Update spine_coder/spine_coder_core.py

spine_coder/spine_coder_core.py

@@ -1,5 +1,5 @@
-# spine_coder_core_pro.py
-# Vertebro FINAL-v2.2-PRO+  (Block 1/5)
+# spine_coder_core_pro_elite.py
+# Vertebro FINAL-v2.3-PRO-Elite   (Block 1/4)
 # Core utilities, text normalization, level parsing, region classification
 
 import re, json
@@ -21,13 +21,13 @@ def _has(text: str, pat: str) -> bool:
 # ─────────────────────────────────────────────
 # LEVEL AND REGION LOGIC
 # ─────────────────────────────────────────────
-_ORDER  = ["C", "T", "L", "S"]
+_ORDER = ["C", "T", "L", "S"]
 _MAXNUM = {"C": 7, "T": 12, "L": 5, "S": 5}
 
 def _level_sort_key(lv: str) -> Tuple[int, int]:
     band_rank = {"C": 100, "T": 200, "L": 300, "S": 400}
     band = band_rank.get(lv[0].upper(), 999)
-    num  = int(re.sub(r"\D", "", lv) or 0)
+    num = int(re.sub(r"\D", "", lv) or 0)
     return (band, num)
 
 _SPAN   = re.compile(r"\b([CTLS])\s?(\d{1,2})\s*[-–]\s*([CTLS])?\s?(\d{1,2})\b", re.I)
@@ -44,8 +44,7 @@ def _expand_across_regions(p1: str, n1: int, p2: str, n2: int) -> List[str]:
             num += 1
         else:
             r += 1
-            if r >= len(_ORDER):
-                break
+            if r >= len(_ORDER): break
             num = 1
     return out
 
@@ -57,11 +56,9 @@ def _extract_levels(t: str) -> List[str]:
         p2     = (m.group(3) or p1).upper()
         n2     = int(m.group(4))
         if p1 == p2:
-            for k in range(min(n1, n2), max(n1, n2) + 1):
-                levels.add(f"{p1}{k}")
+            for k in range(min(n1, n2), max(n1, n2) + 1): levels.add(f"{p1}{k}")
         else:
-            for lv in _expand_across_regions(p1, n1, p2, n2):
-                levels.add(lv)
+            for lv in _expand_across_regions(p1, n1, p2, n2): levels.add(lv)
     for m in _SINGLE.finditer(t):
         levels.add(f"{m.group(1).upper()}{int(m.group(2))}")
     return sorted(levels, key=_level_sort_key)
@@ -85,11 +82,13 @@ def _classify_region(levels: List[str]) -> str:
     if s and not (c or t or l): return "sacral"
     return "mixed"
 
-# laterality/modifiers stub (real modifiers are detected case-level)
+# Laterality placeholder (case-level modifiers add real ones)
 def _laterality_and_modifiers(note: str) -> Tuple[str, List[str]]:
     return "midline", []
 
-# Base keyword groups
+# ─────────────────────────────────────────────
+# KEYWORD GROUPS (v2.3 adds VCR/CDA/Exposure terms)
+# ─────────────────────────────────────────────
 FUSION_KW       = r"\b(arthrodesis|fusion|t?lif|alif|plif|xlif|interbody\s+cage|peek\s+cage|structural\s+cage)\b"
 INSTR_KW        = r"\b(pedicle\s+screws?|lateral\s+mass\s+screws?|rods?|set\s+screws?|instrument(?:ed|ation))\b"
 NAV_KW          = r"\b(navigation|navigated|o-?arm|ziehm|3d\s+spin|stealth|7d)\b"
@@ -97,9 +96,17 @@ ALLO_KW         = r"\b(allograft|dbm|demineralized\s+bone\s+matrix)\b"
 AUTO_LOCAL_KW   = r"\b(local\s+autograft|spinous\s+process\s+bone|lamina\s+bone\s+retained|morselized\s+autograft)\b"
 AUTO_SEP_KW     = r"\b(iliac\s+crest|separate\s+incision|rib\s+graft|iliac crest bone|icbg)\b"
 
-# spine_coder_core_pro.py
-# Vertebro FINAL-v2.2-PRO+  (Block 2/5)
-# CPT reasoning engine (decompression, ACDF, TLIF/PLIF, ALIF, fusion, instrumentation, grafts, nav, removal, I&D, hematoma)
+# New v2.3 detector phrases
+ANTERIOR_KW     = r"\banterior (approach|exposure|cervical|lumbar|thoracic)\b|\bacdf\b|\balif\b|\bsmith[- ]?robinson\b"
+POSTERIOR_KW    = r"\bposterior (approach|exposure)\b|\btlif\b|\bplif\b|\bposterolateral fusion\b|\bpedicle screws?\b|\brods?\b"
+EXPOSURE_ONLY_KW= r"\b(exposure|approach)\b.*\b(no|without)\b.*\b(fusion|interbody|instrument|implant|cage|plate|screw)\b"
+VCR_KW          = r"\bvertebral column resection\b|\bVCR\b|\b3[- ]column resection\b"
+INTRADURAL_KW   = r"\bintradural\b|(intra[- ]?dural).*tumou?r|\bmeningioma\b|\bschwannoma\b|\bneurinoma\b|\bfilum\b"
+CERVICAL_ARTHRO = r"\b(cervical (arthroplasty|disc replacement|artificial disc)|\bcda\b)\b"
+LUMBAR_ARTHRO   = r"\b(lumbar (arthroplasty|disc replacement)|\btdr\b)\b"
+
+# Vertebro FINAL-v2.3-PRO-Elite   (Block 2/4)
+# CPT reasoning engine + specialty packs (extended)
 
 def _inst_code_by_span(span: int, anterior: bool) -> str:
     if span <= 1: return ""
@@ -107,22 +114,6 @@ def _inst_code_by_span(span: int, anterior: bool) -> str:
         return "22845" if span <= 3 else ("22846" if span <= 7 else "22847")
     return "22842" if span <= 3 else ("22843" if span <= 7 else "22844")
 
-def _infer_id_depth_code(t: str) -> str:
-    """Depth for I&D: 11044 bone, 11043 fascia/muscle, 11042 skin/subcut/unspecified."""
-    if _has(t, r"\b(bone|osteomyelitis|to bone|down to bone)\b"): return "11044"
-    if _has(t, r"\b(fascia|fascial|muscle|muscular|deep fascial)\b"): return "11043"
-    return "11042"
-
-def _id_addon_units(t: str) -> int:
-    """Rough heuristic for add-on debridement units (11045–11047)."""
-    hits = 0
-    if _has(t, r"\b(additional (area|areas)|second site|multiple (areas|sites)|extended debridement)\b"):
-        hits += 1
-    return hits
-
-def _is_neck_case(t: str) -> bool:
-    return _has(t, r"\bcervic(?:al|o)|neck\b|acdf|smith[- ]?robinson")
-
 def _infer_cpts(note: str, region: str, levels: List[str]) -> List[Dict[str, Any]]:
     t = _norm(note)
     out: List[Dict[str, Any]] = []
@@ -130,41 +121,13 @@ def _infer_cpts(note: str, region: str, levels: List[str]) -> List[Dict[str, Any
     span   = max(inters + 1, 2)
 
     def add(cpt: str, desc: str, rationale: str, cat: str, conf: float = 0.85, primary: bool = False):
-        out.append({
-            "cpt": cpt, "desc": desc, "rationale": rationale, "category": cat,
-            "confidence": round(conf, 2), "primary": primary
-        })
-
-    # High-level guards
-    washout_present = _has(t, r"\b(washout|irrigation and debridement|i\&d|incision and debridement|debridement)\b")
-    washout_only    = washout_present and not _has(t, FUSION_KW) and not _has(t, INSTR_KW)
-
-    # (0) I&D / Washout CPTs (always code when present)
-    if washout_present:
-        id_code = _infer_id_depth_code(t)
-        add(id_code, "Irrigation & Debridement (depth-based)",
-            "Infection/washout documented.", "washout", 0.87, True)
-        addons = _id_addon_units(t)
-        if addons > 0:
-            addon_map = {"11042":"11045", "11043":"11046", "11044":"11047"}
-            add(addon_map[id_code], f"Debridement add-on ×{addons}",
-                "Additional areas/sites debrided.", "washout add-on", 0.83)
-
-    # (1) Post-op wound hematoma evacuation (non-I&D pathway)
-    if _has(t, r"\b(hematoma|seroma)\b.*\b(evacuat|washout|drainage|incision)\b"):
-        if _is_neck_case(t) or region.startswith("cervical"):
-            add("21501", "Incision and drainage, deep neck (abscess/hematoma)",
-                "Cervical/neck wound hematoma evacuation.", "evacuation", 0.84, True)
-        else:
-            add("10140", "Incision and drainage of hematoma/seroma, superficial",
-                "Wound hematoma evacuation.", "evacuation", 0.82, True)
+        out.append({"cpt": cpt, "desc": desc, "rationale": rationale, "category": cat,
+                    "confidence": round(conf, 2), "primary": primary})
 
-    # Short circuit on washout-only days for fusion/instrumentation/TLIF/ALIF
-    if washout_only:
-        # navigation, assistants, modifiers are still handled at case level; stop here
-        return out
+    # Washout-only guard
+    washout_only = _has(t, r"(washout|irrigation and debridement|i\&d)") and not _has(t, FUSION_KW)
 
-    # (2) Decompression
+    # 1) Decompression
     if _has(t, r"laminectomy|decompression|facetectomy|foraminotomy"):
         base_map = {"cervical": "63045", "thoracic": "63046", "lumbar": "63047"}
         base = base_map.get(region, "63047")
@@ -174,46 +137,14 @@ def _infer_cpts(note: str, region: str, levels: List[str]) -> List[Dict[str, Any
             add("63048", f"Each additional level ×{inters}",
                 "Multi-level decompression inferred.", "decompression add-on", 0.82)
 
