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Update app.py

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@@ -4,75 +4,157 @@ st.set_page_config(layout="wide")
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  st.markdown("""
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- ## Service Code Ranges:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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- 1. Organ Transplant
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- - CPT Code Range: 50300-50380
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- - Rules for Required Evidence of Medical Necessity: Diagnosis, waiting list, physician referral
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- 2. Spinal Fusion Surgery
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- - CPT Code Range: 22532-22812
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- - Rules for Required Evidence of Medical Necessity: Diagnosis, conservative treatment history, physician referral
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- 3. Bariatric Surgery
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- - CPT Code Range: 43644-43775
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- - Rules for Required Evidence of Medical Necessity: BMI, documented weight loss attempts, physician referral, psychological evaluation
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-
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- 4. Joint Replacement Surgery
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- - CPT Code Range: 27130-27447
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- - Rules for Required Evidence of Medical Necessity: Diagnosis, conservative treatment history, physician referral
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-
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- 5. Chemotherapy
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- - CPT Code Range: 96401-96549
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- - Rules for Required Evidence of Medical Necessity: Cancer diagnosis, treatment plan, medication, dosage, and frequency
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-
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- 6. Radiation Therapy
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- - CPT Code Range: 77261-77799
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- - Rules for Required Evidence of Medical Necessity: Cancer diagnosis, treatment plan, physician referral
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-
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- 7. Cardiac Surgery
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- - CPT Code Range: 33010-33999
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- - Rules for Required Evidence of Medical Necessity: Diagnosis, conservative treatment history, physician referral
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-
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- 8. Dialysis
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- - CPT Code Range: 90935-90999
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- - Rules for Required Evidence of Medical Necessity: Diagnosis of kidney disease, treatment plan, physician referral
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-
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- 9. Gastrointestinal Surgery
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- - CPT Code Range: 43620-44979
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- - Rules for Required Evidence of Medical Necessity: Diagnosis, conservative treatment history, physician referral
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-
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- 10. Advanced Imaging Services
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- - CPT Code Range: 70450-72159 (CT), 70540-72198 (MRI)
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- - Rules for Required Evidence of Medical Necessity: Clinical history, prior relevant imaging, symptoms justification
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-
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- 11. Interventional Radiology
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- - CPT Code Range: 37220-37235
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- - Rules for Required Evidence of Medical Necessity: Diagnosis, conservative treatment history, physician referral
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-
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- 12. Sleep Study
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- - CPT Code Range: 95800-95811
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- - Rules for Required Evidence of Medical Necessity: Documented sleep disorder symptoms, sleep diary, physician referral
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-
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- 13. Infusion Therapy
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- - CPT Code Range: 96360-96549
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- - Rules for Required Evidence of Medical Necessity: Diagnosis, medication, dosage, frequency, and duration
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-
