Update spine_coder/spine_coder_core.py

spine_coder/spine_coder_core.py

@@ -1,553 +1,209 @@
+# spine_coder_core.py
+# Vertebro FINAL-v2.2 — Production Hybrid Engine
+
 import re, json
 from typing import Dict, Any, List, Tuple
 
-# ---------- helpers ----------
+# ─────────────────────────────────────────────
+# NORMALIZATION UTILITIES
+# ─────────────────────────────────────────────
 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
+    if not s:
+        return ""
+    s = (s.replace("\u2013", "-").replace("\u2014", "-")
+           .replace("—", "-").replace("–", "-")
+           .replace("\u00A0", " "))
+    return re.sub(r"\s+", " ", s.strip().lower())
 
 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()
-    # Ranges (e.g., L4-5, C4–C7). If prefix changes (C->T), capture both endpoints.
-    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}")
+# ─────────────────────────────────────────────
+# LEVEL / REGION LOGIC
+# ─────────────────────────────────────────────
+_ORDER = ["C", "T", "L", "S"]
+_MAXNUM = {"C":7, "T":12, "L":5, "S":5}
+
+def _level_sort_key(lv:str)->Tuple[int,int]:
+    rank={"C":100,"T":200,"L":300,"S":400}
+    return (rank.get(lv[0].upper(),999), int(re.sub(r"\D","",lv) or 0))
+
+_SPAN = re.compile(r"\b([CTLS])\s?(\d{1,2})\s*[-–]\s*([CTLS])?\s?(\d{1,2})\b", re.I)
+_SINGLE = re.compile(r"\b([CTLS])\s?(\d{1,2})\b", re.I)
+
+def _expand_across_regions(p1:str,n1:int,p2:str,n2:int)->List[str]:
+    p1,p2=p1.upper(),p2.upper()
+    out=[]; i=_ORDER.index(p1); r=i; num=n1
+    while True:
+        out.append(f"{_ORDER[r]}{num}")
+        if _ORDER[r]==p2 and num==n2: break
+        if num<_MAXNUM[_ORDER[r]]:
+            num+=1
         else:
-            lo, hi = sorted([n1, n2])
-            for k in range(lo, hi+1): levels.add(f"{pfx1}{k}")
-    # Singles (e.g., L4, T10)
-    for m in re.finditer(r"\b([CTLS])\s?(\d{1,2})\b", t, flags=re.I):
+            r+=1
+            if r>=len(_ORDER): break
+            num=1
+    return out
+
+def _extract_levels(t:str)->List[str]:
+    t=_norm(t); levels=set()
+    for m in _SPAN.finditer(t):
+        p1,n1=m.group(1).upper(),int(m.group(2))
+        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}")
+        else:
+            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)
+    return sorted(levels,key=_level_sort_key)
 
-def _count_interspaces(levels: List[str]) -> int:
+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)
-    # L5–S1 interspace
-    if "L5" in levels and "S1" in levels: inters += 1
-    # Conservative fallback for multi-level with gaps
-    if inters == 0:
-        for arr in by_band.values():
-            if len(arr) >= 2:
-                inters = 1
-                break
-    return inters
+    return max(0,len(sorted(set(levels),key=_level_sort_key))-1)
 
