Charge Item

A Charge Item is the actual instance of billing for a specific service or product provided to a patient. It references a Charge Item Definition (i.e., the priced “catalog entry”) to derive the cost, plus actual usage details (quantity, date, any overrides). Each Charge Item links to a specific Account (which accumulates charges for a patient or episode of care) and often to an Encounter (the clinical context).

For example, if a nurse administers 2 doses of an expensive medication, the system may create a Charge Item for “Medication: XYZ” with quantity=2, referencing the relevant charge definition for medication pricing. Once a Charge Item is billable, it can appear on an Invoice.

Schema Definition

{
  "id": "<str>",                      // Internal Identifier
  "definition": "<id|fk>",            // Definition pointing to Charge Definition
  "status": "<string>",               // planned | billable | not-billable | aborted | billed | entered-in-error | unknown
  "code": "<code>",                   // A code that identifies the charge, like a billing code
  "patient": "<id|fk>",               // Patient Associated with the charge
  "encounter": "<id|fk>",             // Encounter associated with this ChargeItem
  "facility": "<id|fk>",              // Facility where this Charge Item is created
  "quantity": "<float>",              // Quantity of which the charge item has been serviced
  "unitPriceComponent": [
    "MonetaryComponent"               // Unit price components
  ],
  "totalPriceComponent": [
    "MonetaryComponent"               // Total price components
  ],
  "total_price": {                    // Total Price in Amount
    "Money"
  },
  "overrideReason": {                 // Reason for overriding the list price/factor
    "text": "",
    "code": "<code>"
  },
  "service": {                        // Why was the charged service rendered?
    "resource": "<resource>",
    "id": "id"
  },
  "account": "<id|fk>",               // Account to place this charge
  "note": "<markdown>",               // Comments made about the ChargeItem
  "supportingInformation": [
    { "Reference(Any)" }              // Further information supporting this charge
  ]
}

Core Data Structure

Essential Fields

Field	Description	Technical Notes
id	Internal system identifier	Primary key, auto-generated
definition	Reference to the Charge Item Definition	Links to the catalog entry for this service/item
status	Current state in the billing lifecycle	Controls whether the item can be invoiced
code	Billing code for the service	Often derived from the definition
patient	Reference to the patient	Person receiving the service
encounter	Reference to the healthcare encounter	Links to the clinical context
facility	Reference to the healthcare facility	Location where service was provided
quantity	Number of units provided	Default is 1 for most services
unitPriceComponent	Price breakdown per unit	Includes base, surcharges, discounts, taxes
totalPriceComponent	Price breakdown for all units	Unit price × quantity with all components
total_price	Final calculated amount	Sum of all price components
account	Reference to the billing account	Where this charge accumulates

Status Lifecycle

Status Value	Description	System Behavior
planned	Service is scheduled but not yet provided	Not counted in account balance; not billable
billable	Service provided and ready to bill	Included in account balance; can be invoiced
not-billable	Service provided but won't be billed	Not included in account balance; excluded from invoices
aborted	Service was not completed	Not included in account balance; excluded from invoices
billed	Charge included on an invoice	Included in account balance; cannot be invoiced again
entered-in-error	Charge was created by mistake	Excluded from all calculations and invoices

User Workflows

Editing or Canceling a Charge

If a charge is still billable (and not on an issued invoice), staff can adjust quantity, override price, or mark it not-billable.
If it is billed (already invoiced), any correction typically requires reversing that invoice or adding a credit note.
Marking entered-in-error will remove it from the account’s balance. Log who performed this action.

Automatic Charge Creation

The system will automatically create charges when certain clinical events occur (e.g., lab test result posted). Staff can still review them before they become “billable.”

Schema Definition​

Core Data Structure​

Essential Fields​

Status Lifecycle​

User Workflows​

Editing or Canceling a Charge​

Automatic Charge Creation​