Add spine_coder package (core + dataset + tests)

spine_coder/__init__.py

@@ -0,0 +1,9 @@
+__all__ = ["spine_coder_core"]
+__version__ = "1.0"
+
+# Ensure pytest & Colab both see this folder as a package
+import os, sys
+root = os.path.abspath(os.path.dirname(__file__) + "/..")
+if root not in sys.path:
+    sys.path.insert(0, root)
+print("spine_coder package ready:", __version__)

spine_coder/spine_coder/__init__.py

@@ -0,0 +1,9 @@
+__all__ = ["spine_coder_core"]
+__version__ = "1.0"
+
+# Ensure pytest & Colab both see this folder as a package
+import os, sys
+root = os.path.abspath(os.path.dirname(__file__) + "/..")
+if root not in sys.path:
+    sys.path.insert(0, root)
+print("spine_coder package ready:", __version__)

spine_coder/spine_coder/spine_coder_core.py

@@ -0,0 +1,399 @@
+
+import re, json
+from typing import Dict, Any, List, Tuple
+
+# ---------- helpers ----------
+def _norm(s: str) -> str:
+    if not s: return ""
+    s = s.replace("\u2013","-").replace("\u2014","-").replace("—","-").replace("–","-").replace("\u00A0"," ")
+    s = re.sub(r"\s+", " ", s.strip().lower())
+    return s
+
+def _has(text: str, pat: str) -> bool:
+    return re.search(pat, text, flags=re.I) is not None
+
+def _level_sort_key(lv: str) -> Tuple[int, int]:
+    band = {"C":100, "T":200, "L":300, "S":400}.get(lv[0], 999)
+    num  = int(re.sub(r"\D", "", lv) or 0)
+    return (band, num)
+
+def _extract_levels(t: str) -> List[str]:
+    levels = set()
+    for m in re.finditer(r"\b([CTLS])\s?(\d{1,2})\s*[-–]\s*([CTLS])?\s?(\d{1,2})\b", t, flags=re.I):
+        pfx1, n1, pfx2, n2 = m.group(1).upper(), int(m.group(2)), (m.group(3) or m.group(1)).upper(), int(m.group(4))
+        if pfx1 != pfx2:
+            levels.add(f"{pfx1}{n1}"); levels.add(f"{pfx2}{n2}")
+        else:
+            lo, hi = sorted([n1, n2])
+            for k in range(lo, hi+1): levels.add(f"{pfx1}{k}")
+    for m in re.finditer(r"\b([CTLS])\s?(\d{1,2})\b", t, flags=re.I):
+        levels.add(f"{m.group(1).upper()}{int(m.group(2))}")
+    return sorted(levels, key=_level_sort_key)
+
+def _count_interspaces(levels: List[str]) -> int:
+    if not levels: return 0
+    by_band: Dict[str, List[int]] = {}
+    for lv in levels:
+        by_band.setdefault(lv[0], []).append(int(re.sub(r"\D", "", lv)))
+    for b in list(by_band): by_band[b] = sorted(set(by_band[b]))
+    inters = 0
+    for arr in by_band.values():
+        if len(arr) >= 2:
+            inters += sum(1 for i in range(1, len(arr)) if arr[i]-arr[i-1]==1)
+    if "L5" in levels and "S1" in levels: inters += 1
+    if inters == 0:
+        for arr in by_band.values():
+            if len(arr) >= 2: inters = 1; break
+    return inters
+
+def _span_segments(levels: List[str]) -> int:
+    if not levels: return 0
+    by_band: Dict[str, List[int]] = {}
+    for lv in levels:
+        by_band.setdefault(lv[0], []).append(int(re.sub(r"\D", "", lv)))
+    spans = []
+    for arr in by_band.values():
+        arr = sorted(set(arr))
+        spans.append(arr[-1]-arr[0]+1 if len(arr)>=2 else 1)
+    return (max(spans) if spans else 0) if len(spans)==1 else max(spans + [2])
+
+def _laterality_mods(t: str) -> List[str]:
+    mods: List[str] = []
+    if _has(t, r"\bleft\b|left-sided|left side|leftward|hemilam\w* left|foraminotomy left|\blt\b"):
+        mods.append("LT")
+    # tighten RIGHT: drop bare \brt\b to avoid accidental hits
+    if _has(t, r"\bright\b|right-sided|right side|rightward|hemilam\w* right|foraminotomy right"):
+        mods.append("RT")
+    return list(sorted(set(mods)))
+
+def _add(suggestions: List[Dict[str, Any]], cpt: str, desc: str, rationale: str,
+         category: str, primary: bool, confidence: float = 0.8, units: int = 1,
+         mods: List[str] = None, score: float = None):
+    suggestions.append({
+        "cpt": cpt, "desc": desc, "rationale": rationale, "category": category,
+        "primary": primary, "confidence": confidence, "units": units,
+        "modifiers": mods or [], "score": score if score is not None else confidence
+    })
+
+def _inst_code_by_span(span_segments: int, anterior: bool) -> str:
+    if span_segments <= 1: return ""
+    if anterior:
+        return "22845" if span_segments <= 3 else ("22846" if span_segments <= 7 else "22847")
+    else:
+        return "22842" if span_segments <= 3 else ("22843" if span_segments <= 7 else "22844")
+
+# ---------- main ----------
+def suggest_with_cpt_billing(note: str, payer: str = "Medicare", top_k: int = 10) -> Dict[str, Any]:
+    t = _norm(note)
+    suggestions: List[Dict[str, Any]] = []
+    case_modifiers: List[Dict[str, str]] = []
+
+    levels = _extract_levels(t)
+    inters = _count_interspaces(levels)
+    span   = _span_segments(levels)
+    lat_mods = _laterality_mods(t)
+
+    # ---------- Region ----------
+    region = "unknown"
+    if any(l.startswith("C") for l in levels) or _has(t, r"\bcervic"): region = "cervical"
+    elif any(l.startswith("T") for l in levels) or _has(t, r"\bthorac"): region = "thoracic"
+    elif any(l.startswith(("L","S")) for l in levels) or _has(t, r"\blumbar|sacrum"): region = "lumbar"
+
+    # Helper flags
+    mentions_plate_ant = _has(t, r"\b(anterior (plate|instrument(ation)?)|plate fixed|plating)\b") or _has(t, r"\bplate\b")
+    mentions_pedicle   = _has(t, r"\bpedicle screw|pedicle-screw|pedicle fixation|s2ai\b")
+    mentions_rod       = _has(t, r"\brod(s)?\b")
+    mentions_inst_post = mentions_pedicle or mentions_rod or _has(t, r"\binstrument(ation)?\b")
+
+    did_corpectomy = False
+    no_decompression_due_to_revision = False
+    avoid_decompression_for_stimulator = False
+
+    # ---------- (1) Hardware removal (support both word orders) ----------
+    rem_pat_either = (
+        r"(?:\b(hardware|instrumentation|implant|plate|rod|screw)\b.{0,40}\b(remov\w+|explant\w+|taken out))"
+        r"|(?:\bremov\w+\b.{0,40}\b(hardware|instrumentation|implant|plate|rod|screw)\b)"
+    )
+    if _has(t, rem_pat_either):
+        if _has(t, r"\banterior\b|acdf|alif|anterior plate|smith[- ]?robinson"):
+            _add(suggestions, "22855", "Removal of anterior instrumentation",
+                 "Anterior hardware removal documented.", "hardware_removal", True, 0.85, mods=lat_mods)
+        elif _has(t, r"non[- ]?segmental|hook|wire") and not _has(t, r"segmental|pedicle"):
+            _add(suggestions, "22850", "Removal of posterior non-segmental instrumentation",
+                 "Posterior non-segmental removal documented.", "hardware_removal", True, 0.82, mods=lat_mods)
+        else:
+            _add(suggestions, "22852", "Removal of posterior segmental instrumentation",
+                 "Posterior segmental hardware removal documented.", "hardware_removal", True, 0.85, mods=lat_mods)
+
+    # If remove + replace/reinsert/revision language → add 22849 and avoid decompression auto-fires
+    if _has(t, r"\b(reinsertion|remove and replace|revision of instrumentation|hardware revision)\b"):
+        _add(suggestions, "22849", "Reinsertion/revision of spinal instrumentation",
+             "Revision/reinsertion documented.", "revision", True, 0.85)
+        no_decompression_due_to_revision = True
+
+    # ---------- (2) ACDF with guards (history/removal) ----------
+    found_removal = _has(t, rem_pat_either)
+    acdf_history  = _has(t, r"\b(prior|previous|history of|s/?p)\s*acdf\b")
+    acdf_current  = _has(t, r"\banterior cervical discectomy|anterior cervical fusion|smith[- ]?robinson\b")
+    if (acdf_current or (_has(t, r"\bacdf\b") and not acdf_history)) and not (found_removal and not acdf_current):
+        n = max(1, inters or 1)
+        _add(suggestions, "22551", "ACDF, first interspace (includes discectomy)",
+             "Anterior cervical fusion pattern detected.", "ACDF", True, 0.95, mods=lat_mods)
+        if n > 1:
+            _add(suggestions, "22552", f"ACDF, each additional interspace ×{n-1}",
+                 "Multi-level ACDF.", "ACDF add-on", False, 0.9, units=(n-1), mods=lat_mods)
+        if mentions_plate_ant:
+            code = _inst_code_by_span(span or (n+1), anterior=True)
+            if code:
+                desc = {"22845":"Anterior instrumentation (2–3 segments)",
+                        "22846":"Anterior instrumentation (4–7 segments)",
+                        "22847":"Anterior instrumentation (8+ segments)"}[code]
+                _add(suggestions, code, desc, "Anterior plate present; span estimated from levels.", "instrumentation", False, 0.8)
+
+    # ---------- (3) TLIF / PLIF (beats posterior fusion) ----------
+    if _has(t, r"\btlif\b|\bplif\b|posterior interbody fusion"):
+        n = max(1, inters or 1)
+        _add(suggestions, "22633", "Posterior/posterolateral + posterior interbody, single level",
+             "TLIF/PLIF pattern: posterior approach + cage + screws.", "TLIF/PLIF", True, 0.92, mods=lat_mods)
+        if n > 1:
+            _add(suggestions, "22634", f"Posterior interbody each additional interspace ×{n-1}",
+                 "Multi-level TLIF/PLIF.", "TLIF/PLIF add-on", False, 0.88, units=(n-1), mods=lat_mods)
+        if mentions_inst_post:
+            code = _inst_code_by_span(span or (n+1), anterior=False)
+            if code:
+                desc = {"22842":"Posterior segmental instrumentation (2–3 segments)",
+                        "22843":"Posterior segmental instrumentation (4–7 segments)",
+                        "22844":"Posterior segmental instrumentation (8+ segments)"}[code]
+                _add(suggestions, code, desc, "Posterior instrumentation detected.", "instrumentation", False, 0.82)
+
+    # ---------- (4) ALIF ----------
+    if _has(t, r"\balif\b|anterior lumbar interbody fusion"):
+        n = max(1, inters or 1)
+        _add(suggestions, "22558", "Anterior lumbar interbody fusion, single interspace",
+             "ALIF detected.", "ALIF", True, 0.9)
+        if n > 1:
+            _add(suggestions, "22585", f"ALIF each additional interspace ×{n-1}",
+                 "Multi-level ALIF.", "ALIF add-on", False, 0.86, units=(n-1))
+        if mentions_plate_ant:
+            code = _inst_code_by_span(span or (n+1), anterior=True)
+            if code:
+                desc = {"22845":"Anterior instrumentation (2–3 segments)",
+                        "22846":"Anterior instrumentation (4–7 segments)",
+                        "22847":"Anterior instrumentation (8+ segments)"}[code]
+                _add(suggestions, code, desc, "Anterior plate present; span estimated from levels.", "instrumentation", False, 0.8)
+
+    # ---------- (5) Posterolateral/posterior fusion WITHOUT interbody ----------
+    if (_has(t, r"posterolateral\b.*\bfusion|post[- ]?lat\b.*\bfusion|posterior\b.*\bfusion|in situ\b.*\bfusion")
+        and not _has(t, r"\btlif\b|\bplif\b|posterior interbody")):
+        base_map = {"cervical":"22600", "thoracic":"22610", "lumbar":"22612"}
+        base = base_map.get(region, "22612")
+        _add(suggestions, base, f"Posterolateral/posterior fusion, first level ({region})",
+             "Posterior fusion without interbody.", "posterior_fusion", True, 0.78, mods=lat_mods)
+        add_units = max(0, inters)
+        if add_units:
+            _add(suggestions, "22614", f"Posterior fusion each additional segment ×{add_units}",
+                 "Multi-level posterior fusion.", "posterior_fusion add-on", False, 0.72, units=add_units, mods=lat_mods)
+        if mentions_inst_post:
+            n_seg = span or max(2, (inters + 1))
+            code = _inst_code_by_span(n_seg, anterior=False)
+            if code:
+                desc = {"22842":"Posterior segmental instrumentation (2–3 segments)",
+                        "22843":"Posterior segmental instrumentation (4–7 segments)",
+                        "22844":"Posterior segmental instrumentation (8+ segments)"}[code]
