Examples with Procedure org.hl7.fhir.r4.model.Procedure used on opensource projects

Example 1 with Procedure

use of org.hl7.fhir.r4.model.Procedure in project beneficiary-fhir-data by CMSgov.

the class TransformerUtils method addProcedureCode.

/**
 * @param eob the {@link ExplanationOfBenefit} to (possibly) modify
 * @param diagnosis the {@link Diagnosis} to add, if it's not already present
 * @return the {@link ProcedureComponent#getSequence()} of the existing or newly-added entry
 */
static int addProcedureCode(ExplanationOfBenefit eob, CCWProcedure procedure) {
    Optional<ProcedureComponent> existingProcedure = eob.getProcedure().stream().filter(pc -> pc.getProcedure() instanceof CodeableConcept).filter(pc -> isCodeInConcept((CodeableConcept) pc.getProcedure(), procedure.getFhirSystem(), procedure.getCode())).findAny();
    if (existingProcedure.isPresent())
        return existingProcedure.get().getSequenceElement().getValue();
    ProcedureComponent procedureComponent = new ProcedureComponent().setSequence(eob.getProcedure().size() + 1);
    procedureComponent.setProcedure(createCodeableConcept(procedure.getFhirSystem(), null, retrieveProcedureCodeDisplay(procedure.getCode()), procedure.getCode()));
    if (procedure.getProcedureDate().isPresent()) {
        procedureComponent.setDate(convertToDate(procedure.getProcedureDate().get()));
    }
    eob.getProcedure().add(procedureComponent);
    return procedureComponent.getSequenceElement().getValue();
}

Example 2 with Procedure

use of org.hl7.fhir.r4.model.Procedure in project beneficiary-fhir-data by CMSgov.

the class InpatientClaimTransformer method transformClaim.

