ParticipationFunction

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Lvl- Typ	Concept Code Head Code-defined Value Set	Print Name	Definition, Properties, Relationships
ParticipationFunction [2.16.840.1.113883.5.88] Description: This code is used to specify the exact function an actor had in a service in all necessary detail. This domain may include local extensions (CWE).
0-L	ADMPHYS	admitting physician	Definition: A physician who admitted a patient to a hospital or other care unit that is the context of this service.
0-L	ANEST	anesthesist	Definition: In a typical anesthesia setting an anesthesiologist or anesthesia resident in charge of the anesthesia and life support, but only a witness to the surgical procedure itself. To clarify responsibilities anesthesia should always be represented as a separate service related to the surgery.
0-L	ANRS	anesthesia nurse	Definition: In a typical anesthesia setting the nurse principally assisting the anesthesiologist during the critical periods.
0-L	ATTPHYS	attending physician	Definition: A physician who is primarily responsible for a patient during the hospitalization, which is the context of the service.
0-L	DISPHYS	discharging physician	Definition: A physician who discharged a patient from a hospital or other care unit that is the context of this service.
0-L	FASST	first assistant surgeon	Definition: In a typical surgery setting the assistant facing the primary surgeon. The first assistant performs parts of the operation and assists in others (e.g., incision, approach, electrocoutering, ligatures, sutures).
0-L	MDWF	midwife	Definition: A person (usually female) helping a woman deliver a baby. Responsibilities vary locally, ranging from a mere optional assistant to a full required participant, responsible for (normal) births and pre- and post-natal care for both mother and baby.
0-L	NASST	nurse assistant	Definition: In a typical surgery setting the non-sterile nurse handles material supply from the stock, forwards specimen to pathology, and helps with other non-sterile tasks (e.g., phone calls, etc.).
0-L	PCP	primary care physician	Definition: The healthcare provider that holds primary responsibility for the overall care of a patient.
0-L	PRISURG	primary surgeon	Definition: In a typical surgery setting the primary performing surgeon.
0-L	RNDPHYS	rounding physician	Definition: A physician who made rounds on a patient in a hospital or other care center.
0-L	SASST	second assistant surgeon	Definition: In a typical surgery setting the assistant who primarily holds the hooks.
0-L	SNRS	scrub nurse	Definition: In a typical surgery setting the nurse in charge of the instrumentation.
0-L	TASST	third assistant	Definition: In a typical surgery setting there is rarely a third assistant (e.g., in some Hip operations the third assistant postures the affected leg).
0-A	_AuthorizedParticipationFunction v:AuthorizedParticipationFunction	AuthorizedParticipationFunction	Definition: This code is used to specify the exact function an actor is authorized to have in a service in all necessary detail. Concept Relationships: Generalizes (derived): _AuthorizedReceiverParticipationFunction _ConsenterParticipationFunction _OverriderParticipationFunction
1-A	. _AuthorizedReceiverParticipationFunction . v:AuthorizedReceiverParticipationFunction	AuthorizedReceiverParticipationFunction	Definition: This code is used to specify the exact function an actor is authorized to have as a receiver of information that is the subject of a consent directive or consent override. Concept Relationships: Specializes: _AuthorizedParticipationFunction Generalizes (derived): AUCG AULR AUTM AUWA
2-L	. . AUCG	caregiver information receiver	Definition: Description:Caregiver authorized to receive patient health information. Concept Relationships: Specializes: _AuthorizedReceiverParticipationFunction
2-L	. . AULR	legitimate relationship information receiver	Definition: Description:Provider with legitimate relationship authorized to receive patient health information. Concept Relationships: Specializes: _AuthorizedReceiverParticipationFunction
2-L	. . AUTM	care team information receiver	Definition: Description:Member of care team authorized to receive patient health information. Concept Relationships: Specializes: _AuthorizedReceiverParticipationFunction
2-L	. . AUWA	work area information receiver	Definition: Description:Entities within specified work area authorized to receive patient health information. Concept Relationships: Specializes: _AuthorizedReceiverParticipationFunction
1-A	. _ConsenterParticipationFunction . v:ConsenterParticipationFunction	ConsenterParticipationFunction	Definition: This code is used to specify the exact function an actor is authorized to have in authoring a consent directive. Concept Relationships: Specializes: _AuthorizedParticipationFunction Generalizes (derived): GRDCON POACON PRCON PROMSK SUBCON
2-L	. . GRDCON	legal guardian consent author	Definition: Description:Legal guardian of the subject of consent authorized to author a consent directive for the subject of consent. Concept Relationships: Specializes: _ConsenterParticipationFunction
2-L	. . POACON	healthcare power of attorney consent author	Definition: Description:Person authorized with healthcare power of attorney to author a consent directive for the subject of consent. Concept Relationships: Specializes: _ConsenterParticipationFunction
2-L	. . PRCON	personal representative consent author	Definition: Description:Personal representative of the subject of consent authorized to author a consent directive for the subject of consent. Concept Relationships: Specializes: _ConsenterParticipationFunction
2-L	. . PROMSK	authorized provider masking author	Definition: Definition:Provider authorized to mask information to protect the patient, a third party, or to ensure that the provider has consulted with the patient prior to release of this information. Concept Relationships: Specializes: _ConsenterParticipationFunction
2-L	. . SUBCON	subject of consent author	Definition: Description:Subject of consent authorized to author a consent directive. Concept Relationships: Specializes: _ConsenterParticipationFunction
