- Ya
- 25 Agosti 2026, 14:59 UTC
- Mwandishi
- Kamo
- Ahadi ya
- 2c45179
The entity everything clinical hangs off — a note, an order, a diagnosis and a charge all point at the encounter they arose in. Planned and actual times are separate column pairs, which is both a forward-compatibility decision and just true. R4 gives an Encounter a single period; R5 and R6 split planned from actual, so modelling one now would mean rewriting every encounter row and every scheduling query when that lands. It is also how a practice measures its own lateness — the gap between what was booked and what happened is exactly the thing collapsing them discards. classCode is stored as a plain code plus its system rather than an embedded Coding, because R4 types it as a Coding and R6 changes it; columns survive both. It is not cosmetic either: it drives the place-of-service code on the claim, and a telehealth visit billed as in-person is a false claim. reason is kept apart from the diagnosis. What the patient said and what the clinician concluded are different facts, and a chart that conflates them loses the presenting complaint entirely. EncounterParticipant is a child table because the supervision case cannot be flattened: the billing provider on a claim is computed from the supervision record rather than typed by a biller, and under incident-to rules the role decides whether the visit is billable at all. physicallyPresent is its own field because a supervising physician may be available without being in the room, and inferring presence from the role would silently assert something about a claim nobody checked. EncounterDiagnosis.rank is load-bearing and looks cosmetic. Service lines on a professional claim point at diagnoses BY POSITION — the pointer is an index, not a code — so a stored order that does not match the submitted order misdirects every line, and the claim is either denied or paid against a condition the patient does not have. addressedAtEncounter exists because not every listed diagnosis was actually evaluated, and the E/M level is computed from the ones that were; counting mere presence inflates it. Encounters are never deleted — one created in error becomes entered-in-error and stays, because orders, notes and charges already reference it and a dangling reference is worse than a visibly wrong record. 1651 tests green.