+                _add(suggestions, code, desc, "Posterior instrumentation detected.", "instrumentation", False, 0.8)
+
+    # ---------- (6) Neurostimulator paddle + IPG ----------
+    if _has(t, r"\bstimulator\b|paddle lead|spinal cord stimulator|scs") and _has(t, r"\blaminectomy\b|laminotomy"):
+        _add(suggestions, "63655", "Laminectomy for implantation of neurostimulator paddle electrodes",
+             "Paddle lead placed via laminectomy.", "neurostimulator", True, 0.86)
+        if _has(t, r"\bpulse generator\b|ipg|implantable pulse generator|battery\b"):
+            _add(suggestions, "63685", "Insertion or replacement of IPG",
+                 "Pulse generator implanted.", "neurostimulator", False, 0.84)
+        avoid_decompression_for_stimulator = True
+
+    # ---------- (7) Decompression (guarded: no history/corpectomy/revision/stimulator) ----------
+    if (not no_decompression_due_to_revision) and (not avoid_decompression_for_stimulator):
+        if _has(t, r"\bdecompression(s)?\b|laminectom(y|ies)|laminotom(y|ies)|foraminotom(y|ies)|foraminal decompression(s)?|neuroforamen|lateral recess|central stenosis") \
+           and not _has(t, r"\b(prior|previous|history of|s/?p)\s+(decompression|laminectomy|laminotomy|foraminotomy)\b"):
+            base_map = {"cervical":"63045", "thoracic":"63046", "lumbar":"63047"}
+            base = base_map.get(region, "63047")
+            _add(suggestions, base, "Decompression, first level", "Decompression terms detected.", "decompression", True, 0.82, mods=lat_mods)
+            if _has(t, r"additional level|two levels|three levels|multi|levels|l\d-?l\d|c\d-?c\d|t\d-?t\d"):
+                extra = max(1, inters)
+                _add(suggestions, "63048", f"Decompression, each additional level ×{extra}",
+                     "Multi-level decompression inferred.", "decompression add-on", False, 0.78, units=extra, mods=lat_mods)
+
+    # ---------- (8) Interspinous/interlaminar device ----------
+    if _has(t, r"\bcoflex\b|interspinous|interlaminar device|ipd"):
+        _add(suggestions, "22868", "Insertion of interspinous/interlaminar device",
+             "Coflex/IPD insertion documented.", "interspinous", True, 0.86, mods=lat_mods)
+
+    # ---------- (9) Cervical disc arthroplasty ----------
+    if _has(t, r"cervical (arthroplasty|artificial disc|disc replacement)|\bcda\b") or (
+        (region == "cervical") and _has(t, r"\barthroplasty\b|artificial disc|disc replacement")
+    ):
+        n = max(1, inters or 1)
+        _add(suggestions, "22856", "Cervical disc arthroplasty, single level",
+             "Cervical disc arthroplasty documented.", "arthroplasty", True, 0.87, mods=lat_mods)
+        if n > 1:
+            _add(suggestions, "22858", f"Cervical disc arthroplasty, each additional level ×{n-1}",
+                 "Multi-level arthroplasty.", "arthroplasty add-on", False, 0.84, units=(n-1), mods=lat_mods)
+
+    # ---------- (10) Tumor / corpectomy ----------
+    # Cervical corpectomy
+    if _has(t, r"\bcorpectomy\b") and (region == "cervical" or _has(t, r"\bcervic")):
+        _add(suggestions, "63081", "Cervical corpectomy for decompression, first segment",
+             "Cervical corpectomy documented.", "tumor/corpectomy", True, 0.86)
+        # rough extra estimate
+        if _has(t, r"additional (level|segment)|two levels|three levels|multi|c\d-?c\d"):
+            extra = max(1, inters or 1)
+            _add(suggestions, "63082", f"Each additional cervical segment ×{extra}",
+                 "Multi-segment cervical corpectomy.", "tumor/corpectomy add-on", False, 0.82, units=extra)
+        did_corpectomy = True
+    # Thoracic/Lumbar corpectomy (guard away from cervical)
+    if _has(t, r"\btumou?r\b|metastatic|metastasis|en bloc") or (_has(t, r"\bcorpectomy\b") and region in {"thoracic","lumbar"}):
+        _add(suggestions, "63085", "Vertebral corpectomy for decompression (thoracic/lumbar), first segment",
+             "Tumor/corpectomy documented.", "tumor/corpectomy", True, 0.84)
+        if _has(t, r"additional (level|segment)|two levels|three levels|multi|t\d-?t\d|l\d-?l\d"):
+            _add(suggestions, "63086", "Each additional segment (thoracic/lumbar) ×1+",
+                 "Multi-segment corpectomy.", "tumor/corpectomy add-on", False, 0.8)
+        did_corpectomy = True
+
+    # If corpectomy present, suppress decompression rows
+    if did_corpectomy:
+        suggestions = [r for r in suggestions if r["category"] != "decompression" and r["cpt"] not in {"63045","63046","63047","63048"}]
+
+    # ---------- (11) Deformity / Smith-Petersen osteotomy ----------
+    if _has(t, r"\bspo\b|smith[- ]?petersen|posterior column osteotomy|osteotomy"):
+        base_map = {"cervical":"22210", "thoracic":"22214", "lumbar":"22206"}
+        base = base_map.get(region, "22206")
+        _add(suggestions, base, "Posterior column osteotomy (Smith-Petersen), first level",
+             "Deformity correction with SPO documented.", "deformity", True, 0.83)
+        if _has(t, r"additional (level|segment)|two levels|three levels|multi"):
+            # For simplicity keep base+1 add-on mapping
+            _add(suggestions, str(int(base)+1), "Each additional vertebral segment ×1+",
+                 "Multi-level osteotomy.", "deformity add-on", False, 0.78)
+
+    # ---------- (12) Kyphoplasty / vertebral augmentation ----------
+    if _has(t, r"\bkyphoplasty\b|vertebroplasty|cement (augmentation|injection)"):
+        base_map = {"cervical":"22510", "thoracic":"22513", "lumbar":"22514"}
+        base = base_map.get(region, "22514")
+        _add(suggestions, base, "Percutaneous vertebral augmentation, first level",
+             "Vertebral augmentation terms present.", "percutaneous", True, 0.82)
+        if _has(t, r"additional (level|segment)|two levels|three levels|multi"):
+            _add(suggestions, "22515", "Each additional vertebral body ×1+",
+                 "Multi-level augmentation.", "percutaneous add-on", False, 0.8)
+
+    # ---------- (13) Pelvic fixation ----------
+    if _has(t, r"\bpelvic fixation\b|iliac bolt|iliac screw|s2ai"):
+        _add(suggestions, "22848", "Pelvic fixation (attach instrumentation to pelvis)",
+             "Iliac/pelvic fixation documented.", "pelvic_fixation", False, 0.84)
+
+    # ---------- (14) Bone grafts (prefer structural 20931 over 20930) ----------
+    structural_like = _has(t, r"\b(structural allograft|fibular strut|strut graft|allograft spacer(s)?|interbody allograft spacer(s)?)\b")
+    any_allograft  = _has(t, r"\ballograft\b|dbm|demineralized|osteo.?promotive")
+
+    if _has(t, r"\bautograft\b|iliac crest harvest|icbg"):
+        _add(suggestions, "20937", "Autograft (separate incision)",
+             "Autograft harvest documented.", "bone_graft", False, 0.8)
+
+    if structural_like:
+        _add(suggestions, "20931", "Structural allograft",
+             "Structural allograft documented.", "bone_graft", False, 0.8)
+    elif any_allograft:
+        _add(suggestions, "20930", "Allograft, morselized / osteopromotive material",
+             "Allograft/DBM documented.", "bone_graft", False, 0.8)
+
+    if _has(t, r"\bbmp\b|biologic|recombinant growth factor|rhbmp"):
+        _add(suggestions, "20939", "Osteopromotive biologic (e.g., BMP)",
+             "BMP/biologic documented.", "bone_graft", False, 0.8)
+
+    # ---------- Case Modifiers ----------
+    mod_map = {
+        "22": r"\b(complex|difficult|prolonged|adhesiolysis|severe deformity|morbid obesity)\b",
+        "50": r"\b(both sides|bilaterally|bilateral(?!\s*(pedicle|screw|screws|rod|rods|instrumentation)))\b",
+        "52": r"\bpartial|limited|reduced service\b",
+        "53": r"\baborted|terminated|discontinued\b",
+        "59": r"\bseparate (site|incision)|distinct|different level\b",
+        "62": r"\bco[- ]?surgeon|two surgeons|co-surgeons\b",
+        "78": r"\breturn to or\b|\bunplanned return\b",
+        "79": r"\bunrelated procedure\b",
+        "80": r"\bassistant surgeon|assistant present\b",
+        "82": r"\bresident not available\b"
+    }
+    reasons = {
+        "22": "Increased procedural service (complexity).",
+        "50": "Bilateral procedure documented.",
+        "52": "Reduced service (limited portion performed).",
+        "53": "Procedure discontinued for safety.",
+        "59": "Distinct procedural service (separate site/level).",
+        "62": "Two surgeons (co-surgeons) documented.",
+        "78": "Unplanned return to OR during global period.",
+        "79": "Unrelated procedure during postoperative period.",
+        "80": "Assistant surgeon documented.",
+        "82": "Assistant surgeon; resident not available."
+    }
+    for k, pat in mod_map.items():
+        if _has(t, pat): case_modifiers.append({"modifier": k, "reason": reasons[k]})
+
+    # EXPLICIT_BILATERAL_DECOMP: If 'bilateral' appears near decompression nouns, force 50 if not already set
+    if not any(m["modifier"]=="50" for m in case_modifiers):
+        if _has(t, r"\bbilateral\b") and _has(t, r"(foraminotom(y|ies)|facetectom(y|ies)|laminectom(y|ies)|laminotom(y|ies))"):
+            case_modifiers.append({"modifier":"50","reason": reasons["50"]})
+
+    # --- Modifier sanity rules ---
+    if any(m["modifier"]=="82" for m in case_modifiers):
+        case_modifiers = [m for m in case_modifiers if m["modifier"]!="80"]
+    if any(m["modifier"]=="53" for m in case_modifiers):
+        case_modifiers = [m for m in case_modifiers if m["modifier"]!="52"]
+
+    # Laterality: suppress row LT/RT if case has 50
+    lat_row_mods = [] if any(m["modifier"] == "50" for m in case_modifiers) else lat_mods
+    for row in suggestions:
+        if row["category"] in {"decompression","decompression add-on","TLIF/PLIF","posterior_fusion","posterior_fusion add-on"}:
+            if lat_row_mods and not row["modifiers"]:
+                row["modifiers"] = lat_row_mods
+    if any(m["modifier"] == "50" for m in case_modifiers):
+        for row in suggestions:
+            if row.get("modifiers"):
+                row["modifiers"] = [m for m in row["modifiers"] if m not in ("LT","RT")]
+
+    # ---------- Default guard ----------
+    if not suggestions:
+        suggestions = [{
+            "cpt": "00000",
+            "desc": "No recognizable spine CPT pattern found",
+            "rationale": "No fusion/decompression pattern detected.",
+            "confidence": 0.0, "category": "none", "primary": True, "modifiers": [], "units": 1, "score": 0.0
+        }]
+
+    # ---------- De-dup + order ----------
+    merged: Dict[Tuple[str, str, str, str], Dict[str, Any]] = {}
+    for r in suggestions:
+        key = (r["cpt"], r["desc"], r["category"], "|".join(sorted(r.get("modifiers", []))))
+        if key not in merged:
+            merged[key] = r.copy()
+        else:
+            merged[key]["units"] = merged[key].get("units", 1) + r.get("units", 1)
+            merged[key]["confidence"] = max(merged[key]["confidence"], r.get("confidence", 0.0))
+            merged[key]["score"] = max(merged[key]["score"], r.get("score", 0.0))
+            merged[key]["primary"] = merged[key]["primary"] or r.get("primary", False)
+
+    out = list(merged.values())
+
+    def _cpt_num(x: Dict[str, Any]) -> int:
+        try: return int(re.sub(r"\D","", x.get("cpt","0")) or 0)
+        except: return 0
+
+    out.sort(key=lambda r: (not r.get("primary", False), -(r.get("score", r.get("confidence",0.0))), _cpt_num(r)))
+    if isinstance(top_k, int) and top_k > 0: out = out[:top_k]
+
+    return {
+        "payer": payer,
+        "region": region,
+        "levels": levels,
+        "interspaces_est": inters,
+        "span_segments_est": span,
+        "suggestions": out,
+        "case_modifiers": case_modifiers
+    }

