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from __future__ import annotations |
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"""Billing helpers: CPT autosuggest and 837 claim builder (demo-only).""" |
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from dataclasses import dataclass |
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from typing import List, Dict, Any, Optional |
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from datetime import datetime, timezone |
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import json |
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from pathlib import Path |
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from .config import CPT, PROVIDER |
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@dataclass |
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class CPTSuggestion: |
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code: str |
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rate: float |
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descriptor: str |
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eligible: bool |
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why: str |
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def _why_for_minutes(code: str, minutes: int, spoke: bool) -> str: |
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if code == "99451": |
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if not spoke: |
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return "Eligible when no live interprofessional call; written report only; requires ≥5 minutes." |
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return "Ineligible: 99451 is for written report without live discussion; 'spoke' was checked." |
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ranges = { |
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"99446": (5, 10), |
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"99447": (11, 20), |
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"99448": (21, 30), |
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"99449": (31, 10**9), |
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} |
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lo, hi = ranges[code] |
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base = f"Eligible minutes window {lo}–{hi if hi<10**9 else '∞'}; requires live discussion with referring clinician." |
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if not spoke: |
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return f"Ineligible: requires live discussion (spoke=False). Suggested 99451 if ≥5 minutes." |
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if minutes < lo: |
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return f"Ineligible for {code}: minutes below required threshold ({minutes}<{lo})." |
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return base |
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def autosuggest_cpt(minutes: int, spoke: bool) -> List[CPTSuggestion]: |
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"""Suggest CPT codes based on minutes and whether a live discussion occurred.""" |
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suggestions: List[CPTSuggestion] = [] |
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if spoke: |
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for code in ["99446", "99447", "99448", "99449"]: |
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lo_hi = { |
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"99446": (5, 10), |
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"99447": (11, 20), |
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"99448": (21, 30), |
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"99449": (31, 10**9), |
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}[code] |
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eligible = (minutes >= lo_hi[0]) and (minutes <= lo_hi[1]) |
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suggestions.append(CPTSuggestion( |
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code=code, |
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rate=float(CPT[code]["rate"]), |
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descriptor=str(CPT[code]["descriptor"]), |
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eligible=eligible, |
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why=_why_for_minutes(code, minutes, spoke), |
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)) |
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else: |
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eligible = minutes >= 5 |
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suggestions.append(CPTSuggestion( |
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code="99451", |
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rate=float(CPT["99451"]["rate"]), |
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descriptor=str(CPT["99451"]["descriptor"]), |
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eligible=eligible, |
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why=_why_for_minutes("99451", minutes, spoke), |
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)) |
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return suggestions |
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def build_837_claim(case: Dict[str, Any], code: str, rate: float, minutes: int, |
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spoke: bool, attested: bool, *, template_path: Optional[Path] = None) -> Dict[str, Any]: |
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"""Build a demo 837 claim JSON from a case and billing selection.""" |
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now = datetime.now(timezone.utc).isoformat() |
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template: Dict[str, Any] = {} |
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try: |
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if template_path and Path(template_path).exists(): |
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template = json.loads(Path(template_path).read_text(encoding="utf-8")) |
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except Exception: |
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template = {} |
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claim_id = f"EC-{case.get('case_id','UNKNOWN')}-{datetime.now(timezone.utc).strftime('%Y%m%dT%H%M%SZ')}" |
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out: Dict[str, Any] = { |
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"schema_version": 2, |
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"demo_only": True, |
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"claim_id": claim_id, |
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"created_at": now, |
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"provider": PROVIDER, |
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"patient": case.get("patient", {}), |
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"referring": {"name": (case.get("referrer") or {}).get("name", "Referring Clinician")}, |
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"service": { |
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"cpt_code": code, |
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"minutes": minutes, |
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"spoke_to_referrer": bool(spoke), |
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"amount": float(rate), |
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}, |
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"attested": bool(attested), |
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"source_case_id": case.get("case_id"), |
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} |
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out = {**template, **out} |
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return out |
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