f66b35f5fe
Split dev/ flat directory into dev/scripts/ (29 .py files) and dev/seeds/ (PDFs, Excel, ZIPs, NDJSON, grafana, PY2023). Update all Path(__file__) references to use parents[2] for project root and dev/seeds/ for seed data. Fix path references in src/ too. Add PY2024 CMS quality measure value sets (HWR, UAMCC, ACR) to the REGISTRY and load into DuckDB — enables 2024->2025->2026 diffs. Add HWR tables to notebook DIFF_SPECS now that two years exist.
340 lines
14 KiB
Python
340 lines
14 KiB
Python
"""Generate ALR reference code tables from ALRASRGuide.pdf appendix.
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Extracts Appendix Tables 3, 4, and 5 (pages 41-46) containing:
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- Primary care service codes (CPT/HCPCS)
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- Physician specialty codes
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- Non-physician practitioner codes
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Generates SQLTable models at ``src/aco/table/alr_codes.py``.
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Usage::
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uv run python dev/scripts/generate_alr_reference_tables.py
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Source: dev/ALRASRGuide.pdf
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"""
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from __future__ import annotations
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from pathlib import Path
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def extract_reference_codes() -> dict:
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"""Extract reference code tables from ALRASRGuide.pdf appendix.
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Returns dict with keys: primary_care_codes, physician_specialty_codes,
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non_physician_codes.
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"""
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# Appendix Table 3: Primary Care Service Codes (pages 41-44)
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# Manually extracted from PDF - comprehensive list
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primary_care_codes = [
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# CPT codes
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("96160", "CPT", "Health Risk Assessment", None),
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("96161", "CPT", "Health Risk Assessment", None),
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("96202", "CPT", "Caregiver Services", None),
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("96203", "CPT", "Caregiver Services", None),
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("97550", "CPT", "Caregiver Services", None),
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("97551", "CPT", "Caregiver Services", None),
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("97552", "CPT", "Caregiver Services", None),
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("99201", "CPT", "New Patient Office Visit", None),
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("99202", "CPT", "New Patient Office Visit", None),
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("99203", "CPT", "New Patient Office Visit", None),
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("99204", "CPT", "New Patient Office Visit", None),
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("99205", "CPT", "New Patient Office Visit", None),
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("99211", "CPT", "Established Patient Office Visit", None),
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("99212", "CPT", "Established Patient Office Visit", None),
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("99213", "CPT", "Established Patient Office Visit", None),
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("99214", "CPT", "Established Patient Office Visit", None),
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("99215", "CPT", "Established Patient Office Visit", None),
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("99304", "CPT", "Nursing Facility Initial Care", "Exclude if in SNF"),
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("99305", "CPT", "Nursing Facility Initial Care", "Exclude if in SNF"),
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("99306", "CPT", "Nursing Facility Initial Care", "Exclude if in SNF"),
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("99307", "CPT", "Nursing Facility Subsequent Care", "Exclude if in SNF"),
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("99308", "CPT", "Nursing Facility Subsequent Care", "Exclude if in SNF"),
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("99309", "CPT", "Nursing Facility Subsequent Care", "Exclude if in SNF"),
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("99310", "CPT", "Nursing Facility Subsequent Care", "Exclude if in SNF"),
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("99315", "CPT", "Nursing Facility Discharge", "Exclude if in SNF"),
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("99316", "CPT", "Nursing Facility Discharge", "Exclude if in SNF"),
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("99318", "CPT", "Nursing Facility Annual Assessment", "Exclude if in SNF"),
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("99324", "CPT", "Domiciliary/Rest Home New Patient", None),
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("99325", "CPT", "Domiciliary/Rest Home New Patient", None),
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("99326", "CPT", "Domiciliary/Rest Home New Patient", None),
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("99327", "CPT", "Domiciliary/Rest Home New Patient", None),
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("99328", "CPT", "Domiciliary/Rest Home New Patient", None),
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("99334", "CPT", "Domiciliary/Rest Home Established Patient", None),
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("99335", "CPT", "Domiciliary/Rest Home Established Patient", None),
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("99336", "CPT", "Domiciliary/Rest Home Established Patient", None),
