def test_does_claim_meet_additional_procedure_criteria():
""""Check that the eligibility option correctly filters by additional diagnosis codes."""
measure_code = MeasureCode({
'code': 'code'
})
additional_measure_code = MeasureCode({
'code': 'additional_code'
})
option = EligibilityOption({
'procedureCodes': [measure_code],
'additionalProcedureCodes': [additional_measure_code]
})
claim_measure_code_only = claim.Claim({
'claim_lines': [claim_line.ClaimLine({'clm_line_hcpcs_cd': 'code'})]
})
claim_additional_code_only = claim.Claim({
'claim_lines': [claim_line.ClaimLine({'clm_line_hcpcs_cd': 'additional_code'})]
})
claim_both_codes = claim.Claim({
'claim_lines': [
claim_line.ClaimLine({'clm_line_hcpcs_cd': 'code'}),
claim_line.ClaimLine({'clm_line_hcpcs_cd': 'additional_code'})]
})
assert option._does_claim_meet_additional_procedure_criteria(claim_additional_code_only)
assert option._does_claim_meet_additional_procedure_criteria(claim_both_codes)
assert not (option._does_claim_meet_additional_procedure_criteria(claim_measure_code_only))
def setup(self):
claim_line_data = [
{
'clm_line_hcpcs_cd': 'code',
'mdfr_cds': ['GQ', 'GY'],
'clm_pos_code': '23',
'clm_line_num': 1
},
{'clm_line_hcpcs_cd': 'code', 'mdfr_cds': ['GQ'], 'clm_pos_code': '24'},
{'clm_line_hcpcs_cd': 'code', 'mdfr_cds': ['GY'], 'clm_pos_code': '25'},
{'clm_line_hcpcs_cd': 'code', 'mdfr_cds': [], 'clm_pos_code': None}
]
self.claim_lines = [claim_line.ClaimLine(line) for line in claim_line_data]
self.claim_line_GQ_GY_23 = self.claim_lines[0]
self.claim_line_GQ_24 = self.claim_lines[1]
self.claim_line_GY_25 = self.claim_lines[2]
self.claim_line_no_modifier_no_pos = self.claim_lines[3]
self.plain_measure_code = MeasureCode({'code': 'code'})
self.irrelevant_measure_code = MeasureCode({'code': 'bad_code'})
self.measure_code_pos_24 = MeasureCode(
{'code': 'code', 'placesOfService': ['24']}
)
self.measure_code_pos_26 = MeasureCode(
{'code': 'code', 'placesOfService': ['26']}
)
self.measure_code_exclude_pos_24 = MeasureCode(
{'code': 'code', 'placesOfServiceExclusions': ['24']}
)
self.measure_code_exclude_pos_26 = MeasureCode(
{'code': 'code', 'placesOfServiceExclusions': ['26']}
)
self.measure_code_exclude_GQ = MeasureCode(
{'code': 'code', 'modifierExclusions': ['GQ']}
)
self.measure_code_exclude_GT = MeasureCode(
{'code': 'code', 'modifierExclusions': ['GT']}
)
self.measure_code_include_GQ = MeasureCode(
{'code': 'code', 'modifiers': ['GQ']}
)
self.measure_code_include_GT = MeasureCode(
{'code': 'code', 'modifiers': ['GT']}
)
self.measure_code_both_modifier_x_and_modifiers = MeasureCode(
{'code': 'code', 'modifiers': ['GY'], 'modifierExclusions': ['GT', 'GQ']}
)
def setup(self):
"""Initialization of measure 155."""
self.measure = measure_mapping.get_measure_calculator('155')
self.claim_meets_prefilter_and_filter = claim.Claim({
'bene_sk':
'elderly_patient_id',
'clm_ptnt_birth_dt':
date(1920, 1, 1),
'clm_from_dt':
date(2017, 1, 1),
'claim_lines': [
claim_line.ClaimLine({'clm_line_hcpcs_cd': '1100F'},
{'mdfr_cds': []}),
claim_line.ClaimLine({'clm_line_hcpcs_cd': '92541'}, )
]
})
self.claim_meets_prefilter_but_not_filter = claim.Claim({
'bene_sk':
'elderly_patient_id',
'clm_ptnt_birth_dt':
date(1920, 1, 1),
'clm_from_dt':
date(2017, 1, 1),
'claim_lines': [
claim_line.ClaimLine({'clm_line_hcpcs_cd': '1100F'},
{'mdfr_cds': []})
]
})
self.claim_does_not_meet_prefilter_1 = claim.Claim({
'bene_sk':
'elderly_patient_id',
'clm_ptnt_birth_dt':
date(1920, 1, 1),
'clm_from_dt':
date(2017, 1, 1),
'claim_lines': [
claim_line.ClaimLine(
{'clm_line_hcpcs_cd': '1100F'},
{'mdfr_cds': ['1P']},
),
claim_line.ClaimLine({'clm_line_hcpcs_cd': '92541'}, )
]
})
self.claim_does_not_meet_prefilter_2 = claim.Claim({
'bene_sk':
'elderly_patient_id',
'clm_ptnt_birth_dt':
date(1920, 1, 1),
'clm_from_dt':
date(2017, 1, 1),
'claim_lines':
[claim_line.ClaimLine({'clm_line_hcpcs_cd': '92541'}, )]
})
self.claims = [
self.claim_meets_prefilter_and_filter,
self.claim_meets_prefilter_but_not_filter,
self.claim_does_not_meet_prefilter_1,
self.claim_does_not_meet_prefilter_2,
]
def setup(self):
"""Initialization of a Measure226 object and sample claims."""
self.measure = measure_mapping.get_measure_calculator('226')
# Initialize claims for use in the tests.
self.claim_0_1_performance_met = claim.Claim({
'clm_from_dt':
datetime.date(2018, 1, 1),
'clm_ptnt_birth_dt':
datetime.date(2000, 1, 1),
'claim_lines': [
claim_line.ClaimLine({
'clm_line_hcpcs_cd': '90791',
'mdfr_cds': [],
}),
claim_line.ClaimLine({
'clm_line_hcpcs_cd': 'G9902',
'mdfr_cds': [],
}),
]
})
self.claim_2_eligible = claim.Claim({
'clm_from_dt':
datetime.date(2018, 1, 1),
'clm_ptnt_birth_dt':
datetime.date(2000, 1, 1),
'claim_lines': [
claim_line.ClaimLine({
'clm_line_hcpcs_cd': '90791',
'mