Update spine_coder/spine_coder_core.py

spine_coder/spine_coder_core.py

@@ -95,7 +95,36 @@ def suggest_with_cpt_billing(note: str, payer: str = "Medicare", top_k: int = 10
     suggestions: List[Dict[str, Any]] = []
     case_modifiers: List[Dict[str, str]] = []
 
-    # --- Levels / spans / laterality ---
+    # --- Early guard: exposure-only / access-only -----------------------------
+    # Flexible: catches "anterior exposure of L4–S1 performed by vascular surgeon ... No fusion performed"
+    exposure_only = (
+        _has(t, r"\bexpos(e|ed|ure)\b|\bapproach\b") and
+        _has(t, r"\banterior\b|retroperitoneal|vascular (surgeon|exposure)|access\b") and
+        _has(t, r"\bno (fusion|arthrodesis|interbody|implants?|cage|plate|screw|instrumentation)\b|without (fusion|interbody|instrumentation)") and
+        not _has(t, r"\bfusion|arthrodesis|discectom\w+|interbody|tlif|plif|alif|acdf|arthroplasty|stimulator|instrument|hardware|screw|rod|plate|cage")
+    )
+    if exposure_only:
+        return {
+            "payer": payer,
+            "region": "unknown",
+            "levels": [],
+            "interspaces_est": 0,
+            "span_segments_est": 0,
+            "suggestions": [{
+                "cpt": "00000",
+                "desc": "No recognizable spine CPT pattern found",
+                "rationale": "Exposure-only access without decompression/fusion/instrumentation.",
+                "confidence": 0.0, "category": "none", "primary": True, "modifiers": [], "units": 1, "score": 0.0
+            }],
+            "case_modifiers": [],
+            "flags": [],
+            "flags_map": {},
+            "laterality": "na",
+            "build": "FINAL-v2.1",
+            "mode": "standard",
+        }
+
+    # --- Levels / spans / laterality -----------------------------------------
     levels = _extract_levels(t)
     inters = _count_interspaces(levels)
     span   = _span_segments(levels)
@@ -149,7 +178,6 @@ def suggest_with_cpt_billing(note: str, payer: str = "Medicare", top_k: int = 10
         no_decompression_due_to_revision = True
 
     # ---------- (2b) New posterior instrumentation WITHOUT explicit fusion ----------
-    # If new screws/rods/construct placed but no TLIF/PLIF/posterior-fusion wording, still code instrumentation.
     if (
         not _has(t, r"\btlif\b|\bplif\b|posterolateral\b.*\bfusion|posterior\b.*\bfusion")
         and (mentions_inst_post or _has(t, r"\b(new|placed|inserted|reinserted)\b.{0,20}\b(screw|rod|construct|instrumentation)\b"))
@@ -163,52 +191,69 @@ def suggest_with_cpt_billing(note: str, payer: str = "Medicare", top_k: int = 10
                     "22844":"Posterior segmental instrumentation (8+ segments)"}[code]
             _add(suggestions, code, desc, "New posterior instrumentation documented.", "instrumentation", False, 0.82)
 
-    # ---------- Exposure-only guard ----------
-    exposure_only = _has(t, r"\banterior (exposure|approach) performed\b") and not _has(
-        t, r"\bfusion|discectomy|interbody|arthrodesis|cage|plate|spacer"
-    )
-
-    # ---------- (2) ACDF with guards (history/removal/exposure-only) ----------
+    # ---------- (2) ACDF with guards (history/removal) + broadened trigger ----------
     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) and not exposure_only:
+    acdf_current  = (
+        _has(t, r"\banterior cervical discectomy|anterior cervical fusion|smith[- ]?robinson\b")
+        or (
+            (region in {"cervical","cervicothoracic"})
+            and _has(t, r"\bdiscectom\w+\b")
+            and (_has(t, r"\b(interbody|cage|arthrodesis|plate)\b") or mentions_plate_ant)
+        )
+        or _has(t, r"\bacdf\b")
+    )
+
+    if acdf_current and not (found_removal and not _has(t, r"\bacdf\b")) and not exposure_only:
         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)
+
+        # Plate span inference: "spanning C4–C7" or "span C4–C7"
+        m_span = re.search(r"\bspan\w*\s*(c\d)\s*[-–—]\s*(c\d)\b", t, flags=re.I)
+        plate_span_est = None
+        if m_span:
+            try:
+                c_lo = int(re.sub(r"\D","", m_span.group(1)))
+                c_hi = int(re.sub(r"\D","", m_span.group(2)))
+                if c_hi >= c_lo:
+                    plate_span_est = c_hi - c_lo + 1
+            except Exception:
+                plate_span_est = None
+
         if mentions_plate_ant:
-            est_span = span if (span and span >= 2) else (n + 1)
+            est_span = (plate_span_est if plate_span_est and plate_span_est >= 2
+                        else (span if (span and span >= 2) else (n + 1)))
             code = _inst_code_by_span(est_span, 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)
+                _add(suggestions, code, desc, "Anterior plate present; span estimated from levels/plate span.", "instrumentation", False, 0.8)
 