/**
 * @param claimGroup the CCW {@link InpatientClaim} to transform
 * @return a FHIR {@link ExplanationOfBenefit} resource that represents the specified {@link
 *     InpatientClaim}
 */
private static ExplanationOfBenefit transformClaim(InpatientClaim claimGroup) {
    ExplanationOfBenefit eob = new ExplanationOfBenefit();
    // Common group level fields between all claim types
    TransformerUtils.mapEobCommonClaimHeaderData(eob, claimGroup.getClaimId(), claimGroup.getBeneficiaryId(), ClaimType.INPATIENT, claimGroup.getClaimGroupId().toPlainString(), MedicareSegment.PART_A, Optional.of(claimGroup.getDateFrom()), Optional.of(claimGroup.getDateThrough()), Optional.of(claimGroup.getPaymentAmount()), claimGroup.getFinalAction());
    TransformerUtils.mapEobWeeklyProcessDate(eob, claimGroup.getWeeklyProcessDate());
    // map eob type codes into FHIR
    TransformerUtils.mapEobType(eob, ClaimType.INPATIENT, Optional.of(claimGroup.getNearLineRecordIdCode()), Optional.of(claimGroup.getClaimTypeCode()));
    // set the provider number which is common among several claim types
    TransformerUtils.setProviderNumber(eob, claimGroup.getProviderNumber());
    if (claimGroup.getPatientStatusCd().isPresent()) {
        TransformerUtils.addInformationWithCode(eob, CcwCodebookVariable.NCH_PTNT_STUS_IND_CD, CcwCodebookVariable.NCH_PTNT_STUS_IND_CD, claimGroup.getPatientStatusCd());
    }
    // add EOB information to fields that are common between the Inpatient and SNF claim types
    TransformerUtils.addCommonEobInformationInpatientSNF(eob, claimGroup.getAdmissionTypeCd(), claimGroup.getSourceAdmissionCd(), claimGroup.getNoncoveredStayFromDate(), claimGroup.getNoncoveredStayThroughDate(), claimGroup.getCoveredCareThoughDate(), claimGroup.getMedicareBenefitsExhaustedDate(), claimGroup.getDiagnosisRelatedGroupCd());
    // Claim Operational Indirect Medical Education Amount
    if (claimGroup.getIndirectMedicalEducationAmount().isPresent()) {
        TransformerUtils.addAdjudicationTotal(eob, CcwCodebookVariable.IME_OP_CLM_VAL_AMT, claimGroup.getIndirectMedicalEducationAmount());
    }
    // Claim Operational disproportionate Amount
    if (claimGroup.getDisproportionateShareAmount().isPresent()) {
        TransformerUtils.addAdjudicationTotal(eob, CcwCodebookVariable.DSH_OP_CLM_VAL_AMT, claimGroup.getDisproportionateShareAmount());
    }
    // TODO If actually nullable, should be Optional.
    if (claimGroup.getPassThruPerDiemAmount() != null) {
        TransformerUtils.addAdjudicationTotal(eob, CcwCodebookVariable.CLM_PASS_THRU_PER_DIEM_AMT, claimGroup.getPassThruPerDiemAmount());
    }
    // TODO If actually nullable, should be Optional.
    if (claimGroup.getProfessionalComponentCharge() != null) {
        TransformerUtils.addAdjudicationTotal(eob, CcwCodebookVariable.NCH_PROFNL_CMPNT_CHRG_AMT, claimGroup.getProfessionalComponentCharge());
    }
    // TODO If actually nullable, should be Optional.
    if (claimGroup.getClaimTotalPPSCapitalAmount() != null) {
        TransformerUtils.addAdjudicationTotal(eob, CcwCodebookVariable.CLM_TOT_PPS_CPTL_AMT, claimGroup.getClaimTotalPPSCapitalAmount());
    }
    if (claimGroup.getIndirectMedicalEducationAmount().isPresent()) {
        TransformerUtils.addAdjudicationTotal(eob, CcwCodebookVariable.IME_OP_CLM_VAL_AMT, claimGroup.getIndirectMedicalEducationAmount().get());
    }
    // Claim Uncompensated Care Payment Amount
    if (claimGroup.getClaimUncompensatedCareAmount().isPresent()) {
        TransformerUtils.addAdjudicationTotal(eob, CcwCodebookVariable.CLM_UNCOMPD_CARE_PMT_AMT, claimGroup.getClaimUncompensatedCareAmount().get());
    }
    /*
     * add field values to the benefit balances that are common between the
     * Inpatient and SNF claim types
     */
    TransformerUtils.addCommonGroupInpatientSNF(eob, claimGroup.getCoinsuranceDayCount(), claimGroup.getNonUtilizationDayCount(), claimGroup.getDeductibleAmount(), claimGroup.getPartACoinsuranceLiabilityAmount(), claimGroup.getBloodPintsFurnishedQty(), claimGroup.getNoncoveredCharge(), claimGroup.getTotalDeductionAmount(), claimGroup.getClaimPPSCapitalDisproportionateShareAmt(), claimGroup.getClaimPPSCapitalExceptionAmount(), claimGroup.getClaimPPSCapitalFSPAmount(), claimGroup.getClaimPPSCapitalIMEAmount(), claimGroup.getClaimPPSCapitalOutlierAmount(), claimGroup.getClaimPPSOldCapitalHoldHarmlessAmount());
    // TODO If this is actually nullable, should be Optional.
    if (claimGroup.getDrgOutlierApprovedPaymentAmount() != null) {
        TransformerUtils.addAdjudicationTotal(eob, CcwCodebookVariable.NCH_DRG_OUTLIER_APRVD_PMT_AMT, claimGroup.getDrgOutlierApprovedPaymentAmount());
    }
    // Common group level fields between Inpatient, Outpatient and SNF
    TransformerUtils.mapEobCommonGroupInpOutSNF(eob, claimGroup.getBloodDeductibleLiabilityAmount(), claimGroup.getOperatingPhysicianNpi(), claimGroup.getOtherPhysicianNpi(), claimGroup.getClaimQueryCode(), claimGroup.getMcoPaidSw());
