Examples with INPATIENT org.mitre.synthea.export.BB2RIFStructure.INPATIENT used on opensource projects

Example 1 with INPATIENT

use of org.mitre.synthea.export.BB2RIFStructure.INPATIENT in project synthea by synthetichealth.

the class BB2RIFExporter method exportInpatient.

/**
 * Export inpatient claims details for a single person.
 * @param person the person to export
 * @param startTime earliest claim date to export
 * @param stopTime end time of simulation
 * @throws IOException if something goes wrong
 */
private void exportInpatient(Person person, long startTime, long stopTime) throws IOException {
    HashMap<INPATIENT, String> fieldValues = new HashMap<>();
    boolean previousEmergency = false;
    for (HealthRecord.Encounter encounter : person.record.encounters) {
        if (encounter.stop < startTime) {
            continue;
        }
        boolean isInpatient = encounter.type.equals(EncounterType.INPATIENT.toString());
        boolean isEmergency = encounter.type.equals(EncounterType.EMERGENCY.toString());
        boolean isVA = (ProviderType.VETERAN == encounter.provider.type);
        // IHS facilities have valid 6 digit id, IHS centers don't
        boolean isIHSCenter = (ProviderType.IHS == encounter.provider.type) && encounter.provider.id.length() != 6;
        if (isVA || isIHSCenter || !(isInpatient || isEmergency)) {
            previousEmergency = false;
            continue;
        }
        long claimId = BB2RIFExporter.claimId.getAndDecrement();
        int claimGroupId = BB2RIFExporter.claimGroupId.getAndDecrement();
        long fiDocId = BB2RIFExporter.fiDocCntlNum.getAndDecrement();
        fieldValues.clear();
        staticFieldConfig.setValues(fieldValues, INPATIENT.class, person);
        // The REQUIRED fields
        fieldValues.put(INPATIENT.BENE_ID, (String) person.attributes.get(BB2_BENE_ID));
        fieldValues.put(INPATIENT.CLM_ID, "" + claimId);
        fieldValues.put(INPATIENT.CLM_GRP_ID, "" + claimGroupId);
        fieldValues.put(INPATIENT.FI_DOC_CLM_CNTL_NUM, "" + fiDocId);
        fieldValues.put(INPATIENT.CLM_FROM_DT, bb2DateFromTimestamp(encounter.start));
        fieldValues.put(INPATIENT.CLM_ADMSN_DT, bb2DateFromTimestamp(encounter.start));
        fieldValues.put(INPATIENT.CLM_THRU_DT, bb2DateFromTimestamp(encounter.stop));
        fieldValues.put(INPATIENT.NCH_BENE_DSCHRG_DT, bb2DateFromTimestamp(encounter.stop));
        fieldValues.put(INPATIENT.NCH_WKLY_PROC_DT, bb2DateFromTimestamp(ExportHelper.nextFriday(encounter.stop)));
        fieldValues.put(INPATIENT.PRVDR_NUM, encounter.provider.id);
        fieldValues.put(INPATIENT.AT_PHYSN_NPI, encounter.clinician.npi);
        fieldValues.put(INPATIENT.ORG_NPI_NUM, encounter.provider.npi);
        fieldValues.put(INPATIENT.OP_PHYSN_NPI, encounter.clinician.npi);
        fieldValues.put(INPATIENT.CLM_PMT_AMT, String.format("%.2f", encounter.claim.getTotalClaimCost()));
        if (encounter.claim.payer == Payer.getGovernmentPayer(HealthInsuranceModule.MEDICARE)) {
            fieldValues.put(INPATIENT.NCH_PRMRY_PYR_CLM_PD_AMT, "0");
        } else {
            fieldValues.put(INPATIENT.NCH_PRMRY_PYR_CLM_PD_AMT, String.format("%.2f", encounter.claim.getCoveredCost()));
        }
        fieldValues.put(INPATIENT.PRVDR_STATE_CD, locationMapper.getStateCode(encounter.provider.state));
        // PTNT_DSCHRG_STUS_CD: 1=home, 2=transfer, 3=SNF, 20=died, 30=still here
        String field = null;
        String patientStatus = null;
        if (encounter.ended) {
            // TODO 2=transfer if the next encounter is also inpatient
            field = "1";
            // discharged
            patientStatus = "A";
        } else {
            // the patient is still here
            field = "30";
            // still a patient
            patientStatus = "C";
        }
        if (!person.alive(encounter.stop)) {
            // the patient died before the encounter ended
            field = "20";
            // died
            patientStatus = "B";