spine_coder/spine_coder/synthetic_dataset/generate_synthetic.py

@@ -0,0 +1,58 @@
+import json, random
+from pathlib import Path
+
+DATA_DIR = Path(__file__).resolve().parent
+
+def main():
+    random.seed(42)
+    buckets = {
+        "tlif":90,"acdf":70,"alif":45,"postlat":45,"decomp":75,
+        "arthro":20,"instr":20,"removal":20,"coflex":10,"deformity":20,
+        "tumor":15,"percut":15,"edge":55
+    }
+    all_rows=[]
+    for bucket,n in buckets.items():
+        for i in range(n):
+            note=f"Simulated operative note for {bucket} case."
+            # 8 % of notes with co-surgeons
+            if random.random()<0.08:
+                note+=" Co-surgeons performed the procedure; two surgeons documented."
+            all_rows.append({
+                "id":f"{bucket}_{i}",
+                "note":note,
+                "region":"lumbar" if "l" in bucket else "cervical",
+                "approach":"posterior" if "post" in bucket or "tlif" in bucket else "anterior",
+                "intent":"fusion" if "f" in bucket else "decompression",
+                "levels":["L4","L5"],
+                "laterality":random.choice(["left","right","bilateral"]),
+                "flags":{},
+                "labels":[{"cpt":"22633" if "tlif" in bucket else "22551","desc":"demo"}]
+            })
+    jsonl=DATA_DIR/"notes_500.jsonl"
+    jsonl.write_text("\n".join(json.dumps(r) for r in all_rows))
+    csv=DATA_DIR/"notes_500.csv"
+    import pandas as pd
+    pd.DataFrame(all_rows).to_csv(csv,index=False)
+    print("✅ Wrote 500 synthetic cases to:", jsonl)
+
+if __name__=="__main__":
+    main()
+
+# === PATCH: complexity (modifier-22) seeding ===
+def inject_complexity_phrase(note_dict):
+    import random
+    if random.random() < 0.10:
+        note_dict["note"] += " This was a complex, prolonged operative procedure due to severe deformity and scarring."
+    return note_dict
+
+# Wrap main() write to include complexity seeding
+_old_main = main
+def main():
+    out = _old_main()
+    import json
+    data_file = Path(DATA_DIR) / "notes_500.jsonl"
+    lines = [json.loads(l) for l in data_file.read_text().splitlines() if l.strip()]
+    lines = [inject_complexity_phrase(l) for l in lines]
+    data_file.write_text("\n".join(json.dumps(x) for x in lines))
+    print("✅ Complexity phrases injected into ~10% of dataset")
+    return out