    // Common group level fields between Inpatient, Outpatient Hospice, HHA and SNF
    TransformerUtils.mapEobCommonGroupInpOutHHAHospiceSNF(eob, claimGroup.getOrganizationNpi(), claimGroup.getClaimFacilityTypeCode(), claimGroup.getClaimFrequencyCode(), claimGroup.getClaimNonPaymentReasonCode(), claimGroup.getPatientDischargeStatusCode(), claimGroup.getClaimServiceClassificationTypeCode(), claimGroup.getClaimPrimaryPayerCode(), claimGroup.getAttendingPhysicianNpi(), claimGroup.getTotalChargeAmount(), claimGroup.getPrimaryPayerPaidAmount(), claimGroup.getFiscalIntermediaryNumber(), claimGroup.getFiDocumentClaimControlNumber(), claimGroup.getFiOriginalClaimControlNumber());
    // Common group level fields between Inpatient, HHA, Hospice and SNF
    TransformerUtils.mapEobCommonGroupInpHHAHospiceSNF(eob, claimGroup.getClaimAdmissionDate(), claimGroup.getBeneficiaryDischargeDate(), Optional.of(claimGroup.getUtilizationDayCount()));
    for (Diagnosis diagnosis : extractDiagnoses(claimGroup)) TransformerUtils.addDiagnosisCode(eob, diagnosis);
    for (CCWProcedure procedure : TransformerUtils.extractCCWProcedures(claimGroup.getProcedure1Code(), claimGroup.getProcedure1CodeVersion(), claimGroup.getProcedure1Date(), claimGroup.getProcedure2Code(), claimGroup.getProcedure2CodeVersion(), claimGroup.getProcedure2Date(), claimGroup.getProcedure3Code(), claimGroup.getProcedure3CodeVersion(), claimGroup.getProcedure3Date(), claimGroup.getProcedure4Code(), claimGroup.getProcedure4CodeVersion(), claimGroup.getProcedure4Date(), claimGroup.getProcedure5Code(), claimGroup.getProcedure5CodeVersion(), claimGroup.getProcedure5Date(), claimGroup.getProcedure6Code(), claimGroup.getProcedure6CodeVersion(), claimGroup.getProcedure6Date(), claimGroup.getProcedure7Code(), claimGroup.getProcedure7CodeVersion(), claimGroup.getProcedure7Date(), claimGroup.getProcedure8Code(), claimGroup.getProcedure8CodeVersion(), claimGroup.getProcedure8Date(), claimGroup.getProcedure9Code(), claimGroup.getProcedure9CodeVersion(), claimGroup.getProcedure9Date(), claimGroup.getProcedure10Code(), claimGroup.getProcedure10CodeVersion(), claimGroup.getProcedure10Date(), claimGroup.getProcedure11Code(), claimGroup.getProcedure11CodeVersion(), claimGroup.getProcedure11Date(), claimGroup.getProcedure12Code(), claimGroup.getProcedure12CodeVersion(), claimGroup.getProcedure12Date(), claimGroup.getProcedure13Code(), claimGroup.getProcedure13CodeVersion(), claimGroup.getProcedure13Date(), claimGroup.getProcedure14Code(), claimGroup.getProcedure14CodeVersion(), claimGroup.getProcedure14Date(), claimGroup.getProcedure15Code(), claimGroup.getProcedure15CodeVersion(), claimGroup.getProcedure15Date(), claimGroup.getProcedure16Code(), claimGroup.getProcedure16CodeVersion(), claimGroup.getProcedure16Date(), claimGroup.getProcedure17Code(), claimGroup.getProcedure17CodeVersion(), claimGroup.getProcedure17Date(), claimGroup.getProcedure18Code(), claimGroup.getProcedure18CodeVersion(), claimGroup.getProcedure18Date(), claimGroup.getProcedure19Code(), claimGroup.getProcedure19CodeVersion(), claimGroup.getProcedure19Date(), claimGroup.getProcedure20Code(), claimGroup.getProcedure20CodeVersion(), claimGroup.getProcedure20Date(), claimGroup.getProcedure21Code(), claimGroup.getProcedure21CodeVersion(), claimGroup.getProcedure21Date(), claimGroup.getProcedure22Code(), claimGroup.getProcedure22CodeVersion(), claimGroup.getProcedure22Date(), claimGroup.getProcedure23Code(), claimGroup.getProcedure23CodeVersion(), claimGroup.getProcedure23Date(), claimGroup.getProcedure24Code(), claimGroup.getProcedure24CodeVersion(), claimGroup.getProcedure24Date(), claimGroup.getProcedure25Code(), claimGroup.getProcedure25CodeVersion(), claimGroup.getProcedure25Date())) TransformerUtils.addProcedureCode(eob, procedure);
    for (InpatientClaimLine claimLine : claimGroup.getLines()) {
        ItemComponent item = eob.addItem();
        item.setSequence(claimLine.getLineNumber().intValue());
        TransformerUtils.mapHcpcs(eob, item, Optional.empty(), claimLine.getHcpcsCode(), Collections.emptyList());
        item.setLocation(new Address().setState((claimGroup.getProviderStateCode())));
        // Common item level fields between Inpatient, Outpatient, HHA, Hospice and SNF
        TransformerUtils.mapEobCommonItemRevenue(item, eob, claimLine.getRevenueCenter(), claimLine.getRateAmount(), claimLine.getTotalChargeAmount(), claimLine.getNonCoveredChargeAmount(), claimLine.getUnitCount(), claimLine.getNationalDrugCodeQuantity(), claimLine.getNationalDrugCodeQualifierCode(), claimLine.getRevenueCenterRenderingPhysicianNPI());
        // Common group level field coinsurance between Inpatient, HHA, Hospice and SNF
        TransformerUtils.mapEobCommonGroupInpHHAHospiceSNFCoinsurance(eob, item, claimLine.getDeductibleCoinsuranceCd());
    }
    TransformerUtils.setLastUpdated(eob, claimGroup.getLastUpdated());
    return eob;
}

