add concept map, translate(), add field and initialization in generators.

add CLM_PPS_IND to SupportingInfo StructureDefinition

initial

Author: thomaswilson-eng

apps/bfd-model-idr/augment_sample_resources.py

@@ -183,6 +183,7 @@ def get_sort_key(item):
     "CLM_MDCR_NPMT_RSN_CD": "CLM_MDCR_NPMT_RSN_CD",
     "CLM_OP_SRVC_TYPE_CD": "CLM_OP_SRVC_TYPE_CD",
     "CLM_PPS_IND_CD": "CLM_PPS_IND_CD",
+    "CLM_PPS_IND": "CLM_PPS_IND",
     "DGNS_DRG_CD": "DGNS_DRG_CD",
     "DGNS_DRG_OUTLIER_CD": "DGNS_DRG_OUTLIER_CD",
     "CLM_ACTV_CARE_THRU_DT": "CLM_ACTV_CARE_THRU_DT",

apps/bfd-model-idr/claims_generator.py

@@ -233,6 +233,7 @@ class _ClaimsFile(StrEnum):
             f.CLM_NUM_SK,
             f.CLM_TYPE_CD,
             f.CLM_CRNT_STUS_CD,
+            f.CLM_PPS_IND,
             f.IDR_INSRT_TS,
             f.IDR_UPDT_TS,
         ],

apps/bfd-model-idr/claims_pac.py

@@ -127,6 +127,7 @@ def gen_pac_clm(self, init_clm: RowAdapter):
 
         if pac_clm_type_cd in FISS_CLM_TYPE_CDS:
             clm[f.CLM_RIC_CD] = get_ric_cd_for_clm_type_cd(pac_clm_type_cd)
+            clm[f.CLM_PPS_IND] = random.choice(["N", "Y"])
 
         clm[f.CLM_RLT_COND_SGNTR_SK] = gen_numeric_id(field=f.CLM_RLT_COND_SGNTR_SK, start=-2)
 
@@ -160,6 +161,7 @@ def gen_clm_fiss(self, clm: RowAdapter, init_clm_fiss: RowAdapter | None = None)
         clm_fiss[f.GEO_BENE_SK] = clm[f.GEO_BENE_SK]
         clm_fiss[f.CLM_NUM_SK] = clm[f.CLM_NUM_SK]
         clm_fiss[f.CLM_TYPE_CD] = clm[f.CLM_TYPE_CD]
+        clm_fiss[f.CLM_PPS_IND] = clm[f.CLM_PPS_IND]
 
         add_meta_timestamps(clm_fiss, clm)
 

apps/bfd-model-idr/dictionary-support-files/ExplanationOfBenefit.yaml

@@ -2436,6 +2436,23 @@
   fhirPath: ExplanationOfBenefit.adjudication.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Adjudication' and code='CLM_MDCR_IP_PPS_CPTL_HRMLS_AMT').exists()).amount.value
   profiles:
     - CMS
+- inputPath: ExplanationOfBenefit-Institutional-Base.CLM_PPS_IND
+  appliesTo:
+    - Inpatient
+    - Outpatient
+    - HHA
+    - Hospice
+    - SNF
+  sources:
+    - FISS
+  ccwMapping:
+    - CLM_PPS_IND
+  referenceTable: CLM_PPS_IND
+  sourceView: V2_MDCR_CLM_FISS
+  sourceColumn: CLM_PPS_IND
+  fhirPath: ExplanationOfBenefit.supportingInfo.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information').exists() and category.coding.where(code='CLM_PPS_IND').exists()).code.coding.code
+  profiles:
+    - CMS
 - inputPath: ExplanationOfBenefit-Institutional-Base.CLM_PPS_IND_CD
   appliesTo:
     - Inpatient

apps/bfd-model-idr/field_constants.py

@@ -212,6 +212,7 @@
 CLM_PMT_AMT = "CLM_PMT_AMT"
 CLM_POS_CD = "CLM_POS_CD"
 CLM_PPS_IND_CD = "CLM_PPS_IND_CD"
+CLM_PPS_IND = "CLM_PPS_IND"
 CLM_PPS_MD_WVR_STDZD_VAL_AMT = "CLM_PPS_MD_WVR_STDZD_VAL_AMT"
 CLM_PRCDR_CD = "CLM_PRCDR_CD"
 CLM_PRCDR_PRFRM_DT = "CLM_PRCDR_PRFRM_DT"

apps/bfd-model-idr/maps/ExplanationOfBenefit-Helper.map

@@ -502,6 +502,14 @@ conceptmap "CLM_DGNS_PRCDR_ICD_IND_DIAGNOSIS" {
   s:"0" == t:"http://hl7.org/fhir/sid/icd-10-cm"
 }
 