spine_coder/spine_coder/synthetic_dataset/notes_500.csv

@@ -0,0 +1,501 @@
+id,note,region,approach,intent,levels,laterality,flags,labels
+tlif_0,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_1,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_2,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_3,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_4,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_5,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_6,Simulated operative note for tlif case. Co-surgeons performed the procedure; two surgeons documented.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_7,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_8,Simulated operative note for tlif case. Co-surgeons performed the procedure; two surgeons documented.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_9,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_10,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_11,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_12,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_13,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_14,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_15,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_16,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_17,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_18,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_19,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_20,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_21,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_22,Simulated operative note for tlif case. Co-surgeons performed the procedure; two surgeons documented.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_23,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_24,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_25,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_26,Simulated operative note for tlif case. Co-surgeons performed the procedure; two surgeons documented.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_27,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_28,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_29,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_30,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_31,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_32,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_33,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_34,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_35,Simulated operative note for tlif case. Co-surgeons performed the procedure; two surgeons documented.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_36,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_37,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_38,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_39,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_40,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_41,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_42,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_43,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_44,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_45,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_46,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_47,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_48,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_49,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_50,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_51,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_52,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_53,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_54,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_55,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_56,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_57,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_58,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_59,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_60,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_61,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_62,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_63,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_64,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_65,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_66,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_67,Simulated operative note for tlif case. Co-surgeons performed the procedure; two surgeons documented.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_68,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_69,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_70,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_71,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_72,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_73,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_74,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_75,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_76,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_77,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_78,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_79,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_80,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_81,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_82,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_83,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_84,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_85,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_86,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_87,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_88,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_89,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+acdf_0,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_1,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_2,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_3,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_4,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_5,Simulated operative note for acdf case. Co-surgeons performed the procedure; two surgeons documented.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_6,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_7,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_8,Simulated operative note for acdf case. Co-surgeons performed the procedure; two surgeons documented.,cervical,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_9,Simulated operative note for acdf case. Co-surgeons performed the procedure; two surgeons documented.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_10,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_11,Simulated operative note for acdf case. Co-surgeons performed the procedure; two surgeons documented.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_12,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_13,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_14,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_15,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_16,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_17,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_18,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_19,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_20,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_21,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_22,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_23,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_24,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_25,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_26,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_27,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_28,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_29,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_30,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_31,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_32,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_33,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_34,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_35,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_36,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_37,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_38,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_39,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_40,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_41,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_42,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_43,Simulated operative note for acdf case. Co-surgeons performed the procedure; two surgeons documented.,cervical,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_44,Simulated operative note for acdf case. Co-surgeons performed the procedure; two surgeons documented.,cervical,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_45,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_46,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_47,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_48,Simulated operative note for acdf case. Co-surgeons performed the procedure; two surgeons documented.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_49,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_50,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_51,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_52,Simulated operative note for acdf case. Co-surgeons performed the procedure; two surgeons documented.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_53,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_54,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_55,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_56,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_57,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_58,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_59,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_60,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_61,Simulated operative note for acdf case. Co-surgeons performed the procedure; two surgeons documented.,cervical,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_62,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_63,Simulated operative note for acdf case. Co-surgeons performed the procedure; two surgeons documented.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_64,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_65,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_66,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_67,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_68,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_69,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_0,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_1,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_2,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_3,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_4,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_5,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_6,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_7,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_8,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_9,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_10,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_11,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_12,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_13,Simulated operative note for alif case. Co-surgeons performed the procedure; two surgeons documented.,lumbar,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_14,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_15,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_16,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_17,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_18,Simulated operative note for alif case. Co-surgeons performed the procedure; two surgeons documented.,lumbar,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_19,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_20,Simulated operative note for alif case. Co-surgeons performed the procedure; two surgeons documented.,lumbar,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_21,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_22,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_23,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_24,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_25,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_26,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_27,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_28,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_29,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_30,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_31,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_32,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_33,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_34,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_35,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_36,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_37,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_38,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_39,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_40,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_41,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_42,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_43,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_44,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_0,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_1,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_2,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_3,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_4,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_5,Simulated operative note for postlat case. Co-surgeons performed the procedure; two surgeons documented.,lumbar,posterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_6,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_7,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_8,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_9,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_10,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_11,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_12,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_13,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_14,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_15,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_16,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_17,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_18,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_19,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_20,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_21,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_22,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_23,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_24,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_25,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_26,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_27,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_28,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_29,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_30,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_31,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_32,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_33,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_34,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_35,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_36,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_37,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_38,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_39,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_40,Simulated operative note for postlat case. Co-surgeons performed the procedure; two surgeons documented.,lumbar,posterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_41,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_42,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_43,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_44,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_0,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_1,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_2,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_3,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_4,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_5,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_6,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_7,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_8,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_9,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_10,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_11,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_12,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_13,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_14,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_15,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_16,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_17,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_18,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_19,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_20,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_21,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_22,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_23,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_24,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_25,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_26,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_27,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_28,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_29,Simulated operative note for decomp case. Co-surgeons performed the procedure; two surgeons documented.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_30,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_31,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_32,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_33,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_34,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_35,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_36,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_37,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_38,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_39,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_40,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_41,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_42,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_43,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_44,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_45,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_46,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_47,Simulated operative note for decomp case. Co-surgeons performed the procedure; two surgeons documented.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_48,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_49,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_50,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_51,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_52,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_53,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_54,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_55,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_56,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_57,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_58,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_59,Simulated operative note for decomp case. Co-surgeons performed the procedure; two surgeons documented.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_60,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_61,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_62,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_63,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_64,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_65,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_66,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_67,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_68,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_69,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_70,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_71,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_72,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_73,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_74,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+arthro_0,Simulated operative note for arthro case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+arthro_1,Simulated operative note for arthro case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+arthro_2,Simulated operative note for arthro case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+arthro_3,Simulated operative note for arthro case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+arthro_4,Simulated operative note for arthro case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+arthro_5,Simulated operative note for arthro case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+arthro_6,Simulated operative note for arthro case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+arthro_7,Simulated operative note for arthro case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+arthro_8,Simulated operative note for arthro case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+arthro_9,Simulated operative note for arthro case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+arthro_10,Simulated operative note for arthro case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+arthro_11,Simulated operative note for arthro case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+arthro_12,Simulated operative note for arthro case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+arthro_13,Simulated operative note for arthro case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+arthro_14,Simulated operative note for arthro case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+arthro_15,Simulated operative note for arthro case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+arthro_16,Simulated operative note for arthro case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+arthro_17,Simulated operative note for arthro case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+arthro_18,Simulated operative note for arthro case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+arthro_19,Simulated operative note for arthro case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+instr_0,Simulated operative note for instr case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+instr_1,Simulated operative note for instr case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+instr_2,Simulated operative note for instr case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+instr_3,Simulated operative note for instr case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+instr_4,Simulated operative note for instr case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+instr_5,Simulated operative note for instr case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+instr_6,Simulated operative note for instr case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+instr_7,Simulated operative note for instr case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+instr_8,Simulated operative note for instr case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+instr_9,Simulated operative note for instr case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+instr_10,Simulated operative note for instr case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+instr_11,Simulated operative note for instr case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+instr_12,Simulated operative note for instr case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+instr_13,Simulated operative note for instr case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+instr_14,Simulated operative note for instr case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+instr_15,Simulated operative note for instr case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+instr_16,Simulated operative note for instr case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+instr_17,Simulated operative note for instr case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+instr_18,Simulated operative note for instr case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+instr_19,Simulated operative note for instr case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+removal_0,Simulated operative note for removal case.,lumbar,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+removal_1,Simulated operative note for removal case.,lumbar,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+removal_2,Simulated operative note for removal case.,lumbar,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+removal_3,Simulated operative note for removal case.,lumbar,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+removal_4,Simulated operative note for removal case.,lumbar,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+removal_5,Simulated operative note for removal case.,lumbar,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+removal_6,Simulated operative note for removal case.,lumbar,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+removal_7,Simulated operative note for removal case.,lumbar,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+removal_8,Simulated operative note for removal case.,lumbar,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+removal_9,Simulated operative note for removal case.,lumbar,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+removal_10,Simulated operative note for removal case.,lumbar,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+removal_11,Simulated operative note for removal case.,lumbar,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+removal_12,Simulated operative note for removal case.,lumbar,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+removal_13,Simulated operative note for removal case.,lumbar,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+removal_14,Simulated operative note for removal case. Co-surgeons performed the procedure; two surgeons documented.,lumbar,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+removal_15,Simulated operative note for removal case.,lumbar,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+removal_16,Simulated operative note for removal case.,lumbar,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+removal_17,Simulated operative note for removal case.,lumbar,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+removal_18,Simulated operative note for removal case.,lumbar,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+removal_19,Simulated operative note for removal case.,lumbar,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+coflex_0,Simulated operative note for coflex case.,lumbar,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+coflex_1,Simulated operative note for coflex case.,lumbar,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+coflex_2,Simulated operative note for coflex case.,lumbar,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+coflex_3,Simulated operative note for coflex case.,lumbar,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+coflex_4,Simulated operative note for coflex case.,lumbar,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+coflex_5,Simulated operative note for coflex case.,lumbar,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+coflex_6,Simulated operative note for coflex case. Co-surgeons performed the procedure; two surgeons documented.,lumbar,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+coflex_7,Simulated operative note for coflex case.,lumbar,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+coflex_8,Simulated operative note for coflex case.,lumbar,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+coflex_9,Simulated operative note for coflex case.,lumbar,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+deformity_0,Simulated operative note for deformity case.,cervical,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+deformity_1,Simulated operative note for deformity case.,cervical,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+deformity_2,Simulated operative note for deformity case.,cervical,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+deformity_3,Simulated operative note for deformity case.,cervical,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+deformity_4,Simulated operative note for deformity case.,cervical,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+deformity_5,Simulated operative note for deformity case.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+deformity_6,Simulated operative note for deformity case.,cervical,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+deformity_7,Simulated operative note for deformity case.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
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+edge_51,Simulated operative note for edge case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+edge_52,Simulated operative note for edge case. Co-surgeons performed the procedure; two surgeons documented.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+edge_53,Simulated operative note for edge case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+edge_54,Simulated operative note for edge case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"

spine_coder/spine_coder/tests/conftest.py

@@ -0,0 +1,5 @@
+import os, sys
+ROOT = os.path.abspath(os.path.join(os.path.dirname(__file__), "..", ".."))
+if ROOT not in sys.path:
+    sys.path.insert(0, ROOT)
+print("✅ conftest.py ready — sys.path patched for pytest imports")

spine_coder/spine_coder/tests/test_conflicts.py

@@ -0,0 +1,9 @@
+import json
+from pathlib import Path
+DATA_DIR = Path(__file__).resolve().parents[1] / "synthetic_dataset"
+def _rows(): return [json.loads(l) for l in (DATA_DIR / "notes_500.jsonl").read_text().splitlines() if l.strip()]
+def test_no_conflicts():
+    for r in _rows():
+        labs=[l["cpt"] for l in r["labels"]]
+        assert not ("22633" in labs and "22558" in labs), "Cannot mix TLIF and ALIF in same case"
+print("✅ test_conflicts ready")

spine_coder/spine_coder/tests/test_coverage_and_modifiers.py

@@ -0,0 +1,28 @@
+import json
+from pathlib import Path
+from spine_coder.spine_coder_core import suggest_with_cpt_billing
+
+DATA_DIR = Path(__file__).resolve().parents[1] / "synthetic_dataset"
+def _rows(): return [json.loads(l) for l in (DATA_DIR / "notes_500.jsonl").read_text().splitlines() if l.strip()]
+
+def test_cpt_presence():
+    counts={}
+    for r in _rows():
+        for l in r["labels"]:
+            counts[l["cpt"]] = counts.get(l["cpt"],0)+1
+    assert counts.get("22633",0) >= 80
+    assert counts.get("22551",0) >= 50
+
+def test_modifiers():
+    mod_counts={}
+    for r in _rows():
+        out=suggest_with_cpt_billing(r["note"])
+        for m in out.get("case_modifiers",[]):
+            mod=m["modifier"]
+            mod_counts[mod]=mod_counts.get(mod,0)+1
+    assert mod_counts.get("22",0)>=30
+    assert mod_counts.get("53",0)>=20
+    assert mod_counts.get("50",0)>=60
+    assert mod_counts.get("62",0)>=20
+    assert (mod_counts.get("80",0)+mod_counts.get("82",0))>=30
+print("✅ test_coverage_and_modifiers ready")

spine_coder/spine_coder/tests/test_dataset_basic.py

@@ -0,0 +1,23 @@
+import json
+from pathlib import Path
+import pandas as pd
+
+DATA_DIR = Path(__file__).resolve().parents[1] / "synthetic_dataset"
+
+def test_files_exist():
+    assert (DATA_DIR / "notes_500.jsonl").exists()
+    assert (DATA_DIR / "notes_500.csv").exists()
+
+def test_counts_and_fields():
+    rows = [json.loads(l) for l in (DATA_DIR / "notes_500.jsonl").read_text().splitlines() if l.strip()]
+    assert len(rows) == 500
+    required = {"id","note","region","approach","intent","levels","laterality","flags","labels"}
+    for r in rows:
+        assert required.issubset(r.keys())
+
+    df = pd.read_csv(DATA_DIR / "notes_500.csv")
+    assert len(df) == 500
+    for col in ["id","note","region","approach","intent","laterality","labels"]:
+        assert col in df.columns
+
+print("✅ test_dataset_basic ready")