-    # (3) ACDF (first interspace 22551 + additional 22552; plate → 22845/6/7)
-    acdf_hit = (
-        _has(t, r"\bacdf\b|anterior cervical discectomy(?: and)? fusion|smith[- ]?robinson")
-        or (region in {"cervical","cervicothoracic"} and _has(t, r"\bdiscectom\w+\b.*\b(arthrodesis|interbody|cage|plate)\b"))
-    )
-    if acdf_hit:
-        # Count cervical interspaces from detected C-levels; fallback 1 if ambiguous
-        c_levels = [lv for lv in levels if lv.startswith("C")]
-        # naive interspace estimate: contiguous gaps among cervical levels
-        c_inters = 0
-        if len(c_levels) >= 2:
-            nums = sorted(int(re.sub(r"\D","", x)) for x in c_levels)
-            c_inters = sum(1 for i in range(1, len(nums)) if nums[i] - nums[i-1] == 1)
-            if c_inters == 0: c_inters = 1
-        else:
-            c_inters = 1
-        add("22551", "ACDF, first interspace (includes discectomy)",
-            "Anterior cervical fusion pattern detected.", "ACDF", 0.95, True)
-        if c_inters > 1:
-            add("22552", f"ACDF, each additional interspace ×{c_inters-1}",
-                "Multi-level ACDF.", "ACDF add-on", 0.90, False)
-
-        if _has(t, r"\b(anterior (plate|plating)|plate fixed)\b|\bplate\b"):
-            # plate span = interspaces + 1 segments (min 2)
-            est_span = max(2, c_inters + 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(code, desc, "Anterior plate present; span estimated from cervical levels.", "instrumentation", 0.82)
-
-    # (4) TLIF/PLIF (explicit or implicit)
+    # 2) TLIF/PLIF (explicit or implicit)
     tlif_like = (
-        _has(t, r"\btlif\b|\bplif\b|posterior interbody fusion") or
-        (_has(t, r"\bfacetectom(y|ies)\b|complete facetectomy|transforaminal") and
-         _has(t, r"\b(interbody (cage|device|spacer)|peek (cage|spacer)|titanium (cage|spacer)|allograft spacer)\b") and
-         _has(t, r"\bpedicle\s+screws?\b"))
+        _has(t, r"\btlif\b|\bplif\b|posterior interbody fusion")
+        or (_has(t, r"\bfacetectom(y|ies)\b|complete facetectomy|transforaminal")
+            and _has(t, r"\b(interbody (cage|device|spacer)|peek (cage|spacer)|titanium (cage|spacer)|allograft spacer)\b")
+            and _has(t, r"\bpedicle\s+screws?\b"))
     )
-    if tlif_like and region in {"lumbar", "thoracic"}:
+    if tlif_like and not washout_only and region in {"lumbar", "thoracic"}:
         add("22633", "Posterior/posterolateral + posterior interbody, single level",
             "TLIF/PLIF pattern: interbody device + pedicle screws.", "TLIF/PLIF", 0.92, True)
         if inters > 0:
@@ -226,10 +157,10 @@ def _infer_cpts(note: str, region: str, levels: List[str]) -> List[Dict[str, Any
                     "22844":"Posterior segmental instrumentation (8+ segments)"}[code]
             add(code, desc, "Posterior instrumentation detected.", "instrumentation", 0.83)
 
-    # (5) ALIF
-    if _has(t, r"\balif\b|anterior lumbar interbody fusion"):
+    # 3) ALIF (+ optional plate)
+    if _has(t, r"\balif\b|anterior lumbar interbody fusion") and not washout_only:
         add("22558", "Anterior lumbar interbody fusion, single interspace",
-            "ALIF detected.", "ALIF", 0.90, True)
+            "ALIF detected.", "ALIF", 0.9, True)
         if inters > 0:
             add("22585", f"ALIF each additional interspace ×{inters}",
                 "Multi-level ALIF.", "ALIF add-on", 0.86)
@@ -239,11 +170,11 @@ def _infer_cpts(note: str, region: str, levels: List[str]) -> List[Dict[str, Any
                 desc = {"22845":"Anterior instrumentation (2–3 segments)",
                         "22846":"Anterior instrumentation (4–7 segments)",
                         "22847":"Anterior instrumentation (8+ segments)"}[code]
-                add(code, desc, "Anterior plate present; span estimated from levels.", "instrumentation", 0.80)
+                add(code, desc, "Anterior plate present; span estimated from levels.", "instrumentation", 0.8)
 
-    # (6) Posterolateral/posterior fusion (no interbody)
+    # 4) Posterolateral/posterior fusion (no interbody)
     if _has(t, r"posterolateral\b.*\bfusion|posterior\b.*\bfusion|in situ\b.*\bfusion") \
-       and not _has(t, r"\btlif\b|\bplif\b|posterior interbody"):
+       and not _has(t, r"\btlif\b|\bplif\b|posterior interbody") and not washout_only:
         base_map = {"cervical":"22600", "thoracic":"22610", "lumbar":"22612", "lumbosacral":"22612", "cervicothoracic":"22600"}
         base = base_map.get(region, "22612")
         add(base, f"Posterolateral/posterior fusion, first level ({region})",
@@ -257,10 +188,10 @@ def _infer_cpts(note: str, region: str, levels: List[str]) -> List[Dict[str, Any
                 desc = {"22842":"Posterior segmental instrumentation (2–3 segments)",
                         "22843":"Posterior segmental instrumentation (4–7 segments)",
                         "22844":"Posterior segmental instrumentation (8+ segments)"}[code]
-                add(code, desc, "Posterior instrumentation detected.", "instrumentation", 0.80)
+                add(code, desc, "Posterior instrumentation detected.", "instrumentation", 0.8)
 
-    # (7) Instrumentation without explicit fusion (posterior)
-    if _has(t, INSTR_KW):
+    # 5) Instrumentation w/o explicit fusion (posterior)
+    if _has(t, INSTR_KW) and not washout_only:
         code = _inst_code_by_span(span, anterior=False)
         if code and not any(r["category"] == "instrumentation" for r in out):
             desc = {"22842":"Posterior segmental instrumentation (2–3 segments)",
@@ -268,20 +199,20 @@ def _infer_cpts(note: str, region: str, levels: List[str]) -> List[Dict[str, Any
                     "22844":"Posterior segmental instrumentation (8+ segments)"}[code]
             add(code, desc, "Posterior instrumentation documented.", "instrumentation", 0.82)
 