+conceptmap "CLM_PPS_IND_CD" {
+  prefix s = "https://hl7.org/fhir/string"
+  prefix t = "https://bluebutton.cms.gov/fhir/CodeSystem/CLM-PPS-IND-CD"
+
+  s:"N" == t:" "
+  s:"Y" == t:"2"
+}
+
 conceptmap "HL7_DIAGTYPE" {
   prefix s = "https://hl7.org/fhir/string"
   prefix t = "http://terminology.hl7.org/CodeSystem/ex-diagnosistype"

apps/bfd-model-idr/maps/ExplanationOfBenefit-SupportingInfo-Helper.map

@@ -12,6 +12,7 @@ group addSupportingInfo(source src: SupportingInfoComponent, target tgt: Backbon
     src.CLM_BLOOD_PT_FRNSH_QTY as pintsFurnished -> tgt then addBloodPintsFurnished(src, tgt) "Add blood pints furnished";
     src.CLM_MDCR_INSTNL_MCO_PD_SW as mcoPdSw -> tgt then addMCOPdSw(src, tgt) "Add primary payer switch";
     src.CLM_PPS_IND_CD as ppsInd -> tgt then addPPSInd(src, tgt) "Add PPS Indicator";
+    src.CLM_PPS_IND as ppsInd -> tgt then addPPSInd(src, tgt) "Add PPS Indicator";
     src.TYPE_OF_BILL_CD as tobCode -> tgt then addTypeOfBill(src, tgt) "Add type of bill code";
     src.CLM_NCH_WKLY_PROC_DT as procDt -> tgt then addProcessingDate(src, tgt) "Add processing date";
     src.CLM_ACTV_CARE_THRU_DT as activeThruDt -> tgt then addNCHThroughDate(src, tgt) "Add processing date";
@@ -297,6 +298,7 @@ group addPPSInd(source src: SupportingInfoComponent, target tgt: BackboneElement
     } "Add category";
     src -> tgt.code = create('CodeableConcept') as tgtCC then {
         src.CLM_PPS_IND_CD as val -> tgtCC.coding = c("https://bluebutton.cms.gov/fhir/CodeSystem/CLM-PPS-IND-CD",val) "Add coding";
+        src.CLM_PPS_IND as val -> tgtCC.coding = translate(val,'https://bfd.cms.gov/MappingLanguage/Maps/ExplanationOfBenefit-Helper#CLM_PPS_IND_CD','coding') "Add coding";
     } "Add CC";
 }
 //code. Not necessary, duplicative with BENE_PTNT_STUS_CD. 

apps/bfd-model-idr/sushi/input/fsh/StructureDefinition-SupportingInfoComponent.fsh

@@ -22,7 +22,8 @@ Id: SupportingInfoComponent
 * CLM_ACTV_CARE_THRU_DT 0..1 date "Covered Care Through Date" ""
 * CLM_NCVRD_FROM_DT 0..1 date "Noncovered Stay From Date" ""
 * CLM_NCVRD_THRU_DT 0..1 date "Noncovered Stay Through Date" ""
-* CLM_PPS_IND_CD 0..1 string "Claim PPS Indicator Code" ""
+* CLM_PPS_IND_CD 0..1 string "Claim PPS Indicator Code Institutional" ""
+* CLM_PPS_IND 0..1 string "Claim PPS Indicator Code FISS" ""
 * CLM_NCH_PRMRY_PYR_CD 0..1 string "The code outlining the primary payer." ""
 * CLM_QLFY_STAY_FROM_DT 0..1 date "Qualified Stay From Date" ""
 * CLM_QLFY_STAY_THRU_DT 0..1 date "Qualified Stay Through Date" ""