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:

User Says	Clarify
"scan"	MRI? CT? X-ray? PET?
"back scan"	Lumbar? Thoracic? Cervical? With contrast?
"physical therapy"	Initial eval? Follow-up? How many visits?
"injection"	What type? Where?
"surgery"	What procedure specifically?

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

User Phrase	CPT	Description
"MRI of my back"	72148	MRI lumbar spine w/o contrast
"MRI of my knee"	73721	MRI knee w/o contrast
"CT scan of my head"	70450	CT head w/o contrast
"chest X-ray"	71046	Chest X-ray, 2 views
"mammogram"	77067	Screening mammography

Therapy

User Phrase	CPT	Description
"physical therapy evaluation"	97163	PT eval, high complexity
"physical therapy session"	97110	Therapeutic exercises
"occupational therapy"	97530	Therapeutic activities
"speech therapy"	92507	Speech therapy

Sleep

User Phrase	CPT	Description
"sleep study"	95810	Polysomnography
"home sleep test"	95806	Home sleep study
"CPAP titration"	95811	Polysomnography with CPAP

Injections

User Phrase	CPT	Description
"cortisone shot in my knee"	20610	Joint injection, large
"epidural for back pain"	62322	Lumbar epidural injection
"trigger point injection"	20552	Trigger point injection

Surgery

User Phrase	CPT	Description
"knee replacement"	27447	Total knee arthroplasty
"hip replacement"	27130	Total hip arthroplasty
"cataract surgery"	66984	Cataract removal with IOL
"colonoscopy"	45378	Colonoscopy, diagnostic

Modifiers Matter

Some situations need CPT modifiers:

Modifier	Meaning	Example
-RT	Right side	73721-RT (MRI right knee)
-LT	Left side	73721-LT (MRI left knee)
-50	Bilateral	73721-50 (MRI both knees)
-26	Professional component	72148-26 (interpretation only)
-TC	Technical component	72148-TC (facility charge only)

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..."