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- 14. Pain Management
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- - CPT Code Range: 64400-64530
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- - Rules for Required Evidence of Medical Necessity: Diagnosis, conservative treatment history, treatment plan
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-
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- 15. Cardiac Stress Test
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- - CPT Code Range: 93015-93018
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- - Rules for Required Evidence of Medical Necessity: Documented symptoms, cardiac risk factors, physician referral
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-
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- 16. Pulmonary Function Test
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- - CPT Code Range: 94010-94799
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- - Rules for Required Evidence of Medical Necessity: Documented respiratory issues, physician referral
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-
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- 17. Physical Therapy
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- - CPT Code Range: 97110-97546
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- - Rules for Required Evidence of Medical
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  ## Services
 
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  st.markdown("""
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+ ## Big Four - Diabetes, Heart Disease, Anxiety & Depression and Muskoskeletal Disorders
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+
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+ | Costly Condition | Code Type | Code Value | Emoji | Code Description |
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+ |---------------------------------|-----------|----------------------|-----------|---------------------------------------------------------|
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+ | Diabetes | CPT | 99214, 99215 | 🩺 | Office/outpatient visit |
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+ | | ICD-10 | E08.00 - E13.9 | 🍬 | Diabetes Mellitus |
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+ | | SNOMED | 73211009, 44054006 | 🍬 | Diabetes Mellitus Type 1, Diabetes Mellitus Type 2 |
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+ | | LOINC | 4548-4, 14647-2 | 🍬 | Hemoglobin A1c, Glucose |
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+ | | Omaha | 1405-8, 1435-4 | 🍬 | Diabetes Management, Glucose Monitoring |
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+ | Heart Disease | CPT | 92920, 92928 | 💔 | Percutaneous coronary intervention |
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+ | | ICD-10 | I20.0 - I25.9 | 💔 | Ischemic Heart Diseases |
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+ | | SNOMED | 53741008, 84114007 | 💔 | Coronary Artery Disease, Myocardial Infarction |
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+ | | LOINC | 24331-1, 6768-6 | 💔 | Troponin I, Total Cholesterol |
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+ | | Omaha | 2610-5, 2871-4 | 💔 | Hypertension Management, Lipid Management |
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+ | Anxiety & Depression | CPT | 90791, 90834, 90837 | 😨 | Psychiatric diagnostic evaluation, psychotherapy |
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+ | | ICD-10 | F32.0 - F39 | 😨 | Mood (Affective) Disorders |
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+ | | SNOMED | 42343007, 39607008 | 😨 | Major Depressive Disorder, Generalized Anxiety Disorder |
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+ | | LOINC | 75216-8, 73633-2 | 😨 | PHQ-9 Total Score, GAD-7 Total Score |
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+ | | Omaha | 5250-7, 5361-7 | 😨 | Depression Management, Anxiety Management |
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+ | Musculoskeletal Disorders | CPT | 97110, 97112 | 🏋️‍♂️ | Therapeutic exercises, neuromuscular reeducation |
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+ | | ICD-10 | M00.00 - M99.9 | 🏋️‍♂️ | Diseases of the musculoskeletal system and connective tissue |
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+ | | SNOMED | 239873007, 80931005 | 🏋️‍♂️ | Osteoarthritis, Low Back Pain |
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+ | | LOINC | 8302-2, 71425-3 | 🏋️‍♂️ | Creatine Kinase, Aldolase |
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+ | | Omaha | 3110-2, 3120-6 | 🏋️‍♂️ | Musculoskeletal Assessment, Pain Management |
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+
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+
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+ | Rank | Costly Condition | Approval Code Type | Approval Codes | Code Description | Medical Necessity Rules |
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+ |------|---------------------------------|--------------------|-------------------------|----------------------------------------|--------------------------------------------------------------------------------------------------------------------------|