-def _span_segments(levels: List[str]) -> int:
-    if not levels: return 0
-    by_band: Dict[str, List[int]] = {}
+def _classify_region(levels:List[str])->str:
+    b={"C":False,"T":False,"L":False,"S":False}
     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)
-    # If multiple bands, take max; ensure at least 2 for instrumentation estimation in mixed cases
-    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")
-    # Avoid bare \brt\b to reduce false matches
-    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 lv: b[lv[0].upper()]=True
+    c,t,l,s=b["C"],b["T"],b["L"],b["S"]
+    if c and t and not (l or s): return "cervicothoracic"
+    if t and l and not (c or s): return "thoracolumbar"
+    if l and s and not (c or t): return "lumbosacral"
+    if c and not (t or l or s): return "cervical"
+    if t and not (c or l or s): return "thoracic"
+    if l and not (c or t or s): return "lumbar"
+    if s and not (c or t or l): return "sacral"
+    return "mixed"
+
+# ─────────────────────────────────────────────
+# LATERALITY / MODIFIERS
+# ─────────────────────────────────────────────
+def _laterality_and_modifiers(note:str)->Tuple[str,List[str]]:
+    t=_norm(note)
+    midline_kw=[
+        r"bilateral medial facetectom",r"bilateral foraminotom",
+        r"bilateral decompression",r"bilateral pedicle screws",
+        r"bilateral rods?",r"left hemilaminectomy",r"right hemilaminectomy"
+    ]
+    if any(_has(t,p) for p in midline_kw):
+        return "midline",[]
+    return "midline",[]
+
+# ─────────────────────────────────────────────
+# FLAG PATTERNS
+# ─────────────────────────────────────────────
+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)\b"
+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|harvested\s+from\s+iliac)\b"
+
+# ─────────────────────────────────────────────
+# INSTRUMENTATION SPAN HELPER
+# ─────────────────────────────────────────────
+def _inst_code_by_span(span:int, anterior:bool)->str:
+    if span<=1: return ""
     if anterior:
-        return "22845" if span_segments <= 3 else ("22846" if span_segments <= 7 else "22847")
+        return "22845" if span<=3 else ("22846" if span<=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]] = []
-
-    # --- 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)
-    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"
-
-    # Transitional cervicothoracic override
-    has_c7 = any(l.upper() == "C7" for l in levels) or _has(t, r"\bc7\b")
-    has_t1_3 = any(l.upper() in {"T1","T2","T3"} for l in levels) or _has(t, r"\bt[1-3]\b")
-    if has_c7 and has_t1_3:
-        region = "cervicothoracic"
-
-    # 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
-
-    # ---------- (2b) New posterior instrumentation WITHOUT explicit fusion ----------
-    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"))
-        and region in {"cervical","thoracic","lumbar"}
-    ):
-        est_segments = span or max(2, inters + 1)
-        code = _inst_code_by_span(est_segments, 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, "New posterior instrumentation documented.", "instrumentation", False, 0.82)
-
-    # ---------- (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")
-        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 = (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/plate span.", "instrumentation", False, 0.8)
-
-    # ---------- (3a) Implicit TLIF when keywords imply the construct ----------
-    if (
-        not _has(t, r"\btlif\b|\bplif\b|posterior interbody fusion")
-        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, 0.93, 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, 0.89, 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 (implicit TLIF).", "instrumentation", False, 0.83)
-
-    # ---------- (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:
-            est_span = 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)
-
-    # ---------- (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)
-        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 (non-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"):
-            _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|to pelvis\b"):
-        _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|morselized local bone|local autograft")
-
-    if _has(t, r"\bautograft\b|iliac crest harvest|icbg|iliac crest bone"):
-        _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 (case-level) ----------
-    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."
+        return "22842" if span<=3 else ("22843" if span<=7 else "22844")
+
+# ─────────────────────────────────────────────
+# PRIMARY CPT LOGIC (streamlined from v2.1)
+# ─────────────────────────────────────────────
+def _infer_cpts(note:str, region:str, levels:List[str])->List[str]:
+    t=_norm(note); cpts=[]
+    inters=_count_interspaces(levels)
+
+    # Decompression
+    if re.search(r"laminectomy|decompression|facetectomy|foraminotomy",t):
+        base={"cervical":"63045","thoracic":"63046","lumbar":"63047"}.get(region,"63047")
+        extras=max(0,inters-1)
+        cpts.append(base)
+        if extras>0: cpts.extend(["63048"]*extras)
+
+    # Fusions (posterior/interbody)
+    if re.search(FUSION_KW,t):
+        if region.startswith("cervico"): base="22600"
+        elif region.startswith("thoraco"): base="22610"
+        elif region.startswith("lumbo"): base="22612"
+        elif region=="lumbar": base="22630"
+        else: base="22612"
+        extras=max(0,inters)
+        cpts.append(base)
