Update src/billing.py

src/billing.py

@@ -1,101 +1,131 @@
 # src/billing.py
 from __future__ import annotations
-"""Billing helpers: CPT autosuggest and 837 claim builder (demo-only)."""
 
 from dataclasses import dataclass
 from typing import List, Dict, Any, Optional
-from datetime import datetime, timezone
-import json
-from pathlib import Path
+import re
+import datetime as dt
 
-from .config import CPT, PROVIDER
+
+# ---------------------- Data models ----------------------
 
 @dataclass
 class CPTSuggestion:
     code: str
-    rate: float
     descriptor: str
+    rate: float
     eligible: bool
     why: str
 
-def _why_for_minutes(code: str, minutes: int, spoke: bool) -> str:
-    if code == "99451":
-        if not spoke:
-            return "Eligible when no live interprofessional call; written report only; requires ≥5 minutes."
-        return "Ineligible: 99451 is for written report without live discussion; 'spoke' was checked."
-    ranges = {
-        "99446": (5, 10),
-        "99447": (11, 20),
-        "99448": (21, 30),
-        "99449": (31, 10**9),
-    }
-    lo, hi = ranges[code]
-    base = f"Eligible minutes window {lo}–{hi if hi<10**9 else '∞'}; requires live discussion with referring clinician."
-    if not spoke:
-        return f"Ineligible: requires live discussion (spoke=False). Suggested 99451 if ≥5 minutes."
-    if minutes < lo:
-        return f"Ineligible for {code}: minutes below required threshold ({minutes}<{lo})."
-    return base
-
-def autosuggest_cpt(minutes: int, spoke: bool) -> List[CPTSuggestion]:
-    """Suggest CPT codes based on minutes and whether a live discussion occurred."""
-    suggestions: List[CPTSuggestion] = []
-    if spoke:
-        for code in ["99446", "99447", "99448", "99449"]:
-            lo_hi = {
-                "99446": (5, 10),
-                "99447": (11, 20),
-                "99448": (21, 30),
-                "99449": (31, 10**9),
-            }[code]
-            eligible = (minutes >= lo_hi[0]) and (minutes <= lo_hi[1])
-            suggestions.append(CPTSuggestion(
-                code=code,
-                rate=float(CPT[code]["rate"]),
-                descriptor=str(CPT[code]["descriptor"]),
-                eligible=eligible,
-                why=_why_for_minutes(code, minutes, spoke),
-            ))
-    else:
-        eligible = minutes >= 5
-        suggestions.append(CPTSuggestion(
-            code="99451",
-            rate=float(CPT["99451"]["rate"]),
-            descriptor=str(CPT["99451"]["descriptor"]),
-            eligible=eligible,
-            why=_why_for_minutes("99451", minutes, spoke),
-        ))
-    return suggestions
-
-def build_837_claim(case: Dict[str, Any], code: str, rate: float, minutes: int,
-                    spoke: bool, attested: bool, *, template_path: Optional[Path] = None) -> Dict[str, Any]:
-    """Build a demo 837 claim JSON from a case and billing selection."""
-    now = datetime.now(timezone.utc).isoformat()
-    # Load optional template
-    template: Dict[str, Any] = {}
-    try:
-        if template_path and Path(template_path).exists():
-            template = json.loads(Path(template_path).read_text(encoding="utf-8"))
-    except Exception:
-        template = {}
-
-    claim_id = f"EC-{case.get('case_id','UNKNOWN')}-{datetime.now(timezone.utc).strftime('%Y%m%dT%H%M%SZ')}"
-    out: Dict[str, Any] = {
-        "schema_version": 2,
-        "demo_only": True,
-        "claim_id": claim_id,
-        "created_at": now,
-        "provider": PROVIDER,
-        "patient": case.get("patient", {}),
-        "referring": {"name": (case.get("referrer") or {}).get("name", "Referring Clinician")},
-        "service": {
-            "cpt_code": code,
-            "minutes": minutes,
-            "spoke_to_referrer": bool(spoke),
-            "amount": float(rate),
+@dataclass
+class ICDSuggestion:
+    code: str
+    description: str
+    confidence: float
+    why: str
+
+
+# ---------------------- CPT autosuggest -------------------
+
+def autosuggest_cpt(*, minutes: int, spoke: bool) -> List[CPTSuggestion]:
+    """
+    Very simple heuristic consistent with e-consult time thresholds.
+    Keep your original thresholds; these are illustrative defaults.
+    """
+    table = [
+        ("99451", "Interprofessional e-consultation—5+ min of consultative time", 45.00, minutes >= 5 and not spoke, "Time ≥5 min; no synchronous/phone"),
