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  1. FHIR Specification Feedback
  2. FHIR-36406

PAS Procedure Resource needs to support modifier codes

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    • Icon: Change Request Change Request
    • Resolution: Not Persuasive
    • Icon: Medium Medium
    • US Da Vinci PAS (FHIR)
    • 1.2.0-ballot [deprecated]
    • Financial Mgmt
    • Formal Specification
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      We don't profile Claim.procedure at all (it is not marked as Must Support).  To indicate the procedures being requested, we use the item.productOrService code or, if more details are needed, in the requestedService extension.ServiceRequest.

      HCPCS/CPT modifiers would be found in Claim.item.modifier

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      We don't profile Claim.procedure at all (it is not marked as Must Support).  To indicate the procedures being requested, we use the item.productOrService code or, if more details are needed, in the requestedService extension.ServiceRequest. HCPCS/CPT modifiers would be found in Claim.item.modifier
    • Bob Dieterle / Jeff Brown : 9-0-1

    Description

      as/2022May/StructureDefinition-profile-claim-definitions.html#Claim.procedure.procedure[x] has 2 possible data types, CodableConcept and Resource(Procedure). The Procedure Resource at http://hl7.org/fhir/R4/procedure.html doesn’t seem to allow for procedure modifier codes. These are used today in some Prior Authorization workflows, including common cases such as knee/hip replacements where left/right indicators are required. 

       

      Also, most PA workflows authorize based on CPT/HCPCS codes, and it’s unclear if the  Procedure resource permits codesets other than SNOMED. 

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            chris_cioffi Chris Cioffi
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