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  1. FHIR Specification Feedback
  2. FHIR-35259

AEOB item.ProductOrService can't be required for inpatient EOB

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    • Icon: Change Request Change Request
    • Resolution: Persuasive with Modification
    • Icon: Highest Highest
    • US Da Vinci Patient Cost Transparency (PCT) (FHIR)
    • 0.1.0 [deprecated]
    • Financial Mgmt
    • STU
    • PCT AEOB Bundle
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      Add a VS to include all codes from AMA CPT, CMS HCPCS, CMS HIPPS, and a DAR of Not Applicable.
      Proposed VS Name: USClaim-Medical-ProductOrService-Codes

      This value set should include codes based on the following rules:
      Include all codes defined in http://www.ama-assn.org/go/cpt
      Include all codes defined in http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets
      Include all codes defined in https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ProspMedicareFeeSvcPmtGen/HIPPSCodes
      Include these codes as defined in http://terminology.hl7.org/CodeSystem/data-absent-reason
      Code Display Definition
      not-applicable Not Applicable There is no proper value for this element (e.g. last menstrual period for a male).

      Bind this ValueSet to the davinci-pct-aeob profile ExplanationOfBenefit.item.productOrService

      This ValueSet will be used as the binding for the AEOB ExplanationOfBenefit.item.productOrService (required)

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      Add a VS to include all codes from AMA CPT, CMS HCPCS, CMS HIPPS, and a DAR of Not Applicable. Proposed VS Name: USClaim-Medical-ProductOrService-Codes This value set should include codes based on the following rules: Include all codes defined in  http://www.ama-assn.org/go/cpt Include all codes defined in  http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets Include all codes defined in  https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ProspMedicareFeeSvcPmtGen/HIPPSCodes Include these codes as defined in  http://terminology.hl7.org/CodeSystem/data-absent-reason Code Display Definition not-applicable Not Applicable There is no proper value for this element (e.g. last menstrual period for a male). Bind this ValueSet to the davinci-pct-aeob profile ExplanationOfBenefit.item.productOrService This ValueSet will be used as the binding for the AEOB ExplanationOfBenefit.item.productOrService (required)
    • Rick Geimer/Mark Scrimshire: 11-0-0
    • Enhancement
    • Compatible, substantive
    • Yes

    Description

      EoB.item is required as is EoB.item.ProductOrService, however for inpatient encounters there may not be a productOrService code that is pertinent (the service is specified through a revenue code). 

      Add a DAR not-applicable code to the productOrService code with an invariant that allows it only if the EOB.subtype is inpatient (as was done in CARIN BB).

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            rgeimer Rick Geimer
            corey_spears Corey Spears
            Corey Spears
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            Dates

              Created:
              Updated:
              Resolved: