Stream: CARIN IG for Blue Button®
Topic: Inpatient EOB .item requires .productOrService (CPT4, HCPCS)
Daniel Venton (Feb 12 2021 at 20:57):
The IG:
... item S 0..* BackboneElement Product or service provided
...
.... productOrService S 1..1 CodeableConcept Billing, service, product, or drug code
Binding: Current Procedural Terminology (CPT) - Healthcare Common Procedure Coding System (HCPCS) level II alphanumeric codes - Procedure Codes (required)
My coworkers in the insurance business state the for inpatient claims each line item does not require a CPT4 or HCPCS code, that they can be billed with a revenue code. @Pat Taylor Thoughts?
Corey Spears (Feb 15 2021 at 17:27):
Hi @Daniel Venton , Your coworkers are correct. This was identified as an issue in STU1. Unfortunately that cardinality (of 1..1) is set by the base Resource in FHIR R4.
For the upcoming technical correction to STU1, we will be adding the Data Absent Reason "not-applicable" code to the ValueSet specifically for Inpatient Institutional.
See: https://jira.hl7.org/browse/FHIR-30357
In the future, a request has been made to the HL7 Financial Management Workgroup, which manages the ExplanationOfBenefit resource, to relax the cardinality to 0..1 for FHIR R5.
See: https://jira.hl7.org/browse/FHIR-30333
Last updated: Apr 12 2022 at 19:14 UTC