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+ | 1 | 🍬 Diabetes | CPT | 99214, 99215 | Office/outpatient visit | - Diagnosis confirmation |
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+ | | | ICD-10 | E08.00 - E13.9 | Diabetes Mellitus | - Documented treatment plan |
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+ | | | | | | - Medication adherence |
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+ | | | | | | - Glucose monitoring |
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+ | | | | | | - Physician referral |
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+ | 2 | 💔 Heart Disease | CPT | 92920, 92928 | Percutaneous coronary intervention | - Diagnosis confirmation |
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+ | | | ICD-10 | I20.0 - I25.9 | Ischemic Heart Diseases | - Documented treatment plan |
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+ | | | | | | - Conservative treatment history |
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+ | | | | | | - Cardiac risk factors |
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+ | | | | | | - Physician referral |
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+ | 3 | 😨 Anxiety & Depression | CPT | 90791, 90834, 90837 | Psychiatric diagnostic evaluation, psychotherapy | - Diagnosis confirmation |
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+ | | | ICD-10 | F32.0 - F39 | Mood (Affective) Disorders | - Documented treatment plan |
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+ | | | | | | - Severity assessment |
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+ | | | | | | - Conservative treatment history |
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+ | | | | | | - Physician referral |
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+ | 4 | 🏋️‍♂️ Musculoskeletal Disorders | CPT | 97110, 97112 | Therapeutic exercises, neuromuscular reeducation | - Diagnosis confirmation |
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+ | | | ICD-10 | M00.00 - M99.9 | Diseases of the musculoskeletal system and connective tissue | - Documented treatment plan |
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+ | | | | | | - Conservative treatment history |
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+ | | | | | | - Functional limitation |
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+ | | | | | | - Physician referral |
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+ | 5 | 🦷 Dental Issues | CPT | 00100, 00170 | Anesthesia for intraoral procedures, incision and drainage of abscess | - Diagnosis confirmation |
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+ | | | ICD-10 | K00.0 - K14.9 | Diseases of oral cavity and salivary glands | - Documented treatment plan |
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+ | | | | | | - Conservative treatment history |
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+ | | | | | | - Dentist referral |
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+ | 6 | 🌊 Chronic Kidney Disease | CPT | 90935, 90937 | Hemodialysis, outpatient | - Diagnosis confirmation |
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+ | | | ICD-10 | N18.1 - N18.9 | Chronic kidney disease | - Documented treatment plan |
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+ | | | | | | - Stage of kidney disease |
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+ | | | | | | - Conservative treatment history |
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+ | | | | | | - Physician referral |
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+
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+
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+ ## Costly Top Six with Code Description and Medical Necessity Rules
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+
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+ | Rank | Costly Condition | Approval Code Type | Approval Codes | Code Description | Medical Necessity Rules |
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+ |------|---------------------------------|--------------------|-------------------------|----------------------------------------|--------------------------------------------------------------------------------------------------------------------------|
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+ | 1 | 🍬 Diabetes | CPT | 99214, 99215 | Office/outpatient visit | Diagnosis confirmation, documented treatment plan, medication adherence, glucose monitoring, physician referral |
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+ | | | ICD-10 | E08.00 - E13.9 | Diabetes Mellitus | |
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+ | 2 | 💔 Heart Disease | CPT | 92920, 92928 | Percutaneous coronary intervention | Diagnosis confirmation, documented treatment plan, conservative treatment history, cardiac risk factors, physician referral |
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+ | | | ICD-10 | I20.0 - I25.9 | Ischemic Heart Diseases | |
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+ | 3 | 😨 Anxiety & Depression | CPT | 90791, 90834, 90837 | Psychiatric diagnostic evaluation, psychotherapy | Diagnosis confirmation, documented treatment plan, severity assessment, conservative treatment history, physician referral |
