By name: symptom-to-diagnosis description: Map plain English symptom descriptions to ICD-10 diagnosis codes version: 1.0.0 triggers: - user_describes_symptoms - user_describes_condition - user_mentions_diagnosis
Symptom-to-Diagnosis Skill
This skill translates plain English symptom descriptions into ICD-10 diagnosis codes for internal use. Codes are never shown to users.
Purpose
Patients don't know medical codes. They say things like:
- "My back is killing me"
- "I get dizzy when I stand up"
- "She can't catch her breath"
This skill maps their words to the appropriate ICD-10 codes needed for coverage checks.
Process
1. Listen for Symptoms
Detect when users describe:
- Physical symptoms (pain, numbness, weakness)
- Conditions (diabetes, high blood pressure)
- Problems (can't sleep, trouble breathing)
2. Ask Clarifying Questions
Gather specifics to narrow down the code:
| Question Type | Examples |
|---|---|
| Location | "Where exactly is the pain?" |
| Duration | "How long has this been going on?" |
| Severity | "On a scale of 1-10, how bad is it?" |
| Onset | "Did it start suddenly or gradually?" |
| Character | "Is it sharp, dull, or burning?" |
| Radiation | "Does it spread anywhere else?" |
| Triggers | "Does anything make it better or worse?" |
3. Map to ICD-10
Use the ICD-10 search tool to find the best match:
// Example mapping
userPhrase: "dizzy when I stand up"
clarifications: {
duration: "few weeks",
frequency: "every time",
other_symptoms: "lightheaded, sometimes see spots"
}
→ ICD-10: R55 (Syncope and collapse) or R42 (Dizziness)
4. Store for Learning
Queue the successful mapping:
queueLearning('update_symptom_mapping', {
phrase: "dizzy when I stand up",
code: "R55",
confidence_boost: 0.05
});
Clarifying Question Patterns
For Pain
- "Where exactly is the pain?"
- "How long have you had it?"
- "Does it stay in one place or travel somewhere else?"
- "What does it feel like — sharp, dull, burning, aching?"
- "What were you doing when it started?"
For Neurological Symptoms
- "Can you describe what happens?"
- "How often does it happen?"
- "How long does each episode last?"
- "Is there any warning before it happens?"
- "Have you noticed any patterns or triggers?"
For Breathing Issues
- "When do you notice it most — at rest, with activity, or lying down?"
- "How long has this been going on?"
- "Do you have any cough or chest tightness?"
- "Does anything make it better or worse?"
For General Symptoms
- "Can you tell me more about what you're experiencing?"
- "When did this start?"
- "Is it constant or does it come and go?"
- "Have you noticed anything else unusual?"
Common Mappings
Use learned mappings when confidence is high:
| User Phrase | ICD-10 | Confidence |
|---|---|---|
| "back pain" | M54.5 (Low back pain) | 0.90 |
| "knee pain" | M25.56 (Pain in knee) | 0.88 |
| "dizzy spells" | R42 (Dizziness) | 0.85 |
| "can't sleep" | G47.00 (Insomnia) | 0.82 |
| "short of breath" | R06.02 (Shortness of breath) | 0.87 |
| "chest pain" | R07.9 (Chest pain, unspecified) | 0.75 |
| "headaches" | R51.9 (Headache) | 0.88 |
| "tired all the time" | R53.83 (Fatigue) | 0.80 |
Specificity Matters
ICD-10 rewards specificity. Always try to get the most specific code:
Generic: M54.5 (Low back pain)
Better: M54.51 (Vertebrogenic low back pain)
Best: M54.51 + G89.29 (with chronic pain syndrome)
Questions That Increase Specificity
| Generic Code | Ask | Specific Code |
|---|---|---|
| M54.5 (back pain) | "Does it go into your legs?" | M54.4 (Lumbago with sciatica) |
| R42 (dizziness) | "Do you feel like spinning?" | H81.10 (Benign paroxysmal vertigo) |
| R07.9 (chest pain) | "Does it feel like pressure?" | R07.89 (Other chest pain) |
Multiple Codes
Some situations need multiple codes:
User: "I have diabetes and my feet are numb"
Primary: E11.9 (Type 2 diabetes without complications)
Secondary: E11.42 (Type 2 diabetes with diabetic polyneuropathy)
Red Flags
Some symptoms require immediate medical attention. Don't just map — acknowledge:
| Symptom | Response |
|---|---|
| Chest pain + shortness of breath | "If you're having these symptoms now, please call 911 or go to the ER immediately." |
| Sudden severe headache | "A sudden severe headache can be serious. If this is happening now, please seek emergency care." |
| Sudden numbness/weakness one side | "These could be signs of a stroke. If happening now, call 911." |
After the safety message, you can continue with coverage questions if they confirm it's not an emergency.
What NOT to Do
- Never show codes to users: Say "back pain" not "M54.5"
- Never ask for codes: Say "What's going on?" not "Do you know the ICD-10?"
- Never diagnose: Say "symptoms like these" not "you have sciatica"
- Never guess without clarification: If unsure, ask more questions
Example Conversation
User: "My mom's back is killing her"
Assistant: "I'm sorry to hear your mom is dealing with back pain. To help figure out what Medicare needs, I have a few questions.
Where in her back is the pain — upper, middle, or lower?"
User: "Lower back, and it goes down her left leg"
Assistant: "Lower back pain that goes down into the leg — that's called radiating pain, and it's an important detail.
How long has she been dealing with this?"
User: "About 3 months"
Assistant: "Three months of lower back pain radiating into the leg — thank you. One more question: has she had any numbness or tingling in that leg?"
User: "Yes, her foot tingles sometimes"
Assistant: [Internal: Maps to M54.41 (Lumbago with sciatica, left side) + potentially M79.2 (Neuralgia)]
"That's really helpful information. The combination of back pain, leg pain, and tingling often supports the need for imaging like an MRI.
Has she tried any treatments so far?"