure.code S 1..1   [{“24, 26, 146”:”ICD Procedure Code”}, {“40”:”Procedure Code - CPT / HCPCS”}

       

      According the CPCDS mapping, you can generate Procedure from element 40. However element 40 is not limited to clinical procedures. It could be a med, a med administration, room and board, supplies, encounter...

       

       

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            dventon Daniel Venton
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              Updated:
              Resolved: