Update README.md

README.md

@@ -8,123 +8,21 @@ pinned: false
 license: mit
 duplicated_from: awacke1/Generative-AI-EACN
 ---
-EACN - EDI, ADT, CCD, Note
-
-## EDI Sample with All DX and Services
-
-
-EDI:
-
-
-ISA*00*          *00*          *ZZ*EMRSENDER      *ZZ*RECEIVER       *230504*1345*^*00501*000000001*0*P*:~
-GS*HS*EMRSENDER*RECEIVER*20230504*1345*1*X*005010X221A1~
-ST*278*0001~
-BHT*0078*11*100012345*20230504*1345~
-HL*1**20*1~
-NM1*X3*2*RECEIVER*****46*123456789~
-HL*2*1*21*1~
-NM1*1P*2*DOE*JANE****46*987654321~
-HL*3*2*19*1~
-TRN*1*100012345*987654321~
-UM*HS*100012345*987654321~
-HCR*A*1*ZZZ001~
-HI*BF:7295:::3~
-HI*BF:72148:::1~
-HI*BF:72156:::1~
-HI*BF:72158:::1~
-HI*BF:S72.0:::1~
-HI*BF:M16.10:::1~
-SE*13*0001~
-GE*1*1~
-IEA*1*000000001~
-
-
-## ADT A08 Event
-
-ADT:
-
-
-MSH|^~\&|EMRSENDER|FACILITY_A|RECEIVER|FACILITY_A|20230504||ADT^A08^ADT_A01|0001|P|2.5
-EVN|A08|20230504|||BROWN^SARAH|20230504
-PID|||100012345^^^FACILITY_A^MRN||PATIENT^JOHN^M||||||||||||100012345
-PV1||I|FLOOR^1001^1^FACILITY_A||||987654321^DOE^JANE|||||||||||||||||||||||||20230504
-PV2|||^^^FACILITY_A|||||||||||||||||||||||||||||||||||||3
-PV3|3|ICD10|S72.0^M16.10^Z96.649
-PV4||O
-AL1|1|||^^^72148^72156^72158
-DG1|1|ICD10|S72.0|Fracture of neck of femur|20230504
-DG1|2|ICD10|M16.10|Bilateral primary osteoarthritis of hip|20230504
-ZCD|3|CPT|72148^72156^72158
-
-
-## Clinical Document
-
-CCD:
-
-Clinical Document
-
-**Patient:** John Patient
-
-**Date:** 2023-05-04
-
-**Chief Complaint:**
-John experienced a fall, resulting in a **hip injury**. The patient complains of severe pain and difficulty in walking.
-
-**History of Present Illness:**
-The patient has a history of **bilateral primary osteoarthritis of the hip (M16.10)**. The fall exacerbated the existing condition, causing **fracture of the neck of femur (S72.0)**.
-
-**Physical Examination:**
-Upon examination, the patient had severe pain, limited range of motion, and swelling of the affected hip. Imaging studies were ordered to assess the extent of the damage.
-
-**Imaging Studies:**
-1. **MRI of the pelvis (CPT 72148)**
-2. **MRI of the bilateral hips (CPT 72156)**
-3. **MRI of the bilateral femurs (CPT 72158)**
-
-The MRI scans revealed significant damage to the hip joint, confirming the **fracture of the neck of femur (S72.0)** and worsening of the **bilateral primary osteoarthritis of the hip (M16.10)**.
-
-**Assessment:**
-Based on the clinical findings and imaging results, it is evident that the patient requires immediate surgical intervention to repair the hip joint and prevent further complications.
-
-**Plan:**
-1. Admit the patient to the hospital for surgical treatment.
-2. Perform an emergent **hip replacement surgery (Z96.649)** to repair the hip joint and restore function.
-3. Postoperative rehabilitation and physical therapy to regain strength and mobility.
-
-**Medical Necessity:**
-The emergent hip replacement surgery is medically necessary due to the following factors:
-- Severe pain and functional impairment caused by the **fracture of the neck of femur (S72.0)**
-- Worsening of pre-existing **bilateral primary osteoarthritis of the hip (M16.10)**
-- High risk of complications if left untreated
-
-Based on the clinical evidence, the patient's condition warrants immediate surgical intervention to alleviate pain, restore function, and prevent further complications. The surgery is deemed medically necessary to improve the patient's quality of life and long-term prognosis.
-
-**Attending Physician:** Dr. Sarah Brown
-
-## Note and Summary Index by Code Type
-
-| Code Value | Code Description                               | Code Type       | Decision Relevance                 | Additional Information                      |
-|------------|-----------------------------------------------|-----------------|------------------------------------|---------------------------------------------|
-| 7295       | Authorization and Referral Services           | EDI             | Required for authorization         |                                             |
-| 72148      | MRI of the pelvis                             | CPT             | Medical necessity for imaging      |                                             |
-| 72156      | MRI of the bilateral hips                     | CPT             | Medical necessity for imaging      |                                             |
-| 72158      | MRI of the bilateral femurs                   | CPT             | Medical necessity for imaging      |                                             |
-| S72.0      | Fracture of the neck of femur                 | ICD10           | Diagnosis, treatment decision      |                                             |
-| M16.10     | Bilateral primary osteoarthritis of the hip   | ICD10           | Diagnosis, treatment decision      |                                             |
-| Z96.649    | Presence of unspecified artificial hip joint  | ICD10           | Procedure, treatment decision      |                                             |
-| A08        | Update Patient Information                    | ADT Event       | Patient update after surgery       |                                             |
-| 72148      | MRI of the pelvis                             | ZCD             | Diagnostic code for imaging        |                                             |
-| 72156      | MRI of the bilateral hips                     | ZCD             | Diagnostic code for imaging        |                                             |
-| 72158      | MRI of the bilateral femurs                   | ZCD             | Diagnostic code for imaging        |                                             |
-| 987654321  | Dr. Jane Doe - Initial Attending Physician    | NPI             | Patient care provider              | Taxonomy: 207Q00000X (Family Medicine)      |
-| 123456789  | Dr. Robert Smith - Second Attending Physician | NPI             | Patient care provider              | Taxonomy: 207Q00000X (Family Medicine)      |
-| 000000001  | Dr. Sarah Brown - Surgeon                     | NPI             | Patient care provider, surgery     | Taxonomy: 207XS0106X (Orthopedic Surgery)   |
-| 555444333  | Facility A                                    | Facility NPI    | Patient care facility              | Name: Facility A                            |
-|            |                                               | Facility Address|                                    | Address: 123 Main St, City, State, Zip Code |
-| J7325      | Hyaluronan or derivative, Synvisc or Synvisc-One, for intra-articular injection, 1 mg | HCPCS | Medication used during treatment |        |
-| Q4081      | Injection, dexamethasone sodium phosphate, 1 mg | HCPCS           | Medication used during treatment |                                             |
-| 99238      | Hospital discharge day management, 30 minutes or less | CPT      | Follow-up plan                    |                                             |
-| 99239      | Hospital discharge day management, more than 30 minutes | CPT      | Follow-up plan                    |                                             |
-
-
-
+| No. | Service Type                | CPT Code Range       | Rules for Required Evidence of Medical Necessity        |
+|-----|-----------------------------|----------------------|--------------------------------------------------------|
+| 1   | 🫀 Organ Transplant          | 50300-50380          | Diagnosis📄, waiting list📃, physician referral👩‍⚕️   |
+| 2   | 🦴 Spinal Fusion Surgery     | 22532-22812          | Diagnosis📄, conservative treatment history📚, physician referral👩‍⚕️ |
+| 3   | 🍔 Bariatric Surgery         | 43644-43775          | BMI🏋️, documented weight loss attempts📉, physician referral👩‍⚕️, psychological evaluation🧠 |
+| 4   | 🦵 Joint Replacement Surgery | 27130-27447          | Diagnosis📄, conservative treatment history📚, physician referral👩‍⚕️ |
+| 5   | 💉 Chemotherapy             | 96401-96549          | Cancer diagnosis🦠, treatment plan💊, medication💊, dosage💊, frequency💊 |
+| 6   | ☢️ Radiation Therapy         | 77261-77799          | Cancer diagnosis🦠, treatment plan💊, physician referral👩‍⚕️ |
+| 7   | ❤️ Cardiac Surgery           | 33010-33999          | Diagnosis📄, conservative treatment history📚, physician referral👩‍⚕️ |
+| 8   | 🧊 Dialysis                  | 90935-90999          | Diagnosis of kidney disease🩸, treatment plan💊, physician referral👩‍⚕️ |
+| 9   | 🫁 Gastrointestinal Surgery   | 43620-44979          | Diagnosis📄, conservative treatment history📚, physician referral👩‍⚕️ |
+| 10  | 🖼️ Advanced Imaging Services | 70450-72159 (CT), 70540-72198 (MRI) | Clinical history📚, prior relevant imaging📸, symptoms justification😷 |
+| 11  | 🎯 Interventional Radiology  | 37220-37235          | Diagnosis📄, conservative treatment history📚, physician referral👩‍⚕️ |
+| 12  | 🛌 Sleep Study               | 95800-95811          | Documented sleep disorder symptoms😴, sleep diary📘, physician referral👩‍⚕️ |
+| 13  | 💉 Infusion Therapy          | 96360-96549          | Diagnosis📄, medication💊, dosage💊, frequency💊, duration⏳ |
+| 14  | 💊 Pain Management           | 64400-64530          | Diagnosis📄, conservative treatment history📚, treatment plan💊 |
+| 15  | ❤️ Cardiac Stress Test       | 93015-93018          | Documented symptoms😷, cardiac risk factors❤️, physician referral👩‍⚕️ |
+| 16  | 🫁 Pulmonary Function Test    | 94010-94799          | Documented respiratory issues😷, physician referral👩‍⚕️ |