Procedure

Procedure is a FHIR resource that represents an action that is or was performed on or for a patient. This can be a physical intervention like a surgery or operation, or less invasive like counseling, physiotherapy, or diagnostic procedures.

Procedure resources document what was done, when it was done, who performed it, and how it was coded. They are essential for understanding a patient's surgical and procedural history, tracking care delivery, and supporting utilization management and quality measurement workflows.

Procedure data is available from health insurers (derived from claims), medical record systems (from provider EHRs), and nationwide exchanges (via TEFCA). Procedures are coded with CPT, HCPCS, ICD-10-PCS, and SNOMED CT code systems.

Flexpa makes procedure data available as FHIR resources conforming to the US Core STU 6.1 Procedure Profile to support communicating USCDI v3 data. Data types used in this reference are defined in the FHIR R4 Data Types specification.

FHIR API

https://api.flexpa.com/fhir/Procedure

New to FHIR?

Intro to FHIR

FHIR, or Fast Healthcare Interoperability Resources, is a standard for exchanging healthcare information electronically

Read introduction →

Claims to Clinical

Flexpa generates US Core Encounter, Condition, and Procedure resources from ExplanationOfBenefit claims data

View Claims to Clinical →

#Schema

The FHIR R4 Procedure resource represents an activity performed on, with, or for a patient as part of the provision of care. The US Core Procedure Profile constrains this resource to ensure consistent representation across US healthcare systems.

Procedures are structured around the core question of what was done, when it was performed, who performed it, and why. The code element is the central data point, representing the specific procedure using standard medical coding systems.

Elements

metaMeta: Metadata about the resource. See also Tags defined by Flexpa.
lastUpdatedinstant: The last time the procedure was updated in the Endpoint's system of record
statuscode: The status of the procedure; Codes
preparation
The core event has not started yet, but some staging activities have begun
in-progress
The event is currently occurring
not-done
The event was terminated prior to any activity beyond preparation
on-hold
The event has been temporarily stopped but is expected to resume
stopped
The event was terminated prior to the full completion of the intended actions
completed
The event has now concluded
entered-in-error
The event was entered in error and voided
unknown
The authoring/source system does not know which of the status values currently applies
codeCodeableConcept: The specific procedure performed. Bound to the US Core Procedure Codes value set (extensible), which includes CPT, HCPCS, SNOMED CT, and ICD-10-PCS codes.; Systemhttp://www.ama-assn.org/go/cpt
Current Procedural Terminology (CPT) codes maintained by the AMA - the most common procedure coding system in professional and outpatient claims
Example Codes
99213
Office or other outpatient visit, established patient, low complexity
27447
Arthroplasty, knee, condyle and plateau
36415
Collection of venous blood by venipuncture; Systemhttps://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets
Level II HCPCS codes represent items, supplies, and services not covered by CPT codes
Example Codes
G0438
Annual wellness visit, initial visit
A0425
Ground mileage, per statute mile; Systemhttp://snomed.info/sct
SNOMED CT procedure codes provide a clinical terminology for procedures
Example Codes
80146002
Appendectomy
73761001
Colonoscopy; Systemhttp://www.cms.gov/Medicare/Coding/ICD10
ICD-10-PCS (Procedure Coding System) codes - used primarily for inpatient procedures
Example Codes
0SRD0JZ
Replacement of Left Knee Joint with Synthetic Substitute, Open Approach
0DT70ZZ
Resection of duodenum, open approach
subjectReference(Patient): Reference to the Patient on whom the procedure was performed
encounterReference(Encounter): Reference to the Encounter during which the procedure was performed
performedDateTimedateTime: When the procedure was performed as a single point in time - mutually exclusive with performedPeriod
performedPeriodPeriod: When the procedure was performed as a time range - mutually exclusive with performedDateTime
startdateTime: Starting time of the procedure
enddateTime: End time of the procedure
performerBackboneElement[]: The people who performed the procedure
functionCodeableConcept: The type of involvement of the performer in the procedure; Systemhttp://snomed.info/sct
SNOMED CT performer function codes
Example Codes
304292004
Surgeon
405279007
Primary surgeon
actorReference(Practitioner|PractitionerRole|Organization): The practitioner who was involved in the procedure
onBehalfOfReference(Organization): Organization the performer was acting for
reasonCodeCodeableConcept[]: Coded reason why the procedure was performed; Systemhttp://hl7.org/fhir/sid/icd-10-cm
ICD-10-CM codes used as procedure reasons
Example Codes
M17.12
Unilateral primary osteoarthritis, left knee; Systemhttp://snomed.info/sct
SNOMED CT reason codes
Example Codes
301011002
Foot pain
reasonReferenceReference(Condition|Observation|Procedure|DiagnosticReport)[]: Reference to the justification for the procedure, such as a Condition that was being treated
bodySiteCodeableConcept[]: Target body sites for the procedure; Systemhttp://snomed.info/sct
SNOMED CT body site codes
Example Codes
72696002
Knee region structure

