procedure-identification

name: procedure-identification description: Map plain English service descriptions to CPT procedure codes version: 1.0.0 triggers: - user_mentions_procedure - user_mentions_test - user_mentions_scan - user_mentions_treatment

Procedure Identification Skill

This skill translates plain English service descriptions into CPT procedure codes for internal use. Codes are never shown to users.

Purpose

Patients describe services in everyday language:

• "I need a scan for my back"
• "The doctor wants me to do physical therapy"
• "She needs a sleep study"

This skill maps their words to CPT codes needed for coverage checks.

Process

1. Listen for Procedures

Detect when users mention:

• Tests (MRI, CT, X-ray, blood work)
• Treatments (physical therapy, injections, surgery)
• Services (office visits, consultations)
• Equipment (wheelchair, CPAP, walker)

2. Clarify When Ambiguous

Many descriptions could map to multiple codes:

3. Map to CPT

Use the CPT lookup tool (dev environment only):

// Example mapping
userPhrase: "MRI of my lower back"
clarifications: {
  body_part: "lumbar spine",
  contrast: "without"
}
→ CPT: 72148 (MRI lumbar spine without contrast)

4. Store for Learning

Queue the successful mapping:

queueLearning('update_procedure_mapping', {
  phrase: "MRI of my lower back",
  code: "72148",
  confidence_boost: 0.05
});

Clarifying Question Patterns

For Imaging (Scans)

1. "What type of scan — MRI, CT, or X-ray?"
2. "Which part of the body?"
3. "Did they mention anything about contrast or dye?"

For Physical Therapy

1. "Is this the first evaluation or ongoing sessions?"
2. "How many visits per week are planned?"
3. "Is it for a specific injury or general conditioning?"

For Injections

1. "What type of injection?"
2. "Where in the body?"
3. "Is it for pain, inflammation, or something else?"

For Surgery

1. "What procedure is being recommended?"
2. "Is it outpatient or will they stay in the hospital?"
3. "Has the doctor given you any paperwork about it?"

For Equipment (DME)

1. "What equipment do they need?"
2. "Is it for home use?"
3. "Will it be rented or purchased?"

Common Mappings

Use learned mappings when confidence is high:

Imaging

Therapy

Sleep

Injections

Surgery

Modifiers Matter

Some situations need CPT modifiers:

Similar Procedures

Help users understand differences:

MRI vs CT

User: "What's the difference between MRI and CT?"

Response: "Both are imaging tests, but they work differently:
- MRI uses magnets and is better for soft tissues like muscles, tendons, and the brain
- CT uses X-rays and is faster, better for bones and emergencies

Your doctor chose [X] because [reason based on their condition]."

Screening vs Diagnostic

Screening mammogram (77067): Routine, no symptoms
Diagnostic mammogram (77066): Following up on a finding

What NOT to Do

• Never show codes: Say "back MRI" not "CPT 72148"
• Never ask for codes: Say "What test?" not "Do you know the CPT?"
• Never assume: If "scan" could be MRI or CT, ask
• Never skip laterality: Left knee vs right knee matters

Example Conversation

User: "The doctor wants her to get a scan for her back"

Assistant: "I can help figure out what Medicare needs for that scan.

Do you know what type of scan — is it an MRI, CT scan, or X-ray?"

User: "I think an MRI"

Assistant: "Good — MRIs give detailed pictures that can help see what's causing her symptoms.

Is the scan for her lower back, middle back, or upper back/neck area?"

User: "Lower back"

Assistant: [Internal: Maps to 72148 (MRI lumbar spine w/o contrast) or 72149 (with contrast)]

"Perfect — an MRI of the lower back. One more question: did they mention anything about using contrast dye, or is it just a regular MRI?"

User: "Just regular, no dye"

Assistant: [Internal: Confirms 72148]

"Got it — a lumbar spine MRI without contrast. Let me check what Medicare typically requires for this..."