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("99337", "CPT", "Domiciliary/Rest Home Established Patient", None),
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("99339", "CPT", "Individual Physician Supervision", None),
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("99340", "CPT", "Individual Physician Supervision", None),
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("99341", "CPT", "Home Visit New Patient", None),
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("99342", "CPT", "Home Visit New Patient", None),
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("99343", "CPT", "Home Visit New Patient", None),
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("99344", "CPT", "Home Visit New Patient", None),
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("99345", "CPT", "Home Visit New Patient", None),
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("99347", "CPT", "Home Visit Established Patient", None),
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("99348", "CPT", "Home Visit Established Patient", None),
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("99349", "CPT", "Home Visit Established Patient", None),
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("99350", "CPT", "Home Visit Established Patient", None),
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("99354", "CPT", "Prolonged Services", None),
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("99355", "CPT", "Prolonged Services", None),
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("99406", "CPT", "Smoking Cessation 3-10 min", None),
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("99407", "CPT", "Smoking Cessation >10 min", None),
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("99421", "CPT", "Online Digital E&M 5-10 min", None),
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("99422", "CPT", "Online Digital E&M 11-20 min", None),
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("99423", "CPT", "Online Digital E&M 21+ min", None),
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("99424", "CPT", "Principal Care Management first 30 min", None),
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("99425", "CPT", "Principal Care Management each additional 30 min", None),
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("99426", "CPT", "Principal Care Management initial", None),
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("99427", "CPT", "Principal Care Management subsequent", None),
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("99437", "CPT", "Chronic Care Management", None),
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("99439", "CPT", "Chronic Care Management", None),
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("99441", "CPT", "Telephone E&M 5-10 min (COVID PHE)", None),
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("99442", "CPT", "Telephone E&M 11-20 min (COVID PHE)", None),
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("99443", "CPT", "Telephone E&M 21-30 min (COVID PHE)", None),
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("99483", "CPT", "Cognitive Impairment Assessment", None),
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("99484", "CPT", "Behavioral Health Integration first 20 min", None),
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("99487", "CPT", "Complex Chronic Care Management first 60 min", None),
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(
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"99489",
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"CPT",
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"Complex Chronic Care Management each additional 30 min",
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None,
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),
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("99490", "CPT", "Chronic Care Management first 20 min", None),
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("99491", "CPT", "Chronic Care Management 30 min", None),
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("99492", "CPT", "Behavioral Health Integration initial", None),
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("99493", "CPT", "Behavioral Health Integration subsequent", None),
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("99494", "CPT", "Behavioral Health Integration subsequent", None),
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("99495", "CPT", "Transitional Care 14 days", None),
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("99496", "CPT", "Transitional Care 7 days", None),
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("99497", "CPT", "Advance Care Planning first 30 min", "Exclude if inpatient"),
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(
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"99498",
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"CPT",
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"Advance Care Planning each additional 30 min",
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"Exclude if inpatient",
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),
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# HCPCS codes
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("G0019", "HCPCS", "Community Health Integration", None),
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("G0022", "HCPCS", "Community Health Integration", None),
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("G0023", "HCPCS", "Principal Illness Navigation first 60 min", None),
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("G0024", "HCPCS", "Principal Illness Navigation each additional 30 min", None),
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("G0101", "HCPCS", "Cervical/Vaginal Cancer Screening", None),
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("G0136", "HCPCS", "Social Determinants of Health Assessment", None),
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("G0317", "HCPCS", "Prolonged E&M first hour", None),
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("G0318", "HCPCS", "Prolonged E&M each additional 30 min", None),
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("G0402", "HCPCS", "Welcome to Medicare Visit", None),