     # ---------- (3a) Implicit TLIF when keywords imply the construct ----------
-    # Fire when facetectomy + interbody cage/device + pedicle screws appear together.
     if (
         not _has(t, r"\btlif\b|\bplif\b|posterior interbody fusion")
-        and _has(t, r"\bfacetectom(y|ies)\b|complete facetectomy|hemifacetectomy")
-        and _has(t, r"\binterbody (cage|device|spacer)\b|peek cage|titanium cage|allograft spacer")
+        and _has(t, r"\bfacetectom(y|ies)\b|complete facetectomy|hemifacetectomy|transforaminal")
+        and _has(t, r"\binterbody (cage|device|spacer)\b|peek (cage|spacer)|titanium (cage|spacer)|allograft spacer")
         and (mentions_pedicle or _has(t, r"\bpedicle screw(s)?\b"))
         and region in {"lumbar", "thoracic"}
     ):
         n = max(1, inters or 1)
         _add(suggestions, "22633", "Posterior/posterolateral + posterior interbody, single level",
-             "Implicit TLIF/PLIF: facetectomy + interbody device + pedicle screws.", "TLIF/PLIF", True, 0.92, mods=lat_mods)
+             "Implicit TLIF/PLIF: facetectomy + interbody device + pedicle screws.", "TLIF/PLIF", True, 0.93, mods=lat_mods)
         if n > 1:
             _add(suggestions, "22634", f"Posterior interbody each additional interspace ×{n-1}",
-                 "Multi-level implicit TLIF/PLIF.", "TLIF/PLIF add-on", False, 0.88, units=(n-1), mods=lat_mods)
+                 "Multi-level implicit TLIF/PLIF.", "TLIF/PLIF add-on", False, 0.89, units=(n-1), mods=lat_mods)
         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)
+            _add(suggestions, code, desc, "Posterior instrumentation detected (implicit TLIF).", "instrumentation", False, 0.83)
 
     # ---------- (3) TLIF / PLIF (beats posterior fusion) ----------
     if _has(t, r"\btlif\b|\bplif\b|posterior interbody fusion"):
@@ -227,7 +272,7 @@ def suggest_with_cpt_billing(note: str, payer: str = "Medicare", top_k: int = 10
                 _add(suggestions, code, desc, "Posterior instrumentation detected.", "instrumentation", False, 0.82)
 
     # ---------- (4) ALIF ----------
-    if _has(t, r"\balif\b|anterior lumbar interbody fusion") and not exposure_only:
+    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)
@@ -395,7 +440,7 @@ def suggest_with_cpt_billing(note: str, payer: str = "Medicare", top_k: int = 10
     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
+    # Force -50 if 'bilateral' appears near decompression nouns and 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"]})
@@ -446,8 +491,9 @@ def suggest_with_cpt_billing(note: str, payer: str = "Medicare", top_k: int = 10
     has_50 = any(m["modifier"] == "50" for m in case_modifiers)
     lat_row_mods = [] if has_50 else lat_mods
     for row in out:
-        if lat_row_mods and not row.get("modifiers"):
-            row["modifiers"] = lat_row_mods[:]
+        if row["category"] in {"decompression","decompression add-on","TLIF/PLIF","posterior_fusion","posterior_fusion add-on"}:
+            if lat_row_mods and not row.get("modifiers"):
+                row["modifiers"] = lat_row_mods[:]
     if has_50:
         for row in out:
             if row.get("modifiers"):
@@ -484,7 +530,7 @@ def suggest_with_cpt_billing(note: str, payer: str = "Medicare", top_k: int = 10
     elif _has(t, bilateral_procedure_pat):
         case_laterality = "bilateral"
 
-    # ---------- OPTIONAL: surface tech flags in primary rationale (non-billing, trust-building) ----------
+    # ---------- OPTIONAL: surface tech flags in primary rationale ----------
     if flags_list:
         for r in out:
             if r.get("primary", False):