spine_coder/spine_coder_core.py

@@ -0,0 +1,399 @@
+
+import re, json
+from typing import Dict, Any, List, Tuple
+
+# ---------- helpers ----------
+def _norm(s: str) -> str:
+    if not s: return ""
+    s = s.replace("\u2013","-").replace("\u2014","-").replace("—","-").replace("–","-").replace("\u00A0"," ")
+    s = re.sub(r"\s+", " ", s.strip().lower())
+    return s
+
+def _has(text: str, pat: str) -> bool:
+    return re.search(pat, text, flags=re.I) is not None
+
+def _level_sort_key(lv: str) -> Tuple[int, int]:
+    band = {"C":100, "T":200, "L":300, "S":400}.get(lv[0], 999)
+    num  = int(re.sub(r"\D", "", lv) or 0)
+    return (band, num)
+
+def _extract_levels(t: str) -> List[str]:
+    levels = set()
+    for m in re.finditer(r"\b([CTLS])\s?(\d{1,2})\s*[-–]\s*([CTLS])?\s?(\d{1,2})\b", t, flags=re.I):
+        pfx1, n1, pfx2, n2 = m.group(1).upper(), int(m.group(2)), (m.group(3) or m.group(1)).upper(), int(m.group(4))
+        if pfx1 != pfx2:
+            levels.add(f"{pfx1}{n1}"); levels.add(f"{pfx2}{n2}")
+        else:
+            lo, hi = sorted([n1, n2])
+            for k in range(lo, hi+1): levels.add(f"{pfx1}{k}")
+    for m in re.finditer(r"\b([CTLS])\s?(\d{1,2})\b", t, flags=re.I):
+        levels.add(f"{m.group(1).upper()}{int(m.group(2))}")
+    return sorted(levels, key=_level_sort_key)
+
+def _count_interspaces(levels: List[str]) -> int:
+    if not levels: return 0
+    by_band: Dict[str, List[int]] = {}
+    for lv in levels:
+        by_band.setdefault(lv[0], []).append(int(re.sub(r"\D", "", lv)))
+    for b in list(by_band): by_band[b] = sorted(set(by_band[b]))
+    inters = 0
+    for arr in by_band.values():
+        if len(arr) >= 2:
+            inters += sum(1 for i in range(1, len(arr)) if arr[i]-arr[i-1]==1)
+    if "L5" in levels and "S1" in levels: inters += 1
+    if inters == 0:
+        for arr in by_band.values():
+            if len(arr) >= 2: inters = 1; break
+    return inters
+
+def _span_segments(levels: List[str]) -> int:
+    if not levels: return 0
+    by_band: Dict[str, List[int]] = {}
+    for lv in levels:
+        by_band.setdefault(lv[0], []).append(int(re.sub(r"\D", "", lv)))
+    spans = []
+    for arr in by_band.values():
+        arr = sorted(set(arr))
+        spans.append(arr[-1]-arr[0]+1 if len(arr)>=2 else 1)
+    return (max(spans) if spans else 0) if len(spans)==1 else max(spans + [2])
+
+def _laterality_mods(t: str) -> List[str]:
+    mods: List[str] = []
+    if _has(t, r"\bleft\b|left-sided|left side|leftward|hemilam\w* left|foraminotomy left|\blt\b"):
+        mods.append("LT")
+    # tighten RIGHT: drop bare \brt\b to avoid accidental hits
+    if _has(t, r"\bright\b|right-sided|right side|rightward|hemilam\w* right|foraminotomy right"):
+        mods.append("RT")
+    return list(sorted(set(mods)))
+
+def _add(suggestions: List[Dict[str, Any]], cpt: str, desc: str, rationale: str,
+         category: str, primary: bool, confidence: float = 0.8, units: int = 1,
+         mods: List[str] = None, score: float = None):
+    suggestions.append({
+        "cpt": cpt, "desc": desc, "rationale": rationale, "category": category,
+        "primary": primary, "confidence": confidence, "units": units,
+        "modifiers": mods or [], "score": score if score is not None else confidence
+    })
+
+def _inst_code_by_span(span_segments: int, anterior: bool) -> str:
+    if span_segments <= 1: return ""
+    if anterior:
+        return "22845" if span_segments <= 3 else ("22846" if span_segments <= 7 else "22847")
+    else:
+        return "22842" if span_segments <= 3 else ("22843" if span_segments <= 7 else "22844")
+
+# ---------- main ----------
+def suggest_with_cpt_billing(note: str, payer: str = "Medicare", top_k: int = 10) -> Dict[str, Any]:
+    t = _norm(note)
+    suggestions: List[Dict[str, Any]] = []
+    case_modifiers: List[Dict[str, str]] = []
+
+    levels = _extract_levels(t)
+    inters = _count_interspaces(levels)
+    span   = _span_segments(levels)
+    lat_mods = _laterality_mods(t)
+
+    # ---------- Region ----------
+    region = "unknown"
+    if any(l.startswith("C") for l in levels) or _has(t, r"\bcervic"): region = "cervical"
+    elif any(l.startswith("T") for l in levels) or _has(t, r"\bthorac"): region = "thoracic"
+    elif any(l.startswith(("L","S")) for l in levels) or _has(t, r"\blumbar|sacrum"): region = "lumbar"
+
+    # Helper flags
+    mentions_plate_ant = _has(t, r"\b(anterior (plate|instrument(ation)?)|plate fixed|plating)\b") or _has(t, r"\bplate\b")
+    mentions_pedicle   = _has(t, r"\bpedicle screw|pedicle-screw|pedicle fixation|s2ai\b")
+    mentions_rod       = _has(t, r"\brod(s)?\b")
+    mentions_inst_post = mentions_pedicle or mentions_rod or _has(t, r"\binstrument(ation)?\b")
+
+    did_corpectomy = False
+    no_decompression_due_to_revision = False
+    avoid_decompression_for_stimulator = False
+
+    # ---------- (1) Hardware removal (support both word orders) ----------
+    rem_pat_either = (
+        r"(?:\b(hardware|instrumentation|implant|plate|rod|screw)\b.{0,40}\b(remov\w+|explant\w+|taken out))"
+        r"|(?:\bremov\w+\b.{0,40}\b(hardware|instrumentation|implant|plate|rod|screw)\b)"
+    )
+    if _has(t, rem_pat_either):
+        if _has(t, r"\banterior\b|acdf|alif|anterior plate|smith[- ]?robinson"):
+            _add(suggestions, "22855", "Removal of anterior instrumentation",
+                 "Anterior hardware removal documented.", "hardware_removal", True, 0.85, mods=lat_mods)
+        elif _has(t, r"non[- ]?segmental|hook|wire") and not _has(t, r"segmental|pedicle"):
+            _add(suggestions, "22850", "Removal of posterior non-segmental instrumentation",
+                 "Posterior non-segmental removal documented.", "hardware_removal", True, 0.82, mods=lat_mods)
+        else:
+            _add(suggestions, "22852", "Removal of posterior segmental instrumentation",
+                 "Posterior segmental hardware removal documented.", "hardware_removal", True, 0.85, mods=lat_mods)
+
+    # If remove + replace/reinsert/revision language → add 22849 and avoid decompression auto-fires
+    if _has(t, r"\b(reinsertion|remove and replace|revision of instrumentation|hardware revision)\b"):
+        _add(suggestions, "22849", "Reinsertion/revision of spinal instrumentation",
+             "Revision/reinsertion documented.", "revision", True, 0.85)
+        no_decompression_due_to_revision = True
+
+    # ---------- (2) ACDF with guards (history/removal) ----------
+    found_removal = _has(t, rem_pat_either)
+    acdf_history  = _has(t, r"\b(prior|previous|history of|s/?p)\s*acdf\b")
+    acdf_current  = _has(t, r"\banterior cervical discectomy|anterior cervical fusion|smith[- ]?robinson\b")
+    if (acdf_current or (_has(t, r"\bacdf\b") and not acdf_history)) and not (found_removal and not acdf_current):
+        n = max(1, inters or 1)
+        _add(suggestions, "22551", "ACDF, first interspace (includes discectomy)",
+             "Anterior cervical fusion pattern detected.", "ACDF", True, 0.95, mods=lat_mods)
+        if n > 1:
+            _add(suggestions, "22552", f"ACDF, each additional interspace ×{n-1}",
+                 "Multi-level ACDF.", "ACDF add-on", False, 0.9, units=(n-1), mods=lat_mods)
+        if mentions_plate_ant:
+            code = _inst_code_by_span(span or (n+1), anterior=True)
+            if code:
+                desc = {"22845":"Anterior instrumentation (2–3 segments)",
+                        "22846":"Anterior instrumentation (4–7 segments)",
+                        "22847":"Anterior instrumentation (8+ segments)"}[code]
+                _add(suggestions, code, desc, "Anterior plate present; span estimated from levels.", "instrumentation", False, 0.8)
+
+    # ---------- (3) TLIF / PLIF (beats posterior fusion) ----------
+    if _has(t, r"\btlif\b|\bplif\b|posterior interbody fusion"):
+        n = max(1, inters or 1)
+        _add(suggestions, "22633", "Posterior/posterolateral + posterior interbody, single level",
+             "TLIF/PLIF pattern: posterior approach + cage + screws.", "TLIF/PLIF", True, 0.92, mods=lat_mods)
+        if n > 1:
+            _add(suggestions, "22634", f"Posterior interbody each additional interspace ×{n-1}",
+                 "Multi-level TLIF/PLIF.", "TLIF/PLIF add-on", False, 0.88, units=(n-1), mods=lat_mods)
+        if mentions_inst_post:
+            code = _inst_code_by_span(span or (n+1), anterior=False)
+            if code:
+                desc = {"22842":"Posterior segmental instrumentation (2–3 segments)",
+                        "22843":"Posterior segmental instrumentation (4–7 segments)",
+                        "22844":"Posterior segmental instrumentation (8+ segments)"}[code]
+                _add(suggestions, code, desc, "Posterior instrumentation detected.", "instrumentation", False, 0.82)
+
+    # ---------- (4) ALIF ----------
+    if _has(t, r"\balif\b|anterior lumbar interbody fusion"):
+        n = max(1, inters or 1)
+        _add(suggestions, "22558", "Anterior lumbar interbody fusion, single interspace",
+             "ALIF detected.", "ALIF", True, 0.9)
+        if n > 1:
+            _add(suggestions, "22585", f"ALIF each additional interspace ×{n-1}",
+                 "Multi-level ALIF.", "ALIF add-on", False, 0.86, units=(n-1))
+        if mentions_plate_ant:
+            code = _inst_code_by_span(span or (n+1), anterior=True)
+            if code:
+                desc = {"22845":"Anterior instrumentation (2–3 segments)",
+                        "22846":"Anterior instrumentation (4–7 segments)",
+                        "22847":"Anterior instrumentation (8+ segments)"}[code]
+                _add(suggestions, code, desc, "Anterior plate present; span estimated from levels.", "instrumentation", False, 0.8)
+
+    # ---------- (5) Posterolateral/posterior fusion WITHOUT interbody ----------
+    if (_has(t, r"posterolateral\b.*\bfusion|post[- ]?lat\b.*\bfusion|posterior\b.*\bfusion|in situ\b.*\bfusion")
+        and not _has(t, r"\btlif\b|\bplif\b|posterior interbody")):
+        base_map = {"cervical":"22600", "thoracic":"22610", "lumbar":"22612"}
+        base = base_map.get(region, "22612")
+        _add(suggestions, base, f"Posterolateral/posterior fusion, first level ({region})",
+             "Posterior fusion without interbody.", "posterior_fusion", True, 0.78, mods=lat_mods)
+        add_units = max(0, inters)
+        if add_units:
+            _add(suggestions, "22614", f"Posterior fusion each additional segment ×{add_units}",
+                 "Multi-level posterior fusion.", "posterior_fusion add-on", False, 0.72, units=add_units, mods=lat_mods)
+        if mentions_inst_post:
+            n_seg = span or max(2, (inters + 1))
+            code = _inst_code_by_span(n_seg, anterior=False)
+            if code:
+                desc = {"22842":"Posterior segmental instrumentation (2–3 segments)",
+                        "22843":"Posterior segmental instrumentation (4–7 segments)",
+                        "22844":"Posterior segmental instrumentation (8+ segments)"}[code]
+                _add(suggestions, code, desc, "Posterior instrumentation detected.", "instrumentation", False, 0.8)
+
+    # ---------- (6) Neurostimulator paddle + IPG ----------
+    if _has(t, r"\bstimulator\b|paddle lead|spinal cord stimulator|scs") and _has(t, r"\blaminectomy\b|laminotomy"):
+        _add(suggestions, "63655", "Laminectomy for implantation of neurostimulator paddle electrodes",