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("G0438", "HCPCS", "Annual Wellness Visit initial", None),
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("G0439", "HCPCS", "Annual Wellness Visit subsequent", None),
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("G0442", "HCPCS", "Alcohol Misuse Screening 15 min", None),
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("G0443", "HCPCS", "Alcohol Misuse Counseling", None),
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("G0444", "HCPCS", "Depression Screening Annual", None),
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(
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"G0463",
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"HCPCS",
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"Hospital Outpatient Clinic Visit (ETA hospitals only)",
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None,
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),
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("G0506", "HCPCS", "Chronic Care Management", None),
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("G2010", "HCPCS", "Remote Evaluation Video/Images", None),
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("G2012", "HCPCS", "Virtual Check-In 5-10 min", None),
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("G2058", "HCPCS", "Care Management Services for BHI", None),
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("G2064", "HCPCS", "Care Management Services 20 min", None),
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("G2065", "HCPCS", "Care Management Services 40 min", None),
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("G2086", "HCPCS", "Opioid Use Disorder Treatment 70-100 min", None),
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("G2087", "HCPCS", "Opioid Use Disorder Treatment 100-130 min", None),
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("G2088", "HCPCS", "Opioid Use Disorder Treatment 130+ min", None),
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("G2211", "HCPCS", "Complex E&M Add-on", None),
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("G2212", "HCPCS", "Prolonged Office E&M", None),
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("G2214", "HCPCS", "Chronic Pain Management", None),
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("G2252", "HCPCS", "Communication Technology Services Brief", None),
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("G3002", "HCPCS", "Chronic Pain Management Initial", None),
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("G3003", "HCPCS", "Chronic Pain Management Subsequent", None),
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]
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# Appendix Table 4: Physician Specialty Codes (page 45)
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physician_specialty_codes = [
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# Step 1: Primary Care Physicians
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("01", 1, "General Practice"),
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("08", 1, "Family Practice"),
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("11", 1, "Internal Medicine"),
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("37", 1, "Pediatric Medicine"),
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("38", 1, "Geriatric Medicine"),
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# Step 2: Specialist Physicians
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("06", 2, "Cardiology"),
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("12", 2, "Osteopathic Manipulative Medicine"),
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("13", 2, "Neurology"),
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("16", 2, "Obstetrics/Gynecology"),
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("23", 2, "Sports Medicine"),
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("25", 2, "Physical Medicine and Rehabilitation"),
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("26", 2, "Psychiatry"),
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("27", 2, "Geriatric Psychiatry"),
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("29", 2, "Pulmonary Disease"),
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("39", 2, "Nephrology"),
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("46", 2, "Endocrinology"),
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("70", 2, "Multispecialty Clinic/Group"),
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("79", 2, "Addiction Medicine"),
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("82", 2, "Hematology"),
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("83", 2, "Hematology/Oncology"),
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("84", 2, "Preventive Medicine"),
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("86", 2, "Neuropsychiatry"),
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("90", 2, "Medical Oncology"),
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("98", 2, "Gynecology/Oncology"),
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]
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# Appendix Table 5: Non-Physician Practitioner Codes (page 46)
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non_physician_codes = [
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("50", "Nurse Practitioner"),
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("89", "Clinical Nurse Specialist"),
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("97", "Physician Assistant"),
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]
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return {
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"primary_care_codes": primary_care_codes,
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"physician_specialty_codes": physician_specialty_codes,
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"non_physician_codes": non_physician_codes,
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}
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def generate_module(data: dict) -> str:
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"""Generate the alr_codes.py module source code."""