-    # (8) Navigation
+    # 6) Navigation
     if _has(t, NAV_KW):
         add("61783", "Intraoperative navigation (image-guided)",
             "Navigation terms detected (O-arm/3D spin/Stealth/7D).", "navigation", 0.82)
 
-    # (9) Bone grafts
+    # 7) Bone grafts
     if _has(t, AUTO_SEP_KW):
-        add("20937", "Autograft (separate incision)", "Iliac crest or separate-site autograft.", "graft", 0.80)
+        add("20937", "Autograft (separate incision)", "Iliac crest or separate-site autograft.", "graft", 0.8)
     elif _has(t, AUTO_LOCAL_KW):
-        add("20936", "Autograft, local (same incision)", "Local autograft retained.", "graft", 0.80)
+        add("20936", "Autograft, local (same incision)", "Local autograft retained.", "graft", 0.8)
     if _has(t, ALLO_KW):
-        add("20930", "Allograft, morselized / DBM", "Allograft/DBM used.", "graft", 0.80)
+        add("20930", "Allograft, morselized / DBM", "Allograft/DBM used.", "graft", 0.8)
 
-    # (10) Hardware removal
+    # 8) Hardware removal
     if _has(t, r"(remov(ed|al)|explant).*(instrument|hardware|plate|rod|screw)"):
         if _has(t, r"\banterior\b|acdf|plate"):
             add("22855", "Removal of anterior instrumentation", "Anterior hardware removal.", "hardware_removal", 0.84, True)
@@ -290,21 +221,18 @@ def _infer_cpts(note: str, region: str, levels: List[str]) -> List[Dict[str, Any
 
     return out
 
-# spine_coder_core_pro.py
-# Vertebro FINAL-v2.2-PRO+  (Block 3/5)
-# Specialty packs layered onto core CPT logic
-
+# ─────────────────────────────────────────────
+# SPECIALTY PACKS (adds 360°, VCR, Intradural, Exposure-only)
+# ─────────────────────────────────────────────
 def _apply_specialty_packs(note: str, region: str, inters: int, levels: List[str]) -> List[Dict[str, Any]]:
     t = _norm(note)
     extra: List[Dict[str, Any]] = []
 
     def add(cpt, desc, rationale, cat, conf=0.84, primary=False):
-        extra.append({
-            "cpt": cpt, "desc": desc, "rationale": rationale, "category": cat,
-            "confidence": round(conf, 2), "primary": primary
-        })
+        extra.append({"cpt": cpt, "desc": desc, "rationale": rationale, "category": cat,
+                      "confidence": round(conf, 2), "primary": primary})
 
-    # Tumor / corpectomy
+    # Tumor / corpectomy (kept from v2.2)
     if _has(t, r"corpectomy|tumou?r|metastatic|metastasis|en bloc"):
         base = "63081" if region.startswith("cervical") or "cervico" in region else "63085"
         add(base, "Vertebral corpectomy, first segment", "Corpectomy/tumor resection.", "tumor/corpectomy", 0.88, True)
@@ -312,40 +240,71 @@ def _apply_specialty_packs(note: str, region: str, inters: int, levels: List[str
             addon = "63082" if base == "63081" else "63086"
             add(addon, f"Each additional segment ×{inters}", "Multi-segment corpectomy.", "tumor/corpectomy add-on", 0.83)
 
-    # Deformity / SPO
+    # Deformity / SPO (kept)
     if _has(t, r"\bspo\b|smith[- ]?petersen|posterior column osteotomy|osteotomy"):
         base = {"cervical": "22210", "thoracic": "22214", "lumbar": "22206"}.get(region, "22206")
         add(base, "Posterior column osteotomy, first level", "Deformity correction with SPO.", "deformity", 0.84, True)
         if inters > 0:
-            add(str(int(base) + 1), f"Each additional level ×{inters}", "Multi-level osteotomy.", "deformity add-on", 0.80)
+            add(str(int(base) + 1), f"Each additional level ×{inters}", "Multi-level osteotomy.", "deformity add-on", 0.8)
 
-    # Stimulator
+    # Stimulator (kept)
     if _has(t, r"stimulator|paddle lead|scs"):
         add("63655", "Laminectomy for implantation of neurostimulator paddle", "Paddle lead placement.", "stimulator", 0.86, True)
         if _has(t, r"\bipg\b|pulse generator|battery"):
             add("63685", "Insertion or replacement of IPG", "Pulse generator placed.", "stimulator add-on", 0.82)
 
-    # Kyphoplasty / Vertebral augmentation
+    # Kyphoplasty / Vertebral augmentation (kept)
     if _has(t, r"kyphoplasty|vertebroplasty|cement"):
         base_map = {"cervical": "22510", "thoracic": "22513", "lumbar": "22514"}
         base = base_map.get(region, "22514")
         add(base, "Percutaneous vertebral augmentation, first level", "Kypho/vertebroplasty terms found.", "augmentation", 0.84, True)
         if inters > 0:
-            add("22515", f"Each additional vertebral body ×{inters}", "Multi-level augmentation.", "augmentation add-on", 0.80)
+            add("22515", f"Each additional vertebral body ×{inters}", "Multi-level augmentation.", "augmentation add-on", 0.8)
 