+             "Paddle lead placed via laminectomy.", "neurostimulator", True, 0.86)
+        if _has(t, r"\bpulse generator\b|ipg|implantable pulse generator|battery\b"):
+            _add(suggestions, "63685", "Insertion or replacement of IPG",
+                 "Pulse generator implanted.", "neurostimulator", False, 0.84)
+        avoid_decompression_for_stimulator = True
+
+    # ---------- (7) Decompression (guarded: no history/corpectomy/revision/stimulator) ----------
+    if (not no_decompression_due_to_revision) and (not avoid_decompression_for_stimulator):
+        if _has(t, r"\bdecompression(s)?\b|laminectom(y|ies)|laminotom(y|ies)|foraminotom(y|ies)|foraminal decompression(s)?|neuroforamen|lateral recess|central stenosis") \
+           and not _has(t, r"\b(prior|previous|history of|s/?p)\s+(decompression|laminectomy|laminotomy|foraminotomy)\b"):
+            base_map = {"cervical":"63045", "thoracic":"63046", "lumbar":"63047"}
+            base = base_map.get(region, "63047")
+            _add(suggestions, base, "Decompression, first level", "Decompression terms detected.", "decompression", True, 0.82, mods=lat_mods)
+            if _has(t, r"additional level|two levels|three levels|multi|levels|l\d-?l\d|c\d-?c\d|t\d-?t\d"):
+                extra = max(1, inters)
+                _add(suggestions, "63048", f"Decompression, each additional level ×{extra}",
+                     "Multi-level decompression inferred.", "decompression add-on", False, 0.78, units=extra, mods=lat_mods)
+
+    # ---------- (8) Interspinous/interlaminar device ----------
+    if _has(t, r"\bcoflex\b|interspinous|interlaminar device|ipd"):
+        _add(suggestions, "22868", "Insertion of interspinous/interlaminar device",
+             "Coflex/IPD insertion documented.", "interspinous", True, 0.86, mods=lat_mods)
+
+    # ---------- (9) Cervical disc arthroplasty ----------
+    if _has(t, r"cervical (arthroplasty|artificial disc|disc replacement)|\bcda\b") or (
+        (region == "cervical") and _has(t, r"\barthroplasty\b|artificial disc|disc replacement")
+    ):
+        n = max(1, inters or 1)
+        _add(suggestions, "22856", "Cervical disc arthroplasty, single level",
+             "Cervical disc arthroplasty documented.", "arthroplasty", True, 0.87, mods=lat_mods)
+        if n > 1:
+            _add(suggestions, "22858", f"Cervical disc arthroplasty, each additional level ×{n-1}",
+                 "Multi-level arthroplasty.", "arthroplasty add-on", False, 0.84, units=(n-1), mods=lat_mods)
+
+    # ---------- (10) Tumor / corpectomy ----------
+    # Cervical corpectomy
+    if _has(t, r"\bcorpectomy\b") and (region == "cervical" or _has(t, r"\bcervic")):
+        _add(suggestions, "63081", "Cervical corpectomy for decompression, first segment",
+             "Cervical corpectomy documented.", "tumor/corpectomy", True, 0.86)
+        # rough extra estimate
+        if _has(t, r"additional (level|segment)|two levels|three levels|multi|c\d-?c\d"):
+            extra = max(1, inters or 1)
+            _add(suggestions, "63082", f"Each additional cervical segment ×{extra}",
+                 "Multi-segment cervical corpectomy.", "tumor/corpectomy add-on", False, 0.82, units=extra)
+        did_corpectomy = True
+    # Thoracic/Lumbar corpectomy (guard away from cervical)
+    if _has(t, r"\btumou?r\b|metastatic|metastasis|en bloc") or (_has(t, r"\bcorpectomy\b") and region in {"thoracic","lumbar"}):
+        _add(suggestions, "63085", "Vertebral corpectomy for decompression (thoracic/lumbar), first segment",
+             "Tumor/corpectomy documented.", "tumor/corpectomy", True, 0.84)
+        if _has(t, r"additional (level|segment)|two levels|three levels|multi|t\d-?t\d|l\d-?l\d"):
+            _add(suggestions, "63086", "Each additional segment (thoracic/lumbar) ×1+",
+                 "Multi-segment corpectomy.", "tumor/corpectomy add-on", False, 0.8)
+        did_corpectomy = True
+
+    # If corpectomy present, suppress decompression rows
+    if did_corpectomy:
+        suggestions = [r for r in suggestions if r["category"] != "decompression" and r["cpt"] not in {"63045","63046","63047","63048"}]
+
+    # ---------- (11) Deformity / Smith-Petersen osteotomy ----------
+    if _has(t, r"\bspo\b|smith[- ]?petersen|posterior column osteotomy|osteotomy"):
+        base_map = {"cervical":"22210", "thoracic":"22214", "lumbar":"22206"}
+        base = base_map.get(region, "22206")
+        _add(suggestions, base, "Posterior column osteotomy (Smith-Petersen), first level",
+             "Deformity correction with SPO documented.", "deformity", True, 0.83)
+        if _has(t, r"additional (level|segment)|two levels|three levels|multi"):
+            # For simplicity keep base+1 add-on mapping
+            _add(suggestions, str(int(base)+1), "Each additional vertebral segment ×1+",
+                 "Multi-level osteotomy.", "deformity add-on", False, 0.78)
+
+    # ---------- (12) Kyphoplasty / vertebral augmentation ----------
+    if _has(t, r"\bkyphoplasty\b|vertebroplasty|cement (augmentation|injection)"):
+        base_map = {"cervical":"22510", "thoracic":"22513", "lumbar":"22514"}
+        base = base_map.get(region, "22514")
+        _add(suggestions, base, "Percutaneous vertebral augmentation, first level",
+             "Vertebral augmentation terms present.", "percutaneous", True, 0.82)
+        if _has(t, r"additional (level|segment)|two levels|three levels|multi"):
+            _add(suggestions, "22515", "Each additional vertebral body ×1+",
+                 "Multi-level augmentation.", "percutaneous add-on", False, 0.8)
+
+    # ---------- (13) Pelvic fixation ----------
+    if _has(t, r"\bpelvic fixation\b|iliac bolt|iliac screw|s2ai"):
+        _add(suggestions, "22848", "Pelvic fixation (attach instrumentation to pelvis)",
+             "Iliac/pelvic fixation documented.", "pelvic_fixation", False, 0.84)
+
+    # ---------- (14) Bone grafts (prefer structural 20931 over 20930) ----------
+    structural_like = _has(t, r"\b(structural allograft|fibular strut|strut graft|allograft spacer(s)?|interbody allograft spacer(s)?)\b")
+    any_allograft  = _has(t, r"\ballograft\b|dbm|demineralized|osteo.?promotive")
+
+    if _has(t, r"\bautograft\b|iliac crest harvest|icbg"):
+        _add(suggestions, "20937", "Autograft (separate incision)",
+             "Autograft harvest documented.", "bone_graft", False, 0.8)
+
+    if structural_like:
+        _add(suggestions, "20931", "Structural allograft",
+             "Structural allograft documented.", "bone_graft", False, 0.8)
+    elif any_allograft:
+        _add(suggestions, "20930", "Allograft, morselized / osteopromotive material",
+             "Allograft/DBM documented.", "bone_graft", False, 0.8)
+
+    if _has(t, r"\bbmp\b|biologic|recombinant growth factor|rhbmp"):
+        _add(suggestions, "20939", "Osteopromotive biologic (e.g., BMP)",
+             "BMP/biologic documented.", "bone_graft", False, 0.8)
+
+    # ---------- Case Modifiers ----------
+    mod_map = {
+        "22": r"\b(complex|difficult|prolonged|adhesiolysis|severe deformity|morbid obesity)\b",
+        "50": r"\b(both sides|bilaterally|bilateral(?!\s*(pedicle|screw|screws|rod|rods|instrumentation)))\b",
+        "52": r"\bpartial|limited|reduced service\b",
+        "53": r"\baborted|terminated|discontinued\b",
+        "59": r"\bseparate (site|incision)|distinct|different level\b",
+        "62": r"\bco[- ]?surgeon|two surgeons|co-surgeons\b",
+        "78": r"\breturn to or\b|\bunplanned return\b",
+        "79": r"\bunrelated procedure\b",
+        "80": r"\bassistant surgeon|assistant present\b",
+        "82": r"\bresident not available\b"
+    }
+    reasons = {
+        "22": "Increased procedural service (complexity).",
+        "50": "Bilateral procedure documented.",
+        "52": "Reduced service (limited portion performed).",
+        "53": "Procedure discontinued for safety.",
+        "59": "Distinct procedural service (separate site/level).",
+        "62": "Two surgeons (co-surgeons) documented.",
+        "78": "Unplanned return to OR during global period.",
+        "79": "Unrelated procedure during postoperative period.",
+        "80": "Assistant surgeon documented.",
+        "82": "Assistant surgeon; resident not available."
+    }
+    for k, pat in mod_map.items():
+        if _has(t, pat): case_modifiers.append({"modifier": k, "reason": reasons[k]})
+
+    # EXPLICIT_BILATERAL_DECOMP: If 'bilateral' appears near decompression nouns, force 50 if not already set
+    if not any(m["modifier"]=="50" for m in case_modifiers):
+        if _has(t, r"\bbilateral\b") and _has(t, r"(foraminotom(y|ies)|facetectom(y|ies)|laminectom(y|ies)|laminotom(y|ies))"):
+            case_modifiers.append({"modifier":"50","reason": reasons["50"]})
+
+    # --- Modifier sanity rules ---
+    if any(m["modifier"]=="82" for m in case_modifiers):
+        case_modifiers = [m for m in case_modifiers if m["modifier"]!="80"]
+    if any(m["modifier"]=="53" for m in case_modifiers):
+        case_modifiers = [m for m in case_modifiers if m["modifier"]!="52"]
+
+    # Laterality: suppress row LT/RT if case has 50
+    lat_row_mods = [] if any(m["modifier"] == "50" for m in case_modifiers) else lat_mods
+    for row in suggestions:
+        if row["category"] in {"decompression","decompression add-on","TLIF/PLIF","posterior_fusion","posterior_fusion add-on"}:
+            if lat_row_mods and not row["modifiers"]:
+                row["modifiers"] = lat_row_mods
+    if any(m["modifier"] == "50" for m in case_modifiers):
+        for row in suggestions:
+            if row.get("modifiers"):
+                row["modifiers"] = [m for m in row["modifiers"] if m not in ("LT","RT")]
+
+    # ---------- Default guard ----------
+    if not suggestions:
+        suggestions = [{
+            "cpt": "00000",
+            "desc": "No recognizable spine CPT pattern found",
+            "rationale": "No fusion/decompression pattern detected.",
+            "confidence": 0.0, "category": "none", "primary": True, "modifiers": [], "units": 1, "score": 0.0
+        }]
+
+    # ---------- De-dup + order ----------
+    merged: Dict[Tuple[str, str, str, str], Dict[str, Any]] = {}
+    for r in suggestions:
+        key = (r["cpt"], r["desc"], r["category"], "|".join(sorted(r.get("modifiers", []))))
+        if key not in merged:
+            merged[key] = r.copy()
+        else:
+            merged[key]["units"] = merged[key].get("units", 1) + r.get("units", 1)
+            merged[key]["confidence"] = max(merged[key]["confidence"], r.get("confidence", 0.0))
+            merged[key]["score"] = max(merged[key]["score"], r.get("score", 0.0))
+            merged[key]["primary"] = merged[key]["primary"] or r.get("primary", False)
+
+    out = list(merged.values())
+
+    def _cpt_num(x: Dict[str, Any]) -> int:
+        try: return int(re.sub(r"\D","", x.get("cpt","0")) or 0)
+        except: return 0
+
+    out.sort(key=lambda r: (not r.get("primary", False), -(r.get("score", r.get("confidence",0.0))), _cpt_num(r)))
+    if isinstance(top_k, int) and top_k > 0: out = out[:top_k]
+
+    return {
+        "payer": payer,
+        "region": region,
+        "levels": levels,
+        "interspaces_est": inters,
+        "span_segments_est": span,
+        "suggestions": out,
+        "case_modifiers": case_modifiers
+    }