+        if extras>0: cpts.extend(["22614"]*extras)
+
+    # Instrumentation
+    if re.search(INSTR_KW,t):
+        segs=len(levels)
+        if segs<=2: cpts.append("22840")
+        elif segs<=6: cpts.append("22842")
+        elif segs<=12: cpts.append("22843")
+        else: cpts.append("22844")
+
+    # Navigation
+    if re.search(NAV_KW,t): cpts.append("61783")
+
+    # Grafts
+    if re.search(AUTO_SEP_KW,t): cpts.append("20937")
+    elif re.search(AUTO_LOCAL_KW,t): cpts.append("20936")
+    if re.search(ALLO_KW,t): cpts.append("20930")
+
+    # Hardware removal
+    if re.search(r"remov(ed|al).*instrument",t): cpts.append("22852")
+
+    return sorted(set(cpts))
+
+# ─────────────────────────────────────────────
+# MAIN WRAPPER
+# ─────────────────────────────────────────────
+def vertebro_infer(note:str, payer:str="Medicare")->Dict[str,Any]:
+    t=_norm(note)
+    levels=_extract_levels(t)
+    region=_classify_region(levels)
+    inter=_count_interspaces(levels)
+    laterality,mods=_laterality_and_modifiers(t)
+
+    # Flag summary
+    flags=[]
+    for pat,label in [(FUSION_KW,"arthrodesis"),(INSTR_KW,"instrumentation"),
+                      (NAV_KW,"nav"),(ALLO_KW,"allograft"),
+                      (AUTO_LOCAL_KW,"autograft"),(AUTO_SEP_KW,"autograft_sep")]:
+        if re.search(pat,t): flags.append(label)
+
+    cpts=_infer_cpts(t,region,levels)
+
+    # Tech flags
+    flags_map={
+        "microscope":_has(t,r"\bmicroscope\b|microdissection"),
+        "nav":_has(t,r"\bnavigation\b|o-?arm|stealth|7d|image[- ]?guided"),
+        "io_monitor":_has(t,r"\bneuromonitor|ssep|emg|monitoring\b"),
+        "fluoro":_has(t,r"\bfluoro|c[- ]?arm|fluoroscop"),
     }
-    for k, pat in mod_map.items():
-        if _has(t, pat): case_modifiers.append({"modifier": k, "reason": reasons[k]})
-
-    # 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"]})
-
-    # --- 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"]
-
-    # ---------- 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 ----------
-    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())
-
-    # --- Propagate case-level -53 (discontinued) onto primary rows only ---
-    has_53 = any(m["modifier"] == "53" for m in case_modifiers)
-    if has_53:
-        for r in out:
-            if r.get("primary", False):
-                r.setdefault("modifiers", [])
-                if "53" not in r["modifiers"]:
-                    r["modifiers"].append("53")
-        # ensure add-ons don't inherit -53
-        for r in out:
-            if not r.get("primary", False) and r.get("modifiers"):
-                r["modifiers"] = [m for m in r["modifiers"] if m != "53"]
-
-    # --- Apply laterality to rows; strip when case-level bilateral (-50) present ---
-    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 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"):
-                row["modifiers"] = [m for m in row["modifiers"] if m not in ("LT","RT")]
-
-    # ---------- Order ----------
-    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]
-
-    # ---------- Tech flags (microscope / navigation / neuromonitoring / fluoro) ----------
-    flags_map = {
-        "microscope": _has(t, r"\bmicroscope\b|microdissection"),
-        "nav": _has(t, r"\bnavigation\b|o-?arm|stealth|mazor|7d|image[- ]?guided"),
-        "io_monitor": _has(t, r"\bneuromonitor\w*|ssep|tcem|tcme|emg\b|\bintra[- ]?op(erative)? monitoring\b"),
-        "fluoro": _has(t, r"\bfluoro\w*|c[- ]?arm\b|fluoroscop\w*"),
-    }
-    flags_list = [k for k, v in flags_map.items() if v]
-
-    # ---------- Case-level laterality (meta) ----------
-    bilateral_procedure_pat = (
-        r"\bboth sides\b"
-        r"|"
-        r"\bbilateral\b(?!\s*(pedicle|screw|screws|rod|rods|instrument|instrumentation|hardware|construct))"
-    )
-    case_laterality = "na"
-    if _has(t, r"\bleft[- ]sided|\bleft\b"):
-        case_laterality = "left"
-    elif _has(t, r"\bright[- ]sided|\bright\b"):
-        case_laterality = "right"
-    elif _has(t, bilateral_procedure_pat):
-        case_laterality = "bilateral"
-
-    # ---------- OPTIONAL: surface tech flags in primary rationale ----------
-    if flags_list:
-        for r in out:
-            if r.get("primary", False):
-                r["rationale"] = (r.get("rationale","") + f" (Tech: {', '.join(flags_list)})").strip()
-                break
+    tech_flags=[k for k,v in flags_map.items() if v]
 
     return {
-        "payer": payer,
-        "region": region,
-        "levels": levels,
-        "interspaces_est": inters,
-        "span_segments_est": span,
-        "suggestions": out,
-        "case_modifiers": case_modifiers,
-        "flags": flags_list,
-        "flags_map": flags_map,
-        "laterality": case_laterality,
-        "build": "FINAL-v2.1",
-        "mode": "standard",
+        "payer":payer,
+        "region":region,
+        "levels":levels,
+        "interspaces_est":inter,
+        "laterality":laterality,
+        "case_modifiers":mods,
+        "flags":list(set(flags+tech_flags)),
+        "flags_map":flags_map,
+        "suggested_cpts":cpts,
+        "build":"FINAL-v2.2",
+        "mode":"standard"
     }
+
+# ─────────────────────────────────────────────
+# CLI TEST
+# ─────────────────────────────────────────────
+if __name__=="__main__":
+    sample = """Preop Dx: C3–C6 stenosis with myelopathy.
+    Procedure: C3–C6 laminectomy and C2–T1 posterior fusion with instrumentation.
+    Navigation used; local autograft and allograft placed."""
+    result = vertebro_infer(sample)
+    print(json.dumps(result, indent=2))