BFD-4543: Refactor Diagnoses Implementation (#3062)

Co-authored-by: aschey-forpeople <162160982+aschey-forpeople@users.noreply.github.com>
Co-authored-by: Austin Schey <austin.schey@forpeople.us>

Author: 2 people

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

@@ -108,7 +108,7 @@ group createEOBBase(source src: ExplanationOfBenefitBase, target tgt: BFDEOB){
 
     src.CLM_TYPE_CD as typeCd where((typeCd > 70 and typeCd <= 82) or (typeCd >= 2700 and typeCd < 2900) or (typeCd >= 1700 and typeCd < 1900)) -> tgt then{
       src.diagnoses as diagnoses -> tgt.diagnosis = create('BackboneElement') as tgtDiagnosis then addDiagnosesProfessional(diagnoses, tgtDiagnosis) "Add diagnoses";
-    } "Add diagnoses for institutional claims.";
+    } "Add diagnoses for professional claims.";
 
 
     //Supportinginfo!

apps/bfd-model-idr/out/ExplanationOfBenefit-Carrier.json

@@ -981,8 +981,8 @@
     }],
     "sequence" : 1,
     "careTeamSequence" : [1],
-    "informationSequence" : [29,
-    30],
+    "diagnosisSequence" : [2],
+    "informationSequence" : [29],
     "revenue" : {
       "coding" : [{
         "system" : "https://bluebutton.cms.gov/fhir/CodeSystem/CLM-REV-CNTR-CD",

apps/bfd-model-idr/out/ExplanationOfBenefit.json

@@ -1259,7 +1259,6 @@
   "item" : [{
     "sequence" : 1,
     "careTeamSequence" : [4],
-    "diagnosisSequence" : [4],
     "revenue" : {
       "coding" : [{
         "system" : "https://bluebutton.cms.gov/fhir/CodeSystem/CLM-REV-CNTR-CD",

apps/bfd-model-idr/sample-data/EOB-Base-Sample.json

@@ -229,7 +229,6 @@
     ],
     "lineItemComponents":[
         {
-            "CLM_LINE_DGNS_CD": "M48.062",
             "PRVDR_RNDRNG_PRVDR_NPI_NUM": "1942945159",
             "CLM_LINE_ADD_ON_PYMT_AMT": "11.11",
             "CLM_LINE_NON_EHR_RDCTN_AMT": "11.12",

apps/bfd-model-idr/sample-data/EOB-Carrier-Sample.json

@@ -142,6 +142,7 @@
     ],
     "lineItemComponents": [
         {
+            "CLM_LINE_DGNS_CD": "M48.062",
             "diagnosisRelatedLine": "1",
             "CLM_RNDRG_PRVDR_TYPE_CD": "5",
             "CARR_LINE_PRVDR_TYPE_CD": "5",

apps/bfd-model-idr/sample-data/EOB-Inpatient-FISS-Sample.json

@@ -164,7 +164,6 @@
     ],
     "lineItemComponents": [
         {
-            "CLM_LINE_DGNS_CD": "E78.00",
             "diagnosisRelatedLine": "5",
             "CLM_LINE_NUM": "1",
             "CLM_LINE_HCPCS_CD": "99213",

apps/bfd-pipeline-idr/test_samples2/SYNTHETIC_CLM_PROD.csv

@@ -8,8 +8,8 @@ D,,9,2021-10-03,2,322823692140,1,86974,40,25000,,2025-08-30 21:02:39.643878,
 D,,9,2021-10-03,3,322823692140,1,86974,40,E8889,,2025-10-18 14:19:16.348560,
 D,,9,2021-10-03,4,322823692140,1,86974,40,V1005,,2025-06-24 04:53:33.189945,
 S,5A1D70Z,0,2021-09-29,0,322823692141,1,86974,10,,,2026-02-07 03:19:40.183655,
-P,B2111ZZ,0,2021-10-03,1,322823692141,1,86974,10,,,2025-09-07 06:16:52.190134,2025-11-28 06:54:15.224368
-D,,0,,1,322823692141,1,86974,10,,U,2025-11-06 19:19:41.633089,2026-01-23 22:23:54.903590
+P,,0,,1,322823692141,1,86974,10,W5541XA,,2025-09-07 06:16:52.190134,2025-11-28 06:54:15.224368
+D,,0,,1,322823692141,1,86974,10,W5541XA,U,2025-11-06 19:19:41.633089,2026-01-23 22:23:54.903590
 A,,0,,1,322823692141,1,86974,10,V972,~,2025-11-16 21:36:13.404555,
 E,,,,1,322823692141,1,86974,10,W5813XD,0,2025-07-15 20:24:54.375036,
 1,,0,,1,322823692141,1,86974,10,W5813XD,~,2025-06-17 08:58:32.463431,