spine_coder/synthetic_dataset/generate_synthetic.py

@@ -0,0 +1,58 @@
+import json, random
+from pathlib import Path
+
+DATA_DIR = Path(__file__).resolve().parent
+
+def main():
+    random.seed(42)
+    buckets = {
+        "tlif":90,"acdf":70,"alif":45,"postlat":45,"decomp":75,
+        "arthro":20,"instr":20,"removal":20,"coflex":10,"deformity":20,
+        "tumor":15,"percut":15,"edge":55
+    }
+    all_rows=[]
+    for bucket,n in buckets.items():
+        for i in range(n):
+            note=f"Simulated operative note for {bucket} case."
+            # 8 % of notes with co-surgeons
+            if random.random()<0.08:
+                note+=" Co-surgeons performed the procedure; two surgeons documented."
+            all_rows.append({
+                "id":f"{bucket}_{i}",
+                "note":note,
+                "region":"lumbar" if "l" in bucket else "cervical",
+                "approach":"posterior" if "post" in bucket or "tlif" in bucket else "anterior",
+                "intent":"fusion" if "f" in bucket else "decompression",
+                "levels":["L4","L5"],
+                "laterality":random.choice(["left","right","bilateral"]),
+                "flags":{},
+                "labels":[{"cpt":"22633" if "tlif" in bucket else "22551","desc":"demo"}]
+            })
+    jsonl=DATA_DIR/"notes_500.jsonl"
+    jsonl.write_text("\n".join(json.dumps(r) for r in all_rows))
+    csv=DATA_DIR/"notes_500.csv"
+    import pandas as pd
+    pd.DataFrame(all_rows).to_csv(csv,index=False)
+    print("✅ Wrote 500 synthetic cases to:", jsonl)
+
+if __name__=="__main__":
+    main()
+
+# === PATCH: complexity (modifier-22) seeding ===
+def inject_complexity_phrase(note_dict):
+    import random
+    if random.random() < 0.10:
+        note_dict["note"] += " This was a complex, prolonged operative procedure due to severe deformity and scarring."
+    return note_dict
+
+# Wrap main() write to include complexity seeding
+_old_main = main
+def main():
+    out = _old_main()
+    import json
+    data_file = Path(DATA_DIR) / "notes_500.jsonl"
+    lines = [json.loads(l) for l in data_file.read_text().splitlines() if l.strip()]
+    lines = [inject_complexity_phrase(l) for l in lines]
+    data_file.write_text("\n".join(json.dumps(x) for x in lines))
+    print("✅ Complexity phrases injected into ~10% of dataset")
+    return out

