Add new mapping file for outpatient HCPCS code to revenue center

synthetichealth · Jun 26, 2023 · e2ac8c1 · e2ac8c1
1 parent 4dac197
commit e2ac8c1
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Showing 5 changed files with 16 additions and 6 deletions.
diff --git a/.gitignore b/.gitignore
@@ -33,6 +33,7 @@ src/main/resources/export/snf_rev_cntr_code_map.json
 src/main/resources/export/hha_rev_cntr_code_map.json
 src/main/resources/export/hospice_rev_cntr_code_map.json
 src/main/resources/export/inpatient_rev_cntr_code_map.json
+src/main/resources/export/outpatient_rev_cntr_code_map.json
 
 # H2 database files
 **/*.mv.db

diff --git a/src/main/java/org/mitre/synthea/export/rif/BB2RIFExporter.java b/src/main/java/org/mitre/synthea/export/rif/BB2RIFExporter.java
@@ -82,6 +82,7 @@ public class BB2RIFExporter {
   final CodeMapper hhaRevCntrMapper;
   final CodeMapper hospiceRevCntrMapper;
   final CodeMapper inpatientRevCntrMapper;
+  final CodeMapper outpatientRevCntrMapper;
   final Map<String, RandomCollection<String>> externalCodes;
   final CMSStateCodeMapper locationMapper;
   final BeneficiaryExporter beneExp;
@@ -111,6 +112,7 @@ private BB2RIFExporter() {
     hhaRevCntrMapper = new CodeMapper("export/hha_rev_cntr_code_map.json");
     hospiceRevCntrMapper = new CodeMapper("export/hospice_rev_cntr_code_map.json");
     inpatientRevCntrMapper = new CodeMapper("export/inpatient_rev_cntr_code_map.json");
+    outpatientRevCntrMapper = new CodeMapper("export/outpatient_rev_cntr_code_map.json");
     locationMapper = new CMSStateCodeMapper();
     externalCodes = loadExternalCodes();
     try {

diff --git a/src/main/java/org/mitre/synthea/export/rif/InpatientExporter.java b/src/main/java/org/mitre/synthea/export/rif/InpatientExporter.java
@@ -196,6 +196,8 @@ long export(Person person, long startTime, long stopTime) throws IOException {
         }
 
         // Add a total charge entry.
+        fieldValues.remove(BB2RIFStructure.INPATIENT.REV_CNTR_NDC_QTY);
+        fieldValues.remove(BB2RIFStructure.INPATIENT.REV_CNTR_NDC_QTY_QLFR_CD);
         fieldValues.put(BB2RIFStructure.INPATIENT.CLM_LINE_NUM, Integer.toString(claimLine));
         // HCPCS 99221: "Inpatient hospital visits: Initial and subsequent"
         fieldValues.put(BB2RIFStructure.INPATIENT.REV_CNTR, "0001");

diff --git a/src/main/java/org/mitre/synthea/export/rif/OutpatientExporter.java b/src/main/java/org/mitre/synthea/export/rif/OutpatientExporter.java
@@ -121,18 +121,20 @@ long export(Person person, long startTime, long stopTime) throws IOException {
       }
 
       String originalRandomRevCenter = fieldValues.get(BB2RIFStructure.OUTPATIENT.REV_CNTR);
-      if (encounter.type.equals(HealthRecord.EncounterType.VIRTUAL.toString())) {
-        String revCenter = person.randBoolean() ? "0780" : "0789";
-        fieldValues.put(BB2RIFStructure.OUTPATIENT.REV_CNTR, revCenter);
-      }
 
       synchronized (exporter.rifWriters.getOrCreateWriter(BB2RIFStructure.OUTPATIENT.class)) {
         int claimLine = 1;
         for (Claim.ClaimEntry lineItem : billableItems) {
           String hcpcsCode = null;
           if (lineItem.entry instanceof HealthRecord.Procedure) {
             hcpcsCode = getFirstMappedHCPCSCode(lineItem.entry.codes, person);
-            fieldValues.put(BB2RIFStructure.OUTPATIENT.REV_CNTR, originalRandomRevCenter);
+            String revCenter = originalRandomRevCenter;
+            if (encounter.type.equals(HealthRecord.EncounterType.VIRTUAL.toString())) {
+              revCenter = person.randBoolean() ? "0780" : "0789";
+            } else if (exporter.outpatientRevCntrMapper.canMap(hcpcsCode)) {
+              revCenter = exporter.outpatientRevCntrMapper.map(hcpcsCode, person);
+            }
+            fieldValues.put(BB2RIFStructure.OUTPATIENT.REV_CNTR, revCenter);
             fieldValues.remove(BB2RIFStructure.OUTPATIENT.REV_CNTR_IDE_NDC_UPC_NUM);
             fieldValues.remove(BB2RIFStructure.OUTPATIENT.REV_CNTR_NDC_QTY);
             fieldValues.remove(BB2RIFStructure.OUTPATIENT.REV_CNTR_NDC_QTY_QLFR_CD);
@@ -158,6 +160,9 @@ long export(Person person, long startTime, long stopTime) throws IOException {
         }
 
         // Add a total charge entry.
+        fieldValues.remove(BB2RIFStructure.OUTPATIENT.REV_CNTR_IDE_NDC_UPC_NUM);
+        fieldValues.remove(BB2RIFStructure.OUTPATIENT.REV_CNTR_NDC_QTY);
+        fieldValues.remove(BB2RIFStructure.OUTPATIENT.REV_CNTR_NDC_QTY_QLFR_CD);
         fieldValues.put(BB2RIFStructure.OUTPATIENT.CLM_LINE_NUM, Integer.toString(claimLine));
         fieldValues.put(BB2RIFStructure.OUTPATIENT.REV_CNTR_DT,
                 RIFExporter.bb2DateFromTimestamp(encounter.start));

diff --git a/src/main/resources/export/bfd_field_values.tsv b/src/main/resources/export/bfd_field_values.tsv
@@ -565,7 +565,7 @@ Line	Field	BENEFICIARY	BENEFICIARY_HISTORY	INPATIENT	OUTPATIENT	CARRIER	PDE	DME
 563	RDS_NOV_IND	Coded	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	TRUE	
 564	RDS_OCT_IND	Coded	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	TRUE	
 565	RDS_SEPT_IND	Coded	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	TRUE	
-566	REV_CNTR	N/A	N/A	"0300,0301,0305,0450,0730,0306,0324,0424,0420,0272 (most frequent)"	"XXXX (lots of alternatives)"	N/A	N/A	N/A	"0551,0551,0551,0421,0421,0023,0001 (hha codes)"	"0571,0571,0551,0551,0651,0001 (hospice codes)"	Coded	FALSE	
+566	REV_CNTR	N/A	N/A	"0300,0301,0305,0450,0730,0306,0324,0424,0420,0272 (most frequent)"	"0250,0272,0270,0258,0710,0370,0637,0259,0271,0521,0251 (most frequent)"	N/A	N/A	N/A	"0551,0551,0551,0421,0421,0023,0001 (hha codes)"	"0571,0571,0551,0551,0651,0001 (hospice codes)"	Coded	FALSE	
 567	REV_CNTR_1ST_ANSI_CD	N/A	N/A	N/A		N/A	N/A	N/A		N/A	N/A	TRUE	
 568	REV_CNTR_1ST_MSP_PD_AMT	N/A	N/A	N/A	0	N/A	N/A	N/A	N/A	N/A	N/A	FALSE	
 569	REV_CNTR_2ND_ANSI_CD	N/A	N/A	N/A		N/A	N/A	N/A	N/A	N/A	N/A	TRUE