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+ | | | ICD-10 | F32.0 - F39 | Mood (Affective) Disorders | |
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+ | 4 | 🏋️‍♂️ Musculoskeletal Disorders | CPT | 97110, 97112 | Therapeutic exercises, neuromuscular reeducation | Diagnosis confirmation, documented treatment plan, conservative treatment history, functional limitation, physician referral |
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+ | | | ICD-10 | M00.00 - M99.9 | Diseases of the musculoskeletal system and connective tissue | |
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+ | 5 | 🦷 Dental Issues | CPT | 00100, 00170 | Anesthesia for intraoral procedures, incision and drainage of abscess | Diagnosis confirmation, documented treatment plan, conservative treatment history, dentist referral |
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+ | | | ICD-10 | K00.0 - K14.9 | Diseases of oral cavity and salivary glands | |
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+ | 6 | 🌊 Chronic Kidney Disease | CPT | 90935, 90937 | Hemodialysis, outpatient | Diagnosis confirmation, documented treatment plan, stage of kidney disease, conservative treatment history, physician referral |
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+ | | | ICD-10 | N18.1 - N18.9 | Chronic kidney disease | |
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+
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+
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+ ## Costly Top Six:
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+
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+ | Rank | Costly Condition | 💰 Spending (billions) | CPT Range Start | CPT Range Finish | ICD-10 Diagnosis Codes |
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+ |------|---------------------------------|------------------------|-----------------|------------------|------------------------|
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+ | 1 | 🍬 Diabetes | 327 | 48100 | 48999 | E08.00 - E13.9 |
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+ | 2 | 💔 Heart Disease | 230 | 92920 | 93799 | I20.0 - I25.9 |
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+ | 3 | 😨 Anxiety & Depression | 210 | 90791 | 90899 | F32.0 - F39 |
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+ | 4 | 🏋️‍♂️ Musculoskeletal Disorders | 176 | 97110 | 97799 | M00.00 - M99.9 |
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+ | 5 | 🦷 Dental Issues | 130 | 00100 | 00192 | K00.0 - K14.9 |
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+ | 6 | 🌊 Chronic Kidney Disease | 110 | 50010 | 50999 | N18.1 - N18.9 |
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+
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+
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+ ## Service Types and Associated Evidence of Med Nec
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+
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+ | No. | Service Type | CPT Code Range | Rules for Required Evidence of Medical Necessity |
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+ |-----|-----------------------------|----------------------|--------------------------------------------------------|
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+ | 1 | 🫀 Organ Transplant | 50300-50380 | Diagnosis📄, waiting list📃, physician referral👩‍⚕️ |
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+ | 2 | 🦴 Spinal Fusion Surgery | 22532-22812 | Diagnosis📄, conservative treatment history📚, physician referral👩‍⚕️ |
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+ | 3 | 🍔 Bariatric Surgery | 43644-43775 | BMI🏋️, documented weight loss attempts📉, physician referral👩‍⚕️, psychological evaluation🧠 |
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+ | 4 | 🦵 Joint Replacement Surgery | 27130-27447 | Diagnosis📄, conservative treatment history📚, physician referral👩‍⚕️ |
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+ | 5 | 💉 Chemotherapy | 96401-96549 | Cancer diagnosis🦠, treatment plan💊, medication💊, dosage💊, frequency💊 |
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+ | 6 | ☢️ Radiation Therapy | 77261-77799 | Cancer diagnosis🦠, treatment plan💊, physician referral👩‍⚕️ |
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+ | 7 | ❤️ Cardiac Surgery | 33010-33999 | Diagnosis📄, conservative treatment history📚, physician referral👩‍⚕️ |
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+ | 8 | 🧊 Dialysis | 90935-90999 | Diagnosis of kidney disease🩸, treatment plan💊, physician referral👩‍⚕️ |
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+ | 9 | 🫁 Gastrointestinal Surgery | 43620-44979 | Diagnosis📄, conservative treatment history📚, physician referral👩‍⚕️ |
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+ | 10 | 🖼️ Advanced Imaging Services | 70450-72159 (CT), 70540-72198 (MRI) | Clinical history📚, prior relevant imaging📸, symptoms justification😷 |
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+ | 11 | 🎯 Interventional Radiology | 37220-37235 | Diagnosis📄, conservative treatment history📚, physician referral👩‍⚕️ |
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+ | 12 | 🛌 Sleep Study | 95800-95811 | Documented sleep disorder symptoms😴, sleep diary📘, physician referral👩‍⚕️ |