Procedure Example

{
  "resourceType": "Procedure",
  "id": "3255ee92-6ac7-6bca-9c11-e9ba988bb239",
  "meta": {
    "lastUpdated": "2024-03-15T10:30:00Z",
    "profile": [
      "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure"
    ]
  },
  "status": "completed",
  "code": {
    "coding": [
      {
        "system": "http://www.ama-assn.org/go/cpt",
        "code": "27447",
        "display": "Arthroplasty, knee, condyle and plateau"
      }
    ],
    "text": "Total knee replacement"
  },
  "subject": {
    "reference": "Patient/example"
  },
  "encounter": {
    "reference": "Encounter/example"
  },
  "performedDateTime": "2024-01-15",
  "performer": [
    {
      "function": {
        "coding": [
          {
            "system": "http://snomed.info/sct",
            "code": "304292004",
            "display": "Surgeon"
          }
        ]
      },
      "actor": {
        "identifier": {
          "system": "http://hl7.org/fhir/sid/us-npi",
          "value": "1234567890"
        },
        "display": "Dr. Robert Johnson, MD"
      }
    }
  ],
  "reasonCode": [
    {
      "coding": [
        {
          "system": "http://hl7.org/fhir/sid/icd-10-cm",
          "code": "M17.12",
          "display": "Unilateral primary osteoarthritis, left knee"
        }
      ]
    }
  ],
  "bodySite": [
    {
      "coding": [
        {
          "system": "http://snomed.info/sct",
          "code": "72696002",
          "display": "Knee region structure"
        }
      ]
    }
  ]
}

#Example FHIRPaths

Data Point	FHIRPath Expression
Procedure CPT codes	`code.coding.where(system = 'http://www.ama-assn.org/go/cpt')`
Procedure HCPCS codes	`code.coding.where(system = 'https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets')`
Procedure ICD-10-PCS codes	`code.coding.where(system = 'http://www.cms.gov/Medicare/Coding/ICD10')`
All procedure codes	`code.coding`
Procedure date (with fallback)	`(performedDateTime \| performedPeriod.start \| performedPeriod.end).first()`
Performer NPI	`performer.actor.identifier.where(system = 'http://hl7.org/fhir/sid/us-npi')`
Reason codes (ICD-10-CM)	`reasonCode.coding.where(system = 'http://hl7.org/fhir/sid/icd-10-cm')`
Body site	`bodySite.coding`

#API

GEThttps://api.flexpa.com/fhir/Procedure/:id

#Read

A read is the most basic operation in FHIR. It allows you to retrieve the current version of a single resource by its ID.

For a full list of available Resources, please refer to the FHIR Resources documentation.

Request headers

AuthorizationstringRequired: An Authorization: Bearer header value must presented with a Patient Access Token or an Application Access Token

Request path parameters

identifierstring: The identifier of the resource to be retrieved - used in the last part of the URL path segment

Error codes

transient429 status code: The API is expected to return a 429 status code until the data is ready to be retrieved. This error is returned by the API while in the initial sync period, which typically lasts less than 1 minute.; You will need to implement retry logic to handle this error. If you are using the Node SDK which we demonstrate in our Quickstart guide, retry logic is already built in and you don't need to implement it yourself.
processing422 status code: The API is expected to return a 422 when Flexpa fails to synchronize any resources from the Endpoint for the requested Patient. Please re-authorize or reach out to support.

Request

GET

/fhir/Procedure/:id

ACCESS_TOKEN=flexpa-link-access-token

curl https://api.flexpa.com/fhir/Procedure/3255ee92-6ac7-6bca-9c11-e9ba988bb239 \
  -H "Authorization: Bearer $ACCESS_TOKEN"

GEThttps://api.flexpa.com/fhir/Procedure

#Search

Searches on Flexpa API follow the RESTful style of the FHIR specification by submitting a GET HTTP request to the base URL of the resource with parameters to define the exact search criteria to filter the response.

Request headers

AuthorizationstringRequired: An Authorization: Bearer header value must presented with a Patient Access Token or an Application Access Token

Search parameters

_idtoken: The logical ID of the resource
patientreference: Search by subject - a patient
datedate: When the procedure was performed
codetoken: A code to identify a procedure
statustoken: Current status of the procedure
identifiertoken: A unique identifier for a procedure
encounterreference: Encounter created as part of
performerreference: The reference to the practitioner
reason-codetoken: Coded reason procedure performed
reason-referencereference: The justification that the procedure was performed

Error codes

transient429 status code: The API is expected to return a 429 status code until the data is ready to be retrieved. This error is returned by the API while in the initial sync period, which typically lasts less than 1 minute.; You will need to implement retry logic to handle this error. If you are using the Node SDK which we demonstrate in our Quickstart guide, retry logic is already built in and you don't need to implement it yourself.
processing422 status code: The API is expected to return a 422 when Flexpa fails to synchronize any resources from the Endpoint for the requested Patient. Please re-authorize or reach out to support.

Request

GET

/fhir/Procedure

ACCESS_TOKEN=flexpa-link-access-token

curl https://api.flexpa.com/fhir/Procedure \
  -H "Authorization: Bearer $ACCESS_TOKEN"

FHIR API

New to FHIR?

Intro to FHIR

Related

Claims to Clinical

Elements

Procedure Example

Request headers

Request path parameters

Error codes

Request

Request headers

Search parameters

Error codes

Request