1-A	. _OverriderParticipationFunction . v:OverriderParticipationFunction	OverriderParticipationFunction	Definition: This code is used to specify the exact function an actor is authorized to have in authoring a consent override. Concept Relationships: Specializes: _AuthorizedParticipationFunction Generalizes (derived): AUCOV AUEMROV
2-L	. . AUCOV	consent overrider	Definition: Description:Entity authorized to override a consent directive. Concept Relationships: Specializes: _OverriderParticipationFunction
2-L	. . AUEMROV	emergency overrider	Definition: Description:Entity authorized to override a consent directive or privacy policy in an emergency. Concept Relationships: Specializes: _OverriderParticipationFunction
0-A	_CoverageParticipationFunction v:CoverageParticipationFunction	CoverageParticipationFunction	Definition: Definition: Set of codes indicating the manner in which sponsors, underwriters, and payers participate in a policy or program. Concept Relationships: Generalizes (derived): _PayorParticipationFunction _SponsorParticipationFunction _UnderwriterParticipationFunction
1-A	. _PayorParticipationFunction . v:PayorParticipationFunction	PayorParticipationFunction	Definition: Definition: Set of codes indicating the manner in which payors participate in a policy or program.</ Concept Relationships: Specializes: _CoverageParticipationFunction Generalizes (derived): CLMADJ ENROLL FFSMGT MCMGT PROVMGT UMGT
2-L	. . CLMADJ	claims adjudication	Definition: Definition: Manages all operations required to adjudicate fee for service claims or managed care encounter reports. Concept Relationships: Specializes: _PayorParticipationFunction
2-L	. . ENROLL	enrollment broker	Definition: Definition: Managing the enrollment of covered parties. Concept Relationships: Specializes: _PayorParticipationFunction
2-L	. . FFSMGT	ffs management	Definition: Definition: Managing all operations required to administer a fee for service or indemnity health plan including enrolling covered parties and providing customer service, provider contracting, claims payment, care management and utilization review. Concept Relationships: Specializes: _PayorParticipationFunction
2-L	. . MCMGT	managed care management	Definition: Definition: Managing all operations required to administer a managed care plan including enrolling covered parties and providing customer service,, provider contracting, claims payment, care management and utilization review. Concept Relationships: Specializes: _PayorParticipationFunction
2-L	. . PROVMGT	provider management	Definition: Definition: Managing provider contracting, provider services, credentialing, profiling, performance measures, and ensuring network adequacy. Concept Relationships: Specializes: _PayorParticipationFunction
2-L	. . UMGT	utilization management	Definition: Definition: Managing utilization of services by ensuring that providers adhere to, e.g., payeraTMs clinical protocols for medical appropriateness and standards of medical necessity. May include management of authorizations for services and referrals. Concept Relationships: Specializes: _PayorParticipationFunction
1-A	. _SponsorParticipationFunction . v:SponsorParticipationFunction	SponsorParticipationFunction	Definition: Definition: Set of codes indicating the manner in which sponsors participate in a policy or program. NOTE: use only when the Sponsor is not further specified with a SponsorRoleType as being either a fully insured sponsor or a self insured sponsor. Concept Relationships: Specializes: _CoverageParticipationFunction Generalizes (derived): FULINRD SELFINRD
2-L	. . FULINRD	fully insured	Definition: Definition: Responsibility taken by a sponsor to contract with one or more underwriters for the assumption of full responsibility for the risk and administration of a policy or program. Concept Relationships: Specializes: _SponsorParticipationFunction
2-L	. . SELFINRD	self insured	Definition: Definition: Responsibility taken by a sponsor to organize the underwriting of risk and administration of a policy or program. Concept Relationships: Specializes: _SponsorParticipationFunction
1-A	. _UnderwriterParticipationFunction . v:UnderwriterParticipationFunction	UnderwriterParticipationFunction	Definition: Definition: Set of codes indicating the manner in which underwriters participate in a policy or program. Concept Relationships: Specializes: _CoverageParticipationFunction Generalizes (derived): PAYORCNTR REINS RETROCES SUBCTRT UNDERWRTNG
2-L	. . PAYORCNTR	payor contracting	Definition: Definition: Contracting for the provision and administration of health services to payors while retaining the risk for coverage. Contracting may be for all provision and administration; or for provision of certain types of services; for provision of services by region; and by types of administration, e.g., claims adjudication, enrollment, provider management, and utilization management. Typically done by underwriters for sponsors who need coverage provided to covered parties in multiple regions. The underwriter may act as the payor in some, but not all of the regions in which coverage is provided. Concept Relationships: Specializes: _UnderwriterParticipationFunction
2-L	. . REINS	reinsures	Definition: Definition: Underwriting reinsurance for another underwriter for the policy or program. Concept Relationships: Specializes: _UnderwriterParticipationFunction
2-L	. . RETROCES	retrocessionaires	Definition: Definition: Underwriting reinsurance for another reinsurer. Concept Relationships: Specializes: _UnderwriterParticipationFunction
2-L	. . SUBCTRT	subcontracting risk	Definition: Definition: Delegating risk for a policy or program to one or more subcontracting underwriters, e.g., a major health insurer may delegate risk for provision of coverage under a national health plan to other underwriters by region . Concept Relationships: Specializes: _UnderwriterParticipationFunction
2-L	. . UNDERWRTNG	underwriting	Definition: Definition: Provision of underwriting analysis for another underwriter without assumption of risk. Concept Relationships: Specializes: _UnderwriterParticipationFunction

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Last Published: 20120831 10:21 AM

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