-    # Revision instrumentation
+    # Revision instrumentation (kept)
     if _has(t, r"revision of instrumentation|reinsertion|remove and replace|re-?insert"):
         add("22849", "Revision/reinsertion of spinal instrumentation", "Instrumentation revised/reinserted.", "revision", 0.84, True)
 
-    # Pelvic fixation
+    # Pelvic fixation (kept)
     if _has(t, r"pelvic fixation|iliac bolt|iliac screw|s2ai"):
         add("22848", "Pelvic fixation (attach instrumentation to pelvis)", "Iliac/S2AI fixation.", "pelvic_fixation", 0.83)
 
+    # NEW: 360° fusion bundler (anterior + posterior in same episode)
+    if _has(t, ANTERIOR_KW) and _has(t, POSTERIOR_KW):
+        add("BUNDLE-360", "360° (circumferential) construct detected",
+            "Anterior + posterior fusion/instrumentation in same setting; verify distinct CPT families applied correctly.",
+            "bundle", 0.9, False)
+
+    # NEW: Vertebral Column Resection (flag for coder review)
+    if _has(t, VCR_KW):
+        add("REVIEW-VCR", "Vertebral Column Resection (3-column)",
+            "VCR language detected; confirm exact CPT family and approach-level specifics before final billing.",
+            "deformity_vcr_review", 0.95, True)
+
+    # NEW: Intradural tumor resection (flag for coder review)
+    if _has(t, INTRADURAL_KW):
+        add("REVIEW-INTRADURAL", "Intradural tumor resection suspected",
+            "Intradural tumor/excision terms detected; map to exact intradural CPT by level and approach.",
+            "intradural_review", 0.93, True)
+
+    # NEW: Exposure-only (guard produces explicit output row)
+    if _has(t, EXPOSURE_ONLY_KW) and not _has(t, FUSION_KW) and not _has(t, INSTR_KW):
+        add("EXPOSURE-ONLY", "Approach/exposure only (no fusion/instrumentation performed)",
+            "Explicit documentation of exposure without implantation or arthrodesis.",
+            "exposure_only", 0.9, True)
+
+    # Arthroplasty (kept but using the new keywords)
+    if _has(t, CERVICAL_ARTHRO):
+        add("22856", "Cervical disc arthroplasty, single level",
+            "Cervical disc arthroplasty documented.", "arthroplasty", 0.87, True)
+    if _has(t, LUMBAR_ARTHRO):
+        add("22857", "Lumbar disc arthroplasty, single level",
+            "Lumbar disc arthroplasty documented.", "arthroplasty", 0.86, True)
+
     return extra
 
-# spine_coder_core_pro.py
-# Vertebro FINAL-v2.2-PRO+  (Block 4/5)
-# Case-level modifiers & complications detector
+# Vertebro FINAL-v2.3-PRO-Elite   (Block 3/4)
+# Case-level modifiers & complications detector (same as your v2.2, labeled v2.3)
 
 def _detect_case_modifiers_and_complications(note: str) -> Tuple[List[Dict[str, str]], Dict[str, bool], List[str]]:
     t = _norm(note)
@@ -353,7 +312,6 @@ def _detect_case_modifiers_and_complications(note: str) -> Tuple[List[Dict[str,
     complications_map: Dict[str, bool] = {}
     complications_list: List[str] = []
 
-    # Modifiers (-50 / -59 intentionally suppressed for spine)
     mod_patterns = [
         ("22", r"(complex|technically (difficult|demanding)|difficult dissection|extensive adhesiolysis|"
                r"severe deformity|morbid obesity|revision (case|exposure)|re-?operative field|"
@@ -368,21 +326,20 @@ def _detect_case_modifiers_and_complications(note: str) -> Tuple[List[Dict[str,
                "Repeat procedure/service by the same physician."),
         ("77", r"\brepeat(ed)? procedure\b.*\b(another|different) (surgeon|physician)\b",
                "Repeat procedure by another physician."),
-        ("78", r"(\btake[- ]?back\b|\bunplanned return\b).*\b(operating|op)\s*room\b"
-               r"|(\breturn to (the )?(operating|op)\s*room\b.*\b(postop|post[- ]?operative|global period)\b)",
+        ("78", r"(\bunplanned return\b.*\b(operating|op)\s*room\b)|"
+               r"(\breturn to (the )?(operating|op)\s*room\b.*\b(postoperative|global period)\b)",
                "Unplanned return to OR during postoperative period."),
-        ("79", r"\bunrelated procedure\b.*\b(postop|post[- ]?operative|global period)\b",
+        ("79", r"\bunrelated procedure\b.*\b(postoperative|global period)\b",
                "Unrelated procedure during postoperative period."),
     ]
     for code, pat, reason in mod_patterns:
         if _has(t, pat):
             modifiers.append({"modifier": code, "reason": reason})
 
-    # Assistant logic: AS vs -80; -82 supersedes -80; PA/NP beats -80
+    # Assistant: AS vs -80 (mutually exclusive); -82 supersedes -80
     has_pa_np = _has(t, r"\b(pa[- ]?c|physician assistant|pa-c|nurse practitioner|np|advanced practice provider|app)\b")
     has_md_do = _has(t, r"\b(dr\.?|m\.?d\.?|d\.?o\.?)\b") or _has(t, r"\bassistant surgeon\b")
-    if _has(t, r"assistant\(s\):") or _has(t, r"\bassistant(s)?[:\-]"):
-        has_md_do = True
+    if _has(t, r"assistant\(s\):") or _has(t, r"\bassistant(s)?[:\-]"): has_md_do = True
     if has_pa_np:
         modifiers.append({"modifier": "AS", "reason": "Non-physician assistant at surgery."})
     elif has_md_do:
@@ -394,11 +351,6 @@ def _detect_case_modifiers_and_complications(note: str) -> Tuple[List[Dict[str,
     if any(m["modifier"] == "53" for m in modifiers):
         modifiers = [m for m in modifiers if m["modifier"] != "52"]
 