Example 3 with Procedure

use of org.hl7.fhir.r4.model.Procedure in project beneficiary-fhir-data by CMSgov.

the class SamhsaMatcherR4FromClaimTransformerV2Test method verifySamhsaMatcherForDiagnosisIcd.

/**
 * Verify SAMHSA matcher for ICD item with the given system, code and if the expectation is that
 * there should be a match for this combination.
 *
 * @param system the system value
 * @param code the code
 * @param shouldMatch if the matcher should match on this combination
 */
private void verifySamhsaMatcherForDiagnosisIcd(String system, String code, boolean shouldMatch, ExplanationOfBenefit explanationOfBenefit) {
    ExplanationOfBenefit modifiedEob = explanationOfBenefit.copy();
    // Set diagnosis
    for (ExplanationOfBenefit.DiagnosisComponent diagnosisComponent : modifiedEob.getDiagnosis()) {
        CodeableConcept codeableConcept = diagnosisComponent.getDiagnosisCodeableConcept();
        ArrayList<Coding> codingList = new ArrayList<>();
        codingList.add(new Coding().setSystem(system).setCode(code));
        codeableConcept.setCoding(codingList);
        diagnosisComponent.setPackageCode(null);
    }
    // Set procedure to empty so we dont check it for matches
    for (ExplanationOfBenefit.ProcedureComponent diagnosisComponent : modifiedEob.getProcedure()) {
        CodeableConcept codeableConcept = diagnosisComponent.getProcedureCodeableConcept();
        ArrayList<Coding> codingList = new ArrayList<>();
        codeableConcept.setCoding(codingList);
    }
    // Set item coding to non-SAMHSA so we dont check it for matches
    List<Coding> codings = new ArrayList<>();
    Coding coding = new Coding();
    coding.setSystem(TransformerConstants.CODING_SYSTEM_HCPCS);
    coding.setCode(NON_SAMHSA_HCPCS_CODE);
    codings.add(coding);
    modifiedEob.getItem().get(0).getProductOrService().setCoding(codings);
    assertEquals(shouldMatch, samhsaMatcherV2.test(modifiedEob));
}

Example 4 with Procedure

use of org.hl7.fhir.r4.model.Procedure in project beneficiary-fhir-data by CMSgov.

the class SamhsaMatcherR4FromClaimTransformerV2Test method verifySamhsaMatcherForProcedureIcd.