        }
        fieldValues.put(INPATIENT.PTNT_DSCHRG_STUS_CD, field);
        fieldValues.put(INPATIENT.NCH_PTNT_STATUS_IND_CD, patientStatus);
        fieldValues.put(INPATIENT.CLM_TOT_CHRG_AMT, String.format("%.2f", encounter.claim.getTotalClaimCost()));
        if (isEmergency) {
            // emergency
            field = "1";
        } else if (previousEmergency) {
            // urgent
            field = "2";
        } else {
            // elective
            field = "3";
        }
        fieldValues.put(INPATIENT.CLM_IP_ADMSN_TYPE_CD, field);
        fieldValues.put(INPATIENT.NCH_BENE_IP_DDCTBL_AMT, String.format("%.2f", encounter.claim.getDeductiblePaid()));
        fieldValues.put(INPATIENT.NCH_BENE_PTA_COINSRNC_LBLTY_AM, String.format("%.2f", encounter.claim.getCoinsurancePaid()));
        fieldValues.put(INPATIENT.NCH_IP_NCVRD_CHRG_AMT, String.format("%.2f", encounter.claim.getPatientCost()));
        fieldValues.put(INPATIENT.NCH_IP_TOT_DDCTN_AMT, String.format("%.2f", encounter.claim.getPatientCost()));
        int days = (int) ((encounter.stop - encounter.start) / (1000 * 60 * 60 * 24));
        fieldValues.put(INPATIENT.CLM_UTLZTN_DAY_CNT, "" + days);
        if (days > 60) {
            field = "" + (days - 60);
        } else {
            field = "0";
        }
        fieldValues.put(INPATIENT.BENE_TOT_COINSRNC_DAYS_CNT, field);
        if (days > 60) {
            // days outlier
            field = "1";
        } else if (encounter.claim.getTotalClaimCost() > 100_000) {
            // cost outlier
            field = "2";
        } else {
            // no outlier
            field = "0";
        }
        fieldValues.put(INPATIENT.CLM_DRG_OUTLIER_STAY_CD, field);
        fieldValues.put(INPATIENT.REV_CNTR_TOT_CHRG_AMT, String.format("%.2f", encounter.claim.getCoveredCost()));
        fieldValues.put(INPATIENT.REV_CNTR_NCVRD_CHRG_AMT, String.format("%.2f", encounter.claim.getPatientCost()));
        // OPTIONAL FIELDS
        fieldValues.put(INPATIENT.RNDRNG_PHYSN_NPI, encounter.clinician.npi);
        String icdReasonCode = null;
        if (encounter.reason != null) {
            // values into the principle diagnoses code.
            if (conditionCodeMapper.canMap(encounter.reason.code)) {
                icdReasonCode = conditionCodeMapper.map(encounter.reason.code, person, true);
                fieldValues.put(INPATIENT.PRNCPAL_DGNS_CD, icdReasonCode);
                fieldValues.put(INPATIENT.ADMTG_DGNS_CD, icdReasonCode);
            }
        }
        // Use the active condition diagnoses to enter mapped values
        // into the diagnoses codes.
        List<String> presentOnAdmission = getDiagnosesCodes(person, encounter.start);
        List<String> mappedDiagnosisCodes = getDiagnosesCodes(person, encounter.stop);
        boolean noDiagnoses = mappedDiagnosisCodes.isEmpty();
        if (!noDiagnoses) {
            int smallest = Math.min(mappedDiagnosisCodes.size(), BB2RIFStructure.inpatientDxFields.length);
            for (int i = 0; i < smallest; i++) {
                INPATIENT[] dxField = BB2RIFStructure.inpatientDxFields[i];
                String dxCode = mappedDiagnosisCodes.get(i);
                fieldValues.put(dxField[0], dxCode);
                // 0=ICD10
                fieldValues.put(dxField[1], "0");
                String present = presentOnAdmission.contains(dxCode) ? "Y" : "N";
                fieldValues.put(dxField[2], present);
            }
            if (!fieldValues.containsKey(INPATIENT.PRNCPAL_DGNS_CD)) {
                fieldValues.put(INPATIENT.PRNCPAL_DGNS_CD, mappedDiagnosisCodes.get(0));
            }
        }
        if (fieldValues.containsKey(INPATIENT.PRNCPAL_DGNS_CD)) {
            String icdCode = fieldValues.get(INPATIENT.PRNCPAL_DGNS_CD);
            // Add a DRG code, if applicable
            if (drgCodeMapper.canMap(icdCode)) {
                fieldValues.put(INPATIENT.CLM_DRG_CD, drgCodeMapper.map(icdCode, person));
            }
            // Check for external code...