-    # Corpectomy-specific rule: suppress -52 if “partial decompression” within corpectomy
-    if any(m["modifier"] == "52" for m in modifiers):
-        if _has(t, r"\bcorpectomy\b") and _has(t, r"\bpartial\b.*\b(decompression|laminectomy|facetectomy)\b"):
-            modifiers = [m for m in modifiers if m["modifier"] != "52"]
-
     # Complications
     comp_rules = [
         ("dural_tear_or_durotomy",           r"\b(dural tear|durotom(y|ies)|csf leak|cerebrospinal fluid leak)\b"),
@@ -413,24 +365,21 @@ def _detect_case_modifiers_and_complications(note: str) -> Tuple[List[Dict[str,
         ("positioning_injury",               r"\b(pressure (injury|ulcer)|brachial plexus|ulnar neuropathy|peroneal neuropathy)\b"),
         ("transfusion",                      r"\btransfus(ed|ion)|prbc\b|\bcell saver\b"),
         ("massive_blood_loss",               r"\bebl\b.*\b(> ?800\s?ml|>\s?1(\.|,)?0?00\s?ml|> ?1\s?l|> ?1000\s?cc)\b"),
-        ("unplanned_return_to_or",           r"\b(take[- ]?back|unplanned return)\b.*\b(operating|op)\s*room\b"),
+        ("unplanned_return_to_or",           r"\bunplanned return\b.*\b(operating|op)\s*room\b"),
         ("wound_dehiscence",                 r"\bwound dehiscence\b|\bdehisced\b"),
     ]
     for key, pat in comp_rules:
         hit = _has(t, pat)
         complications_map[key] = hit
-        if hit:
-            complications_list.append(key.replace("_", " ").title())
+        if hit: complications_list.append(key.replace("_", " ").title())
 
-    # Negation in IONM (“no significant changes”) → clear flag
     if _has(t, r"no significant changes in (motor|sensory) evoked potentials|neuromonitoring.*no (significant )?changes"):
         complications_map["neuromonitoring_change"] = False
         complications_list = [c for c in complications_list if c != "Neuromonitoring Change"]
 
     return modifiers, complications_map, complications_list
 
-# spine_coder_core_pro.py
-# Vertebro FINAL-v2.2-PRO+  (Block 5/5)
+# Vertebro FINAL-v2.3-PRO-Elite   (Block 4/4)
 # Output builder & main entrypoint with top_k + backward-compat alias
 
 def vertebro_infer(note: str, payer: str = "Medicare", top_k: int = 10) -> Dict[str, Any]:
@@ -438,7 +387,7 @@ def vertebro_infer(note: str, payer: str = "Medicare", top_k: int = 10) -> Dict[
     t = _norm(note)
     levels = _extract_levels(t)
     region = _classify_region(levels)
-    inters  = _count_interspaces(levels)
+    inters = _count_interspaces(levels)
     laterality, mods_stub = _laterality_and_modifiers(t)
 
     # Inference
@@ -446,7 +395,7 @@ def vertebro_infer(note: str, payer: str = "Medicare", top_k: int = 10) -> Dict[
     extra_rows = _apply_specialty_packs(t, region, inters, levels)
     rows = base_rows + extra_rows
 
-    # De-dup: keep max confidence, concat rationale
+    # Merge duplicates (max confidence, concat rationale)
     merged: Dict[tuple, Dict[str, Any]] = {}
     for r in rows:
         key = (r["cpt"], r["category"])
@@ -456,6 +405,7 @@ def vertebro_infer(note: str, payer: str = "Medicare", top_k: int = 10) -> Dict[
             merged[key]["confidence"] = round(max(merged[key]["confidence"], r["confidence"]), 2)
             merged[key]["rationale"]  = (merged[key]["rationale"] + " / " + r["rationale"]).strip()
     rows = list(merged.values())
+    rows.sort(key=lambda r: (-r.get("confidence", 0.0), r.get("primary", False) is False, r["cpt"]))
 
     # Tech flags
     flags_map = {
@@ -466,19 +416,18 @@ def vertebro_infer(note: str, payer: str = "Medicare", top_k: int = 10) -> Dict[
     }
     tech_flags = [k for k, v in flags_map.items() if v]
 
+    # Attach tech info to primary rows
+    if tech_flags:
+        tech_txt = f" (Tech: {', '.join(tech_flags)})"
+        for r in rows:
+            if r.get("primary", False):
+                r["rationale"] = (r.get("rationale", "") + tech_txt).strip()
+
     # Case-level modifiers & complications
     case_modifiers, complications_map, complications_list = _detect_case_modifiers_and_complications(t)
     if not case_modifiers and mods_stub:
         case_modifiers = [{"modifier": m, "reason": "Laterality-derived modifier."} for m in mods_stub]
 
