README.md

---
title: Vertebro_Duplicate
emoji: 🦴
colorFrom: yellow
colorTo: purple
sdk: gradio
sdk_version: 5.49.1
app_file: app.py
pinned: true
hf_oauth: true
hf_oauth_scopes:
- inference-api
short_description: AI-driven spine billing and operative note analyzer
---

# 🦴 Vertebro — Automated Spine CPT Billing & Operative Note NLP

**Live Demo:** [Vertebro (Hugging Face Space)](https://huggingface.co/spaces/Slaiwala/Vertebro)  
**Developed by:** Shubham Laiwala (Nazarian Lab, BIDMC)  
**Advisor:** Dr. Jason Pittman, Dr. Ara Nazarian 
**Version:** `v1.0 — CPT Logic Core: deterministic spine billing inference`

---

## 💡 Overview

**Vertebro** is an intelligent, rule-based NLP engine that automatically interprets *spine operative notes* and suggests the most relevant **CPT billing codes**, **modifiers**, and **rationales** — all while maintaining payer-aware logic (Medicare, BCBS, Aetna, etc.).

It’s built for:
- **Research:** Rapid auditing of spine operative notes  
- **Billing validation:** Cross-checking documentation against CPT standards  
- **Clinical education:** Understanding how procedural phrasing drives billing logic  

The underlying logic is **deterministic, explainable**, and optimized for cervical, thoracic, and lumbar spine cases.

---

## 🧠 Key Features

| Feature | Description |
|----------|--------------|
| **CPT Suggestion Engine** | Extracts primary and add-on CPT codes from free-text operative notes |
| **Payer Logic** | Adjusts code and modifier recommendations for each payer |
| **Multi-Region Support** | Recognizes cervical, thoracic, and lumbar levels |
| **Explainable Outputs** | Every CPT code includes rationale and confidence score |
| **Modifier Awareness** | Detects 22, 50, 58, 78, 79, 82, and laterality codes automatically |
| **No PHI Retention** | Inputs are transient and never stored or logged |

---

## 🧩 How to Use Vertebro

1. **Open the app:** [Vertebro on Hugging Face](https://huggingface.co/spaces/Slaiwala/Vertebro)  
2. **Paste or type an operative note** (e.g., “Left-sided TLIF L4–L5 with pedicle screws and interbody cage; posterolateral fusion performed. Navigation used.”)  
3. **Select the payer** (e.g., Medicare, BCBS, Aetna)  
4. **Click “Submit.”**  
5. **Review results:**
   - CPT suggestions  
   - Descriptions  
   - Rationales  
   - Categories (fusion, instrumentation, graft, etc.)  
   - Confidence levels  

💬 **Please feel free to test real-life, de-identified operative note examples** from your own cases.  
The more diverse the phrasing, the better we can evaluate the model’s robustness.

---

## 🔍 Example Operative Notes to Try

### 1. Anterior Cervical Discectomy and Fusion (ACDF)
Anterior cervical discectomy and fusion performed at C5–C6 and C6–C7.
PEEK cages placed at both levels with anterior plate fixation.
 

---

### 2. Transforaminal Lumbar Interbody Fusion (TLIF)
Left-sided TLIF L4–L5 with pedicle screws and interbody cage.
Posterolateral fusion performed with local autograft.

---

### 3. Posterior Cervical Fusion with Instrumentation
Posterior cervical fusion from C3–C5 with lateral mass screws and rods.
Local autograft used for fusion.


---

### 4. Hardware Removal
Removal of posterior instrumentation at L2–L4.
No reinstrumentation performed.
 

---

### 5. Decompression Only
L3–L4 decompression with partial medial facetectomy and foraminotomy.
Microscope used.
  

---

## 🧾 Feedback Workflow (Dr. Pittman)

Every time you use **Vertebro**, please:
1. Review the CPT output table.  
2. Compare it with the *true billing sheet or expected codes*.  
3. Provide **feedback** such as:  
   - ✅ “Correct CPTs and rationale.”  
   - ⚠️ “Partially correct — missing code X or modifier Y.”  
   - ❌ “Incorrect — CPT Z should not appear.”  
4. Optionally add notes on **phrasing not recognized** (e.g., “MIS lateral approach not detected”).  

This feedback will be used to iteratively refine and retrain the rule logic and future ML models.

---

## 📈 Testing & Exploration Areas

| Region | Case Type | Focus |
|--------|------------|--------|
| Cervical | ACDF, CDA, Posterior Fusion | Fusion + anterior plating logic |
| Thoracic | Decompression, Instrumentation | Mid-thoracic handling |
| Lumbar | TLIF, PLIF, ALIF, Post-lat Fusion | Interbody vs posterolateral overlap |
| Any | Revision, Hardware Removal | 22849, 22852, staged operations |
| Multi-Level | Complex constructs | Code chaining: 22552, 22614 |
| Graft / Instrumentation | Autograft, Allograft, Plate/Rods | Add-ons: 20936, 20930, 22842 |

---

## 📬 Contact

For questions, case feedback, or feature suggestions, please reach out to:  
**📧** `slaiwala@bidmc.harvard.edu`  
**👤** Developer: *Shubham Laiwala*  
**🏥** Affiliation: Nazarian Lab, BIDMC / Harvard Medical School  

---

### 🩺 Short Summary (for Hugging Face “About” sidebar)

> **Vertebro** automatically suggests CPT codes from spine operative notes using a rule-based NLP engine.  
> Designed for research, billing validation, and clinical education.  
> *Feel free to test real, de-identified operative notes!*