apps/bfd-pipeline-idr/test_samples2/professional/SYNTHETIC_CLM_DCMTN.csv

@@ -1,4 +1,4 @@
 CLM_DT_SGNTR_SK,CLM_NUM_SK,GEO_BENE_SK,CLM_TYPE_CD,CLM_NRLN_RIC_CD,IDR_INSRT_TS,IDR_UPDT_TS
 659052754349,1,86975,71,V,2025-02-05 02:01:20.616567,2025-04-30 10:55:23.977977
 659052754348,1,86974,2800,M,2025-04-25 08:51:26.299139,
-659052754350,1,86975,2700,,2024-01-02 03:09:46.377545,
+659052754350,1,86975,2700,,2024-01-02 03:09:46.377545,

apps/bfd-pipeline-idr/test_samples2/professional/SYNTHETIC_CLM_PROD.csv

@@ -1,9 +1,10 @@
-CLM_PROD_TYPE_CD,CLM_PRCDR_CD,CLM_DGNS_PRCDR_ICD_IND,CLM_PRCDR_PRFRM_DT,CLM_VAL_SQNC_NUM,CLM_DT_SGNTR_SK,CLM_NUM_SK,GEO_BENE_SK,CLM_TYPE_CD,CLM_DGNS_CD,CLM_POA_IND
-P,,9,2021-10-03,1,659052754348,1,86974,2800,30495,Y
-1,,9,2021-10-03,2,659052754348,1,86974,2800,25000,~
-E,,9,2021-10-03,3,659052754348,1,86974,2800,E8889,Y
-P,,9,2021-10-03,4,659052754348,1,86974,2800,V1005,~
-P,,9,2021-10-03,1,659052754349,1,86975,71,30495,Y
-1,,9,2021-10-03,2,659052754349,1,86975,71,25000,~
-E,,9,2021-10-03,3,659052754349,1,86975,71,E8889,Y
-P,,9,2021-10-03,4,659052754349,1,86975,71,V1005,~
+CLM_PROD_TYPE_CD,CLM_PRCDR_CD,CLM_DGNS_PRCDR_ICD_IND,CLM_PRCDR_PRFRM_DT,CLM_VAL_SQNC_NUM,CLM_DT_SGNTR_SK,CLM_NUM_SK,GEO_BENE_SK,CLM_TYPE_CD,CLM_DGNS_CD,CLM_POA_IND,IDR_INSRT_TS,IDR_UPDT_TS
+P,,9,2021-10-03,1,659052754349,1,86975,71,30495,Y,2024-12-06 10:21:38.108346,
+D,,9,,1,659052754349,1,86975,71,30495,~,2023-08-24 15:38:41.961976,2025-03-25 14:38:43.304857
+D,,9,,2,659052754349,1,86975,71,R465,~,2024-09-05 07:39:24.593087,
+D,,9,,3,659052754349,1,86975,71,V970,~,2023-10-08 03:54:03.893757,
+P,,9,2021-10-03,1,659052754348,1,86974,2800,30495,Y,,
+1,,9,2021-10-03,2,659052754348,1,86974,2800,25000,~,,
+E,,9,2021-10-03,3,659052754348,1,86974,2800,E8889,Y,,
+P,,9,2021-10-03,4,659052754348,1,86974,2800,V1005,~,,
+D,,9,2021-10-03,5,659052754348,1,86974,2800,W213,~