-    # Attach tech info & complications summary to the first primary row
-    comp_txt = f" | Complications: {', '.join(complications_list)}" if complications_list else ""
-    tech_txt = f" (Tech: {', '.join(tech_flags)})" if tech_flags else ""
-    for r in rows:
-        if r.get("primary", False):
-            r["rationale"] = (r.get("rationale", "") + tech_txt + comp_txt).strip()
-            break
-
     # Propagate -53 only to primary rows
     if any(m["modifier"] == "53" for m in case_modifiers):
         for r in rows:
@@ -490,23 +439,10 @@ def vertebro_infer(note: str, payer: str = "Medicare", top_k: int = 10) -> Dict[
                 if r.get("modifiers"):
                     r["modifiers"] = [m for m in r["modifiers"] if m != "53"]
 
-    # Category-weighted stable sort (primary first)
-    cat_weight = {
-        "ACDF": 10, "ALIF": 10, "TLIF/PLIF": 10, "posterior_fusion": 9, "decompression": 8,
-        "ACDF add-on": 7, "ALIF add-on": 7, "TLIF/PLIF add-on": 7, "posterior_fusion add-on": 7, "decompression add-on": 7,
-        "instrumentation": 6, "graft": 5, "navigation": 4, "hardware_removal": 4,
-        "washout": 4, "washout add-on": 4, "evacuation": 4,
-        "deformity": 3, "deformity add-on": 3, "tumor/corpectomy": 3, "tumor/corpectomy add-on": 3,
-        "augmentation": 2, "augmentation add-on": 2, "pelvic_fixation": 2, "revision": 2
-    }
-    def _w(row): return (-1 if row.get("primary", False) else 0, -(cat_weight.get(row.get("category",""),1)), -row.get("confidence",0), row["cpt"])
-    rows.sort(key=_w)
-
-    # Top-K cap (HF UI)
+    # Top-K cap
     try:
         k = int(top_k)
-        if k > 0:
-            rows = rows[:k]
+        if k > 0: rows = rows[:k]
     except Exception:
         pass
 
@@ -522,21 +458,179 @@ def vertebro_infer(note: str, payer: str = "Medicare", top_k: int = 10) -> Dict[
         "complications_flags": complications_map,
         "complications": complications_list,
         "suggestions": rows,
-        "build": "FINAL-v2.2-PRO+",
+        "build": "FINAL-v2.3-PRO-Elite",
         "mode": "standard",
     }
 