+        ("99452", "Interprofessional referral service provided by the treating/requesting physician", 35.00, minutes >= 5 and spoke, "Time ≥5 min; spoke to referring clinician"),
+    ]
+    out: List[CPTSuggestion] = []
+    for code, desc, rate, eligible, why in table:
+        out.append(CPTSuggestion(code=code, descriptor=desc, rate=rate, eligible=bool(eligible), why=why))
+    # If both are eligible, prefer 99452 when spoke=True
+    return out
+
+
+# ---------------------- ICD autosuggest -------------------
+
+_HF_PATTERNS = [
+    # (pattern, ICD code, label, reason)
+    (r"\b(hfref|reduced ejection|ef\s*(?:<|≤)?\s*40|ef\s*3\d)\b", "I50.2", "Systolic (HFrEF) heart failure", "Assessment indicates reduced EF / HFrEF"),
+    (r"\b(hfpef|preserved ejection|ef\s*(?:≥|>)\s*50|ef\s*5\d|ef\s*6\d)\b", "I50.3", "Diastolic (HFpEF) heart failure", "Assessment indicates preserved EF / HFpEF"),
+    (r"\bacute decompensated\b", "I50.23", "Acute on chronic systolic HF", "Language suggests acute on chronic HFrEF"),
+    (r"\bhypertension\b.*\bheart failure\b|\bhtn\b.*\bhf\b", "I11.0", "Hypertensive heart disease with HF", "HTN with HF mentioned"),
+    (r"\bcardiorenal\b|\bckd\b|\bcreatinine\b", "N18.9", "Chronic kidney disease, unspecified", "Cardiorenal considerations/CKD labs present"),
+]
+
+def autosuggest_icd(assessment_text: str, plan_text: str, *, max_codes: int = 3) -> List[ICDSuggestion]:
+    """
+    Light rule-based ICD-10 suggestions from Assessment + Plan text.
+    Returns up to max_codes ordered by confidence.
+    """
+    text = f"{assessment_text}\n{plan_text}".lower()
+    hits: Dict[str, ICDSuggestion] = {}
+    for pat, code, label, reason in _HF_PATTERNS:
+        if re.search(pat, text, flags=re.I):
+            # Simple confidence stacking: more matches → slightly higher confidence
+            conf = 0.7
+            if code in hits:
+                hits[code].confidence = min(0.95, hits[code].confidence + 0.1)
+            else:
+                hits[code] = ICDSuggestion(code=code, description=label, confidence=conf, why=reason)
+    # Always include non-specific HF if nothing matched but HF is suggested
+    if ("hf" in text or "heart failure" in text) and not hits:
+        hits["I50.9"] = ICDSuggestion(code="I50.9", description="Heart failure, unspecified", confidence=0.6, why="HF mentioned without phenotype")
+    # Return ordered by confidence
+    return sorted(hits.values(), key=lambda s: s.confidence, reverse=True)[:max_codes]
+
+
+# ---------------------- 837 JSON builder -------------------
+
+def build_837_claim(
+    case: Dict[str, Any],
+    *,
+    code: str,
+    rate: float,
+    minutes: int,
+    spoke: bool,
+    attested: bool,
+    icd_codes: Optional[List[str]] = None,
+) -> Dict[str, Any]:
+    """
+    Build a compact 837-like JSON envelope for demo purposes.
+    Includes ICD diagnosis codes in the 2300-level 'diagnosis_codes' block.
+    """
+    p = case.get("patient", {}) or {}
+    c = case.get("consult", {}) or {}
+    case_id = case.get("case_id", "UNKNOWN")
+
+    today = dt.datetime.utcnow().strftime("%Y-%m-%d")
+    icd_codes = icd_codes or []
+
+    envelope = {
+        "transaction": "837P",
+        "case_id": case_id,
+        "claim": {
+            "provider": {
+                "npi": "1234567890",                 # demo
+                "taxonomy_code": "207RC0000X",       # Cardiology
+                "place_of_service": "02",            # Telehealth (demo)
+            },
+            "patient": {
+                "name": p.get("name") or "Unknown",
+                "sex": p.get("sex") or "",
+                "age": p.get("age") or "",
+            },
+            "referral": {
+                "specialty": c.get("specialty") or "Cardiology",
+                "question": c.get("question") or "",
+            },
+            "service": {
+                "date": today,
+                "cpt_code": code,
+                "charge_amount": round(float(rate), 2),
+                "minutes": int(minutes),
+                "spoke_to_referrer": bool(spoke),
+                "attested": bool(attested),
+            },
+            "diagnosis_codes": icd_codes,  # NEW: ICD-10 list
         },
-        "attested": bool(attested),
-        "source_case_id": case.get("case_id"),
     }
-    out = {**template, **out}
-    return out
+    return envelope