            setExternalCode(person, fieldValues, INPATIENT.PRNCPAL_DGNS_CD, INPATIENT.ICD_DGNS_E_CD1, INPATIENT.ICD_DGNS_E_VRSN_CD1, INPATIENT.CLM_E_POA_IND_SW1, presentOnAdmission);
            setExternalCode(person, fieldValues, INPATIENT.PRNCPAL_DGNS_CD, INPATIENT.FST_DGNS_E_CD, INPATIENT.FST_DGNS_E_VRSN_CD);
        }
        // Use the procedures in this encounter to enter mapped values
        boolean noProcedures = false;
        if (!encounter.procedures.isEmpty()) {
            List<HealthRecord.Procedure> mappableProcedures = new ArrayList<>();
            List<String> mappedProcedureCodes = new ArrayList<>();
            for (HealthRecord.Procedure procedure : encounter.procedures) {
                for (HealthRecord.Code code : procedure.codes) {
                    if (conditionCodeMapper.canMap(code.code)) {
                        mappableProcedures.add(procedure);
                        mappedProcedureCodes.add(conditionCodeMapper.map(code.code, person, true));
                        // take the first mappable code for each procedure
                        break;
                    }
                }
            }
            if (!mappableProcedures.isEmpty()) {
                int smallest = Math.min(mappableProcedures.size(), BB2RIFStructure.inpatientPxFields.length);
                for (int i = 0; i < smallest; i++) {
                    INPATIENT[] pxField = BB2RIFStructure.inpatientPxFields[i];
                    fieldValues.put(pxField[0], mappedProcedureCodes.get(i));
                    // 0=ICD10
                    fieldValues.put(pxField[1], "0");
                    fieldValues.put(pxField[2], bb2DateFromTimestamp(mappableProcedures.get(i).start));
                }
            } else {
                noProcedures = true;
            }
        }
        if (icdReasonCode == null && noDiagnoses && noProcedures) {
            // skip this encounter
            continue;
        }
        previousEmergency = isEmergency;
        synchronized (rifWriters.getOrCreateWriter(INPATIENT.class)) {
            int claimLine = 1;
            for (ClaimEntry lineItem : encounter.claim.items) {
                String hcpcsCode = null;
                if (lineItem.entry instanceof HealthRecord.Procedure) {
                    for (HealthRecord.Code code : lineItem.entry.codes) {
                        if (hcpcsCodeMapper.canMap(code.code)) {
                            hcpcsCode = hcpcsCodeMapper.map(code.code, person, true);
                            // take the first mappable code for each procedure
                            break;
                        }
                    }
                    fieldValues.remove(INPATIENT.REV_CNTR_NDC_QTY);
                    fieldValues.remove(INPATIENT.REV_CNTR_NDC_QTY_QLFR_CD);
                } else if (lineItem.entry instanceof HealthRecord.Medication) {
                    HealthRecord.Medication med = (HealthRecord.Medication) lineItem.entry;
                    if (med.administration) {
                        // Administration of medication
                        hcpcsCode = "T1502";
                        // 1 Unit
                        fieldValues.put(INPATIENT.REV_CNTR_NDC_QTY, "1");
                        // Unit
                        fieldValues.put(INPATIENT.REV_CNTR_NDC_QTY_QLFR_CD, "UN");
                    }
                }
                if (hcpcsCode == null) {
                    continue;
                }
                fieldValues.put(INPATIENT.CLM_LINE_NUM, Integer.toString(claimLine++));
                fieldValues.put(INPATIENT.HCPCS_CD, hcpcsCode);
                fieldValues.put(INPATIENT.REV_CNTR_UNIT_CNT, "" + Integer.max(1, days));
                fieldValues.put(INPATIENT.REV_CNTR_RATE_AMT, String.format("%.2f", (lineItem.cost / Integer.max(1, days))));
                fieldValues.put(INPATIENT.REV_CNTR_TOT_CHRG_AMT, String.format("%.2f", lineItem.cost));
                fieldValues.put(INPATIENT.REV_CNTR_NCVRD_CHRG_AMT, String.format("%.2f", lineItem.copay + lineItem.deductible + lineItem.pocket));
                if (lineItem.pocket == 0 && lineItem.deductible == 0) {
                    // Not subject to deductible or coinsurance
                    fieldValues.put(INPATIENT.REV_CNTR_DDCTBL_COINSRNC_CD, "3");
                } else if (lineItem.pocket > 0 && lineItem.deductible > 0) {
                    // Subject to deductible and coinsurance
                    fieldValues.put(INPATIENT.REV_CNTR_DDCTBL_COINSRNC_CD, "0");
                } else if (lineItem.pocket == 0) {
                    // Not subject to deductible
                    fieldValues.put(INPATIENT.REV_CNTR_DDCTBL_COINSRNC_CD, "1");
                } else {
                    // Not subject to coinsurance
                    fieldValues.put(INPATIENT.REV_CNTR_DDCTBL_COINSRNC_CD, "2");
                }
                rifWriters.writeValues(INPATIENT.class, fieldValues);
            }
            if (claimLine == 1) {
                // If claimLine still equals 1, then no line items were successfully added.
                // Add a single top-level entry.
                fieldValues.put(INPATIENT.CLM_LINE_NUM, Integer.toString(claimLine));
                // HCPCS 99221: "Inpatient hospital visits: Initial and subsequent"
                fieldValues.put(INPATIENT.HCPCS_CD, "99221");
                rifWriters.writeValues(INPATIENT.class, fieldValues);
            }
        }
    }
}