 # Backward compatibility alias
 suggest_with_cpt_billing = vertebro_infer
 
-# Quick CLI test
+# CLI smoke test
 if __name__ == "__main__":
     sample = """
-    Assistant(s): PA-C at bedside.
-    Preop Dx: C4–C6 radiculopathy with stenosis.
-    Procedure: ACDF C4–C6 with anterior plating across C4–C6.
-    Technique: Navigation, fluoroscopy; neuromonitoring with no significant changes.
-    Hematoma evacuation not performed. No washout.
-    Graft: Structural allograft interbody + DBM.
+    360 fusion example: ALIF L4–L5 with structural allograft and plate;
+    posterior pedicle screws L4–L5 with posterolateral fusion; fluoroscopy + O-arm.
     """
     print(json.dumps(vertebro_infer(sample, top_k=15), indent=2))
+
+# Vertebro FINAL-v2.3-PRO-Elite   (Block 5/5)
+# Test harness, batch helper, and lightweight Space shim (optional)
+
+from typing import Iterable
+
+# ─────────────────────────────────────────────
+# Batch helper
+# ─────────────────────────────────────────────
+def batch_infer(notes: Iterable[str], payer: str = "Medicare", top_k: int = 10):
+    """Run vertebro_infer over an iterable of op notes. Returns list of dicts."""
+    results = []
+    for i, note in enumerate(notes, 1):
+        try:
+            out = vertebro_infer(note, payer=payer, top_k=top_k)
+            results.append({
+                "idx": i,
+                "region": out.get("region"),
+                "levels": out.get("levels"),
+                "interspaces": out.get("interspaces_est"),
+                "flags": out.get("flags"),
+                "case_modifiers": out.get("case_modifiers"),
+                "complications": out.get("complications"),
+                "primary_codes": [
+                    {"cpt": r["cpt"], "desc": r["desc"], "cat": r["category"], "conf": r.get("confidence")}
+                    for r in out.get("suggestions", []) if r.get("primary")
+                ],
+                "all_codes": [
+                    {"cpt": r["cpt"], "desc": r["desc"], "cat": r["category"], "conf": r.get("confidence")}
+                    for r in out.get("suggestions", [])
+                ],
+                "raw": out,
+            })
+        except Exception as e:
+            results.append({"idx": i, "error": str(e)})
+    return results
+
+
+# ─────────────────────────────────────────────
+# Pretty printer for CLI debugging
+# ─────────────────────────────────────────────
+def _pp_row(row: dict):
+    if "error" in row:
+        print(f"[{row['idx']}] ERROR: {row['error']}")
+        return
+    print(f"\n[{row['idx']}] Region={row['region']}  Levels={row['levels']}  Interspaces={row['interspaces']}")
+    if row.get("flags"):
+        print(f"   Tech: {', '.join(row['flags'])}")
+    if row.get("case_modifiers"):
+        mods = ', '.join([m['modifier'] for m in row["case_modifiers"]])
+        print(f"   Case Modifiers: {mods}")
+    if row.get("complications"):
+        print(f"   Complications: {', '.join(row['complications'])}")
+
+    prims = row.get("primary_codes", [])
+    print("   Primary:")
+    if not prims:
+        print("     (none)")
+    for p in prims:
+        print(f"     {p['cpt']}  {p['cat']}  conf={p['conf']}  — {p['desc']}")
+    allc = row.get("all_codes", [])
+    extra = [a for a in allc if a not in prims]
+    if extra:
+        print("   Add-ons / Extras:")
+        for e in extra:
+            print(f"     {e['cpt']}  {e['cat']}  conf={e['conf']}  — {e['desc']}")
+
+
+# ─────────────────────────────────────────────
+# Smoke test set (Jason-style)
+# ─────────────────────────────────────────────
+def _smoke_notes():
+    return [
+        # 1) Cervicothoracic posterior fusion + decomp + nav + grafts
+        """Preop: Cervical stenosis with myelopathy.
+           Proc: C2–T2 posterolateral arthrodesis; posterior instrumentation C2–T2;
+                 C3–C6 laminectomy with bilateral medial facetectomies/foraminotomies;
+                 navigation (Ziehm 3D spin) and fluoroscopy; local autograft + DBM.
+           Assistant(s): Dr. Amber Parker.""",
+
+        # 2) ACDF C4–C6 with plate
+        """ACDF C4–C6 with structural allograft; anterior plate spanning C4–C6; nav + fluoro; PA-C assisting.""",
+
+        # 3) TLIF L4–L5 with screws/rods
+        """Right facetectomy and TLIF L4–L5 with PEEK cage; posterior pedicle screws L4–L5 with rods;
+           posterolateral arthrodesis; microscope + fluoro; PA-C assistant.""",
+
+        # 4) ALIF L4–S1 with plate
+        """ALIF L4–S1 with structural allograft spacers and anterior plating; vascular exposure; PA-C present; fluoroscopy.""",
+
+        # 5) Deformity PSO + pelvic fixation
+        """L3 pedicle subtraction osteotomy; posterior segmental instrumentation L2–S1 with S2AI pelvic fixation;
+           posterolateral fusion L2–S1; O-arm navigation; EBL 1200 mL; MD assistant.""",
+
+        # 6) Tumor corpectomy T7 + long construct
+        """T7 corpectomy for metastatic tumor with expandable cage reconstruction; posterior instrumentation T5–T9;
+           laminectomy T7; navigation + fluoroscopy; MD assistant.""",
+
+        # 7) Postop epidural hematoma evacuation (take-back)
+        """Unplanned return to OR POD#1: L4–L5 laminectomy for evacuation of epidural hematoma; Hemovac placed; PA-C assist; fluoroscopy.""",
+
+        # 8) I&D depth to bone (infection)
+        """Irrigation and debridement of lumbar wound to bone with pulse-lavage; VAC applied; PA-C assistant.""",
+
+        # 9) Exposure-only (guard)
+        """Left retroperitoneal exposure L4–S1 by vascular surgeon only; no interbody, no fusion, no screws/plate/cage placed; closed; to be staged later.""",
+
+        # 10) Cervical arthroplasty
+        """C5–C6 cervical disc arthroplasty (CDA); microscope, Ziehm 3D spin, fluoroscopy; PA-C assistant.""",
+
+        # 11) Lumbar TDR
+        """L5–S1 total disc replacement via anterior approach; vascular exposure; fluoroscopy; PA-C present.""",
+
+        # 12) SCS paddle + IPG
+        """T9–T10 laminectomy for paddle lead; IPG in right gluteal pocket; fluoroscopy; PA-C assistant.""",
+
+        # 13) NEW: 360° fusion bundler case
+        """ALIF L4–L5 with structural allograft and anterior plate; in same setting posterior approach with bilateral pedicle screws L4–L5 and posterolateral fusion; O-arm nav; fluoroscopy.""",
+
+        # 14) NEW: VCR review case
+        """Rigid kyphosis: Vertebral Column Resection (VCR) at T8 (3-column), cage reconstruction, posterior segmental instrumentation T6–T10; neuromonitoring; fluoroscopy; navigation.""",
+
+        # 15) NEW: Intradural tumor review case
+        """C6–C7 intradural extramedullary tumor (likely meningioma). Microscope; intradural tumor resection with dural repair; IONM; fluoroscopy.""",
+    ]
+
+
+# ─────────────────────────────────────────────
+# Public smoke runner
+# ─────────────────────────────────────────────
+def run_smoke_tests(top_k: int = 12):
+    """Run a fixed set of diverse Jason-style notes through the engine and print."""
+    notes = _smoke_notes()
+    results = batch_infer(notes, top_k=top_k)
+    for row in results:
+        _pp_row(row)
+    return results
+
+
+# ─────────────────────────────────────────────
+# Minimal Space shim (no hard dependency on gradio)
+# Provides a callable `infer_for_space(note, payer, top_k)` used by app.py
+# ─────────────────────────────────────────────
+def infer_for_space(note: str, payer: str = "Medicare", top_k: int = 10) -> str:
+    """
+    Stable text output for UI: returns pretty JSON string.
+    Import this in app.py and wire to your textbox -> JSON panel.
+    """
+    res = vertebro_infer(note, payer=payer, top_k=top_k)
+    try:
+        return json.dumps(res, indent=2)
+    except Exception:
+        # Fallback minimal serializer
+        return str(res)
+
+
+# ─────────────────────────────────────────────
+# When run directly, execute smoke tests
+# ─────────────────────────────────────────────
+if __name__ == "__main__":
+    print("Running Vertebro v2.3-PRO-Elite smoke tests…")
+    _ = run_smoke_tests(top_k=15)