/**
 * Verify SAMHSA matcher for ICD item with the given system, code and if the expectation is that
 * there should be a match for this combination.
 *
 * @param system the system value
 * @param code the code
 * @param shouldMatch if the matcher should match on this combination
 */
private void verifySamhsaMatcherForProcedureIcd(String system, String code, boolean shouldMatch, ExplanationOfBenefit explanationOfBenefit) {
    ExplanationOfBenefit modifiedEob = explanationOfBenefit.copy();
    // Set diagnosis to empty so we dont check it for matches
    for (ExplanationOfBenefit.DiagnosisComponent diagnosisComponent : modifiedEob.getDiagnosis()) {
        CodeableConcept codeableConcept = diagnosisComponent.getDiagnosisCodeableConcept();
        ArrayList<Coding> codingList = new ArrayList<>();
        codeableConcept.setCoding(codingList);
        diagnosisComponent.setPackageCode(null);
    }
    // Set procedure
    for (ExplanationOfBenefit.ProcedureComponent diagnosisComponent : modifiedEob.getProcedure()) {
        CodeableConcept codeableConcept = diagnosisComponent.getProcedureCodeableConcept();
        ArrayList<Coding> codingList = new ArrayList<>();
        codingList.add(new Coding().setSystem(system).setCode(code));
        codeableConcept.setCoding(codingList);
    }
    // Set item coding to non-SAMHSA so we dont check it for matches
    List<Coding> codings = new ArrayList<>();
    Coding coding = new Coding();
    coding.setSystem(TransformerConstants.CODING_SYSTEM_HCPCS);
    coding.setCode(NON_SAMHSA_HCPCS_CODE);
    codings.add(coding);
    modifiedEob.getItem().get(0).getProductOrService().setCoding(codings);
    assertEquals(shouldMatch, samhsaMatcherV2.test(modifiedEob));
}

Example 5 with Procedure

use of org.hl7.fhir.r4.model.Procedure in project beneficiary-fhir-data by CMSgov.

the class SamhsaMatcherFromClaimTransformerTest method verifySamhsaMatcherForProcedureIcd.

/**
 * Verify SAMHSA matcher for ICD item with the given system, code and if the expectation is that
 * there should be a match for this combination.
 *
 * @param system the system value
 * @param code the code
 * @param shouldMatch if the matcher should match on this combination
 */
private void verifySamhsaMatcherForProcedureIcd(String system, String code, boolean shouldMatch, ExplanationOfBenefit explanationOfBenefit) {
    ExplanationOfBenefit modifiedEob = explanationOfBenefit.copy();
    // Set diagnosis to empty so we dont check it for matches
    for (ExplanationOfBenefit.DiagnosisComponent diagnosisComponent : modifiedEob.getDiagnosis()) {
        CodeableConcept codeableConcept = diagnosisComponent.getDiagnosisCodeableConcept();
        ArrayList<Coding> codingList = new ArrayList<>();
        if (codeableConcept != null) {
            codeableConcept.setCoding(codingList);
            diagnosisComponent.setPackageCode(null);
        }
    }
    // Set procedure
    for (ExplanationOfBenefit.ProcedureComponent diagnosisComponent : modifiedEob.getProcedure()) {
        CodeableConcept codeableConcept = diagnosisComponent.getProcedureCodeableConcept();
        ArrayList<Coding> codingList = new ArrayList<>();
        codingList.add(new Coding().setSystem(system).setCode(code));
        codeableConcept.setCoding(codingList);
    }
    // Set item coding to non-SAMHSA so we dont check it for matches
    List<Coding> codings = new ArrayList<>();
    Coding coding = new Coding();
    coding.setSystem(TransformerConstants.CODING_SYSTEM_HCPCS);
    coding.setCode(NON_SAMHSA_HCPCS_CODE);
    codings.add(coding);
    modifiedEob.getItem().get(0).getService().setCoding(codings);
    assertEquals(shouldMatch, samhsaMatcher.test(modifiedEob));
}