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lines = [
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'"""ALR Reference Code Tables — Primary care service codes and specialty codes.',
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"",
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"Auto-generated from ALRASRGuide.pdf Appendix Tables 3, 4, and 5.",
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"Version #16 (April 2024).",
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"",
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"These reference tables define:",
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"- Primary care service codes (CPT/HCPCS) used in beneficiary assignment",
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"- Physician specialty codes for Step 1 (primary care) and Step 2 (specialist) assignment",
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"- Non-physician practitioner codes eligible for Step 1 assignment",
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"",
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"Source: ALRASRGuide.pdf pages 41-46",
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'"""',
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"",
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"from __future__ import annotations",
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"",
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"from aco.table.base import SQLTable",
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"",
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]
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# Primary Care Service Codes
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lines.extend(
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[
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"",
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"class AlrPrimaryCareServiceCode(SQLTable):",
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' """Primary care service codes for MSSP beneficiary assignment.',
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"",
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" Appendix Table 3: Codes used to identify primary care services",
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" in the assignment algorithm. Includes CPT and HCPCS codes with",
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" exclusion rules for specific settings (SNF, inpatient).",
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"",
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f" {len(data['primary_care_codes'])} codes total.",
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"",
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" Source: ALRASRGuide.pdf pages 41-44",
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' """',
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"",
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' __schema__ = "alr_codes"',
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' __tablename__ = "primary_care_service_code"',
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"",
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" code: str",
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' """CPT or HCPCS code (e.g., 99213, G0438)"""',
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"",
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" code_type: str",
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' """Code type: CPT or HCPCS"""',
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"",
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" description: str",
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' """Service description"""',
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"",
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" exclusion_rule: str | None",
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' """Exclusion rule if applicable (e.g., "Exclude if in SNF")"""',
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"",
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]
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)
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# Physician Specialty Codes
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lines.extend(
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[
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"",
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"class AlrPhysicianSpecialtyCode(SQLTable):",
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' """Physician specialty codes for assignment algorithm.',
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"",
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" Appendix Table 4: Specialty codes used in Step 1 (primary care",
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" physicians) and Step 2 (specialist physicians) assignment logic.",
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"",
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f" {len(data['physician_specialty_codes'])} codes total.",
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"",
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" Source: ALRASRGuide.pdf page 45",
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' """',
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"",
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' __schema__ = "alr_codes"',
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' __tablename__ = "physician_specialty_code"',
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"",
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" specialty_code: str",
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' """Medicare specialty code (e.g., 01, 08, 11)"""',
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"",
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" assignment_step: int",
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' """Assignment step: 1=primary care physicians, 2=specialist physicians"""',
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"",
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" description: str",
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' """Specialty description"""',
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"",
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]
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)
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# Non-Physician Practitioner Codes
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lines.extend(
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[
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"",
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"class AlrNonPhysicianSpecialtyCode(SQLTable):",
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' """Non-physician practitioner codes for Step 1 assignment.',
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"",
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" Appendix Table 5: Non-physician practitioner specialty codes",
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" eligible for Step 1 (primary care) assignment.",
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"",
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f" {len(data['non_physician_codes'])} codes total.",
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"",
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" Source: ALRASRGuide.pdf page 46",
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' """',
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"",
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' __schema__ = "alr_codes"',
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' __tablename__ = "non_physician_specialty_code"',
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"",
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" specialty_code: str",
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' """Medicare specialty code (e.g., 50, 89, 97)"""',
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"",
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" description: str",
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' """Specialty description"""',
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"",
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]
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)
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return "\n".join(lines)
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def main():
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"""Generate src/aco/table/alr_codes.py from ALRASRGuide.pdf appendix."""
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output_path = (
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Path(__file__).resolve().parents[2] / "src" / "aco" / "table" / "alr_codes.py"
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)
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data = extract_reference_codes()
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code = generate_module(data)
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output_path.parent.mkdir(parents=True, exist_ok=True)
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output_path.write_text(code)
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print(f"Generated {output_path}")
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print(f" Primary care service codes: {len(data['primary_care_codes'])}")
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print(f" Physician specialty codes: {len(data['physician_specialty_codes'])}")
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print(f" Non-physician practitioner codes: {len(data['non_physician_codes'])}")
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return 0
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if __name__ == "__main__":
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raise SystemExit(main())
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