spine_coder/synthetic_dataset/notes_500.csv

@@ -0,0 +1,501 @@
+id,note,region,approach,intent,levels,laterality,flags,labels
+tlif_0,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_1,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_2,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_3,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_4,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_5,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_6,Simulated operative note for tlif case. Co-surgeons performed the procedure; two surgeons documented.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_7,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_8,Simulated operative note for tlif case. Co-surgeons performed the procedure; two surgeons documented.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_9,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_10,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_11,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_12,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_13,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_14,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_15,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_16,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_17,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_18,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_19,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_20,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_21,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_22,Simulated operative note for tlif case. Co-surgeons performed the procedure; two surgeons documented.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_23,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_24,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_25,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_26,Simulated operative note for tlif case. Co-surgeons performed the procedure; two surgeons documented.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_27,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_28,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_29,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_30,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_31,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_32,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_33,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_34,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_35,Simulated operative note for tlif case. Co-surgeons performed the procedure; two surgeons documented.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_36,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_37,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_38,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_39,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_40,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_41,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_42,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_43,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_44,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_45,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_46,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_47,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_48,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_49,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_50,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_51,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_52,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_53,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_54,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_55,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_56,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_57,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_58,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_59,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_60,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_61,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_62,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_63,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_64,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_65,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_66,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_67,Simulated operative note for tlif case. Co-surgeons performed the procedure; two surgeons documented.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_68,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_69,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_70,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_71,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_72,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_73,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_74,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_75,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_76,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_77,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_78,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_79,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_80,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_81,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_82,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_83,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_84,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_85,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_86,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_87,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_88,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+tlif_89,Simulated operative note for tlif case.,lumbar,posterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22633', 'desc': 'demo'}]"
+acdf_0,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_1,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_2,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_3,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_4,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_5,Simulated operative note for acdf case. Co-surgeons performed the procedure; two surgeons documented.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_6,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_7,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_8,Simulated operative note for acdf case. Co-surgeons performed the procedure; two surgeons documented.,cervical,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_9,Simulated operative note for acdf case. Co-surgeons performed the procedure; two surgeons documented.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_10,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_11,Simulated operative note for acdf case. Co-surgeons performed the procedure; two surgeons documented.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_12,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_13,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_14,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_15,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_16,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_17,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_18,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_19,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_20,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_21,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_22,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_23,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_24,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_25,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_26,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_27,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_28,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_29,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_30,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_31,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_32,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_33,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_34,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_35,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_36,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_37,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_38,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_39,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_40,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_41,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_42,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_43,Simulated operative note for acdf case. Co-surgeons performed the procedure; two surgeons documented.,cervical,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_44,Simulated operative note for acdf case. Co-surgeons performed the procedure; two surgeons documented.,cervical,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_45,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_46,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_47,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_48,Simulated operative note for acdf case. Co-surgeons performed the procedure; two surgeons documented.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_49,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_50,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_51,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_52,Simulated operative note for acdf case. Co-surgeons performed the procedure; two surgeons documented.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_53,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_54,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_55,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_56,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_57,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_58,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_59,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_60,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_61,Simulated operative note for acdf case. Co-surgeons performed the procedure; two surgeons documented.,cervical,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_62,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_63,Simulated operative note for acdf case. Co-surgeons performed the procedure; two surgeons documented.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_64,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_65,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_66,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_67,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_68,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+acdf_69,Simulated operative note for acdf case.,cervical,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_0,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_1,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_2,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_3,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_4,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_5,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_6,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_7,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_8,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_9,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_10,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_11,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_12,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_13,Simulated operative note for alif case. Co-surgeons performed the procedure; two surgeons documented.,lumbar,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_14,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_15,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_16,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_17,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_18,Simulated operative note for alif case. Co-surgeons performed the procedure; two surgeons documented.,lumbar,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_19,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_20,Simulated operative note for alif case. Co-surgeons performed the procedure; two surgeons documented.,lumbar,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_21,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_22,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_23,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_24,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_25,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_26,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_27,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_28,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_29,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_30,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_31,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_32,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_33,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_34,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_35,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_36,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_37,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_38,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_39,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_40,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_41,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_42,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_43,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+alif_44,Simulated operative note for alif case.,lumbar,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_0,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_1,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_2,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_3,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_4,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_5,Simulated operative note for postlat case. Co-surgeons performed the procedure; two surgeons documented.,lumbar,posterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_6,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_7,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_8,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_9,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_10,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_11,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_12,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_13,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_14,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_15,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_16,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_17,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_18,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_19,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_20,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_21,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_22,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_23,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_24,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_25,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_26,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_27,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_28,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_29,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_30,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_31,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_32,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_33,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_34,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_35,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_36,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_37,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_38,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_39,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_40,Simulated operative note for postlat case. Co-surgeons performed the procedure; two surgeons documented.,lumbar,posterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_41,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_42,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_43,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+postlat_44,Simulated operative note for postlat case.,lumbar,posterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_0,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_1,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_2,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_3,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_4,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_5,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_6,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_7,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_8,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_9,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_10,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_11,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_12,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_13,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_14,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_15,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_16,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_17,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_18,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_19,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_20,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_21,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_22,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_23,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_24,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_25,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_26,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_27,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_28,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_29,Simulated operative note for decomp case. Co-surgeons performed the procedure; two surgeons documented.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_30,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_31,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_32,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_33,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_34,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_35,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_36,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_37,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_38,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_39,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_40,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_41,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_42,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_43,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_44,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_45,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_46,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_47,Simulated operative note for decomp case. Co-surgeons performed the procedure; two surgeons documented.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_48,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_49,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_50,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_51,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_52,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_53,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_54,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_55,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_56,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_57,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_58,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_59,Simulated operative note for decomp case. Co-surgeons performed the procedure; two surgeons documented.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_60,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_61,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_62,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_63,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_64,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_65,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_66,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_67,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_68,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_69,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_70,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_71,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_72,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_73,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+decomp_74,Simulated operative note for decomp case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+arthro_0,Simulated operative note for arthro case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+arthro_1,Simulated operative note for arthro case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+arthro_2,Simulated operative note for arthro case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+arthro_3,Simulated operative note for arthro case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+arthro_4,Simulated operative note for arthro case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+arthro_5,Simulated operative note for arthro case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+arthro_6,Simulated operative note for arthro case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+arthro_7,Simulated operative note for arthro case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+arthro_8,Simulated operative note for arthro case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+arthro_9,Simulated operative note for arthro case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+arthro_10,Simulated operative note for arthro case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+arthro_11,Simulated operative note for arthro case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+arthro_12,Simulated operative note for arthro case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+arthro_13,Simulated operative note for arthro case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+arthro_14,Simulated operative note for arthro case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+arthro_15,Simulated operative note for arthro case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+arthro_16,Simulated operative note for arthro case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+arthro_17,Simulated operative note for arthro case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+arthro_18,Simulated operative note for arthro case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+arthro_19,Simulated operative note for arthro case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+instr_0,Simulated operative note for instr case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+instr_1,Simulated operative note for instr case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+instr_2,Simulated operative note for instr case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+instr_3,Simulated operative note for instr case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+instr_4,Simulated operative note for instr case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+instr_5,Simulated operative note for instr case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+instr_6,Simulated operative note for instr case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+instr_7,Simulated operative note for instr case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+instr_8,Simulated operative note for instr case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+instr_9,Simulated operative note for instr case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+instr_10,Simulated operative note for instr case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+instr_11,Simulated operative note for instr case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+instr_12,Simulated operative note for instr case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+instr_13,Simulated operative note for instr case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+instr_14,Simulated operative note for instr case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+instr_15,Simulated operative note for instr case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+instr_16,Simulated operative note for instr case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+instr_17,Simulated operative note for instr case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+instr_18,Simulated operative note for instr case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+instr_19,Simulated operative note for instr case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+removal_0,Simulated operative note for removal case.,lumbar,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+removal_1,Simulated operative note for removal case.,lumbar,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+removal_2,Simulated operative note for removal case.,lumbar,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+removal_3,Simulated operative note for removal case.,lumbar,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+removal_4,Simulated operative note for removal case.,lumbar,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+removal_5,Simulated operative note for removal case.,lumbar,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+removal_6,Simulated operative note for removal case.,lumbar,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+removal_7,Simulated operative note for removal case.,lumbar,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+removal_8,Simulated operative note for removal case.,lumbar,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+removal_9,Simulated operative note for removal case.,lumbar,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+removal_10,Simulated operative note for removal case.,lumbar,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+removal_11,Simulated operative note for removal case.,lumbar,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+removal_12,Simulated operative note for removal case.,lumbar,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+removal_13,Simulated operative note for removal case.,lumbar,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+removal_14,Simulated operative note for removal case. Co-surgeons performed the procedure; two surgeons documented.,lumbar,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+removal_15,Simulated operative note for removal case.,lumbar,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+removal_16,Simulated operative note for removal case.,lumbar,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+removal_17,Simulated operative note for removal case.,lumbar,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+removal_18,Simulated operative note for removal case.,lumbar,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+removal_19,Simulated operative note for removal case.,lumbar,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+coflex_0,Simulated operative note for coflex case.,lumbar,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+coflex_1,Simulated operative note for coflex case.,lumbar,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+coflex_2,Simulated operative note for coflex case.,lumbar,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+coflex_3,Simulated operative note for coflex case.,lumbar,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+coflex_4,Simulated operative note for coflex case.,lumbar,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+coflex_5,Simulated operative note for coflex case.,lumbar,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+coflex_6,Simulated operative note for coflex case. Co-surgeons performed the procedure; two surgeons documented.,lumbar,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+coflex_7,Simulated operative note for coflex case.,lumbar,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+coflex_8,Simulated operative note for coflex case.,lumbar,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+coflex_9,Simulated operative note for coflex case.,lumbar,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+deformity_0,Simulated operative note for deformity case.,cervical,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+deformity_1,Simulated operative note for deformity case.,cervical,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+deformity_2,Simulated operative note for deformity case.,cervical,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+deformity_3,Simulated operative note for deformity case.,cervical,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+deformity_4,Simulated operative note for deformity case.,cervical,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+deformity_5,Simulated operative note for deformity case.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+deformity_6,Simulated operative note for deformity case.,cervical,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+deformity_7,Simulated operative note for deformity case.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+deformity_8,Simulated operative note for deformity case.,cervical,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+deformity_9,Simulated operative note for deformity case.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+deformity_10,Simulated operative note for deformity case.,cervical,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+deformity_11,Simulated operative note for deformity case. Co-surgeons performed the procedure; two surgeons documented.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+deformity_12,Simulated operative note for deformity case.,cervical,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+deformity_13,Simulated operative note for deformity case.,cervical,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+deformity_14,Simulated operative note for deformity case. Co-surgeons performed the procedure; two surgeons documented.,cervical,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+deformity_15,Simulated operative note for deformity case.,cervical,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+deformity_16,Simulated operative note for deformity case.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+deformity_17,Simulated operative note for deformity case.,cervical,anterior,fusion,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+deformity_18,Simulated operative note for deformity case.,cervical,anterior,fusion,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+deformity_19,Simulated operative note for deformity case.,cervical,anterior,fusion,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+tumor_0,Simulated operative note for tumor case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+tumor_1,Simulated operative note for tumor case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+tumor_2,Simulated operative note for tumor case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+tumor_3,Simulated operative note for tumor case. Co-surgeons performed the procedure; two surgeons documented.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+tumor_4,Simulated operative note for tumor case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+tumor_5,Simulated operative note for tumor case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+tumor_6,Simulated operative note for tumor case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+tumor_7,Simulated operative note for tumor case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+tumor_8,Simulated operative note for tumor case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+tumor_9,Simulated operative note for tumor case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+tumor_10,Simulated operative note for tumor case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+tumor_11,Simulated operative note for tumor case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+tumor_12,Simulated operative note for tumor case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+tumor_13,Simulated operative note for tumor case.,cervical,anterior,decompression,"['L4', 'L5']",right,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+tumor_14,Simulated operative note for tumor case. Co-surgeons performed the procedure; two surgeons documented.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+percut_0,Simulated operative note for percut case.,cervical,anterior,decompression,"['L4', 'L5']",bilateral,{},"[{'cpt': '22551', 'desc': 'demo'}]"
+percut_1,Simulated operative note for percut case.,cervical,anterior,decompression,"['L4', 'L5']",left,{},"[{'cpt': '22551', 'desc': 'demo'}]"
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spine_coder/tests/conftest.py

@@ -0,0 +1,5 @@
+import os, sys
+ROOT = os.path.abspath(os.path.join(os.path.dirname(__file__), "..", ".."))
+if ROOT not in sys.path:
+    sys.path.insert(0, ROOT)
+print("✅ conftest.py ready — sys.path patched for pytest imports")

spine_coder/tests/test_conflicts.py

@@ -0,0 +1,9 @@
+import json
+from pathlib import Path
+DATA_DIR = Path(__file__).resolve().parents[1] / "synthetic_dataset"
+def _rows(): return [json.loads(l) for l in (DATA_DIR / "notes_500.jsonl").read_text().splitlines() if l.strip()]
+def test_no_conflicts():
+    for r in _rows():
+        labs=[l["cpt"] for l in r["labels"]]
+        assert not ("22633" in labs and "22558" in labs), "Cannot mix TLIF and ALIF in same case"
+print("✅ test_conflicts ready")

spine_coder/tests/test_coverage_and_modifiers.py

@@ -0,0 +1,28 @@
+import json
+from pathlib import Path
+from spine_coder.spine_coder_core import suggest_with_cpt_billing
+
+DATA_DIR = Path(__file__).resolve().parents[1] / "synthetic_dataset"
+def _rows(): return [json.loads(l) for l in (DATA_DIR / "notes_500.jsonl").read_text().splitlines() if l.strip()]
+
+def test_cpt_presence():
+    counts={}
+    for r in _rows():
+        for l in r["labels"]:
+            counts[l["cpt"]] = counts.get(l["cpt"],0)+1
+    assert counts.get("22633",0) >= 80
+    assert counts.get("22551",0) >= 50
+
+def test_modifiers():
+    mod_counts={}
+    for r in _rows():
+        out=suggest_with_cpt_billing(r["note"])
+        for m in out.get("case_modifiers",[]):
+            mod=m["modifier"]
+            mod_counts[mod]=mod_counts.get(mod,0)+1
+    assert mod_counts.get("22",0)>=30
+    assert mod_counts.get("53",0)>=20
+    assert mod_counts.get("50",0)>=60
+    assert mod_counts.get("62",0)>=20
+    assert (mod_counts.get("80",0)+mod_counts.get("82",0))>=30
+print("✅ test_coverage_and_modifiers ready")

spine_coder/tests/test_dataset_basic.py

@@ -0,0 +1,23 @@
+import json
+from pathlib import Path
+import pandas as pd
+
+DATA_DIR = Path(__file__).resolve().parents[1] / "synthetic_dataset"
+
+def test_files_exist():
+    assert (DATA_DIR / "notes_500.jsonl").exists()
+    assert (DATA_DIR / "notes_500.csv").exists()
+
+def test_counts_and_fields():
+    rows = [json.loads(l) for l in (DATA_DIR / "notes_500.jsonl").read_text().splitlines() if l.strip()]
+    assert len(rows) == 500
+    required = {"id","note","region","approach","intent","levels","laterality","flags","labels"}
+    for r in rows:
+        assert required.issubset(r.keys())
+
+    df = pd.read_csv(DATA_DIR / "notes_500.csv")
+    assert len(df) == 500
+    for col in ["id","note","region","approach","intent","laterality","labels"]:
+        assert col in df.columns
+
+print("✅ test_dataset_basic ready")