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+ | 13 | 💉 Infusion Therapy | 96360-96549 | Diagnosis📄, medication💊, dosage💊, frequency💊, duration⏳ |
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+ | 14 | 💊 Pain Management | 64400-64530 | Diagnosis📄, conservative treatment history📚, treatment plan💊 |
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+ | 15 | ❤️ Cardiac Stress Test | 93015-93018 | Documented symptoms😷, cardiac risk factors❤️, physician referral👩‍⚕️ |
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+ | 16 | 🫁 Pulmonary Function Test | 94010-94799 | Documented respiratory issues😷, physician referral👩‍⚕️ |
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+ | 17 | 🏃‍♂️ Physical Therapy | 97110-97546 | Diagnosis📄, treatment plan💊, physician referral👩‍⚕️ |
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+ | 18 | 🧠 Mental Health Services | 90791-90899 | Diagnosis📄, treatment plan💊, physician referral👩‍⚕️ |
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+ | 19 | 👓 Vision Services | 92002-92499 | Diagnosis📄, conservative treatment history📚, physician referral👩‍⚕️ |
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+ | 20 | 👂 Hearing Services | 92502-92700 | Diagnosis📄, conservative treatment history📚, physician referral👩‍⚕️ |
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+
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+ ## Services Descending by Costly with CPT and ICD10 code ranges
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+
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+ | Rank | Costly Condition | 💰 Spending (billions) | CPT Range Start | CPT Range Finish | ICD-10 Diagnosis Codes |
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+ |------|-----------------------------|------------------------|-----------------|------------------|------------------------|
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+ | 1 | 🍬 Diabetes | 327 | 48100 | 48999 | E08.00 - E13.9 |
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+ | 2 | 💔 Heart Disease | 230 | 92920 | 93799 | I20.0 - I25.9 |
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+ | 3 | 😨 Anxiety & Depression | 210 | 90791 | 90899 | F32.0 - F39 |
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+ | 4 | 🏋️‍♂️ Musculoskeletal Disorders | 176 | 97110 | 97799 | M00.00 - M99.9 |
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+ | 5 | 🦷 Dental Issues | 130 | 00100 | 00192 | K00.0 - K14.9 |
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+ | 6 | 🌊 Chronic Kidney Disease | 110 | 50010 | 50999 | N18.1 - N18.9 |
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+ | 7 | 😷 Chronic Obstructive Pulmonary Disease | 70 | 94002 | 94799 | J44.0 - J44.9 |
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+ | 8 | 🍺 Liver Disease | 40 | 47000 | 47999 | K70.0 - K77.9 |
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+ | 9 | 🤧 Allergies | 25 | 31231 | 31294 | J30.0 - J39.9 |
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+ | 10 | 🔥 Gastroesophageal Reflux Disease | 17 | 43200 | 43289 | K21.0 - K21.9 |
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+ | 11 | 🎗️ Endometriosis | 22 | 56405 | 58999 | N80.0 - N80.9 |
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+ | 12 | 🚽 Inflammatory Bowel Disease | 14.6 | 44140 | 44238 | K50.00 - K52.9 |
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+ | 13 | 📢 Hearing Loss | 7.1 | 92502 | 92700 | H90.0 - H94.9 |
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+ | 14 | 👓 Cataracts | 10.7 | 92002 | 92499 | H25.0 - H28.9 |
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+ | 15 | 🦠 Hypothyroidism | 3.1 | 60210 | 60271 | E00.0 - E03.9 |
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+ | 16 | 🩸 Anemia | 5.6 | 38100 | 38199 | D50.0 - D64.9 |
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+ | 17 | 😰 Adrenal Disorders | 1 | 60500 | 60699 | E27.0 - E27.9 |
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+ | 18 | 🌞 Skin Cancer | 8.1 | 96910 | 96999 | C43.0 - C44.9 |
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+ | 19 | 💧 Urinary Incontinence | 8 | 51700 | 51798 | N39.3 - N39.4 |
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+ | 20 | 🤕 Peripheral Neuropathy | 19 | 95900 | 96004 | G60.0 - G65.9 |
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+ | 21 | 🍼 Asthma | 6 | 94010 | 94799 | J45.0 - J45.9 |
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+ | 22 | 🦠 Infections | 15 | 10060 | 17999 | A00.0 - B99.9 |
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+ | 23 | 🧠 Neurological Disorders | 12 | 95805 | 95872 | G00.0 - G99.9 |
148
+ | 24 | 🤰 Pregnancy Complications | 20 | 59000 | 59899 | O00.0 - O9A.9 |
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+ | 25 | 💉 Blood Disorders | 8 | 38200 | 38999 | D65.0 - D89.9 |
150
+ | 26 | 🏥 Hospital-Acquired Conditions | 7 | 99800 | 99899 | E87.0 - E87.9 |
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+ | 27 | 🦴 Osteoporosis | 5 | 73300 | 73399 | M80.0 - M82.9 |
152
+ | 28 | 🤒 Infectious Diseases | 10 | 00300 | 00352 | A00.0 - A99.9 |
153
+ | 29 | 🤕 Traumatic Injuries | 9 | 11000 | 11012 | S00.0 - T98.9 |
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+ | 30 | 🍔 Obesity | 4 | 27800 | 27899 | E66.0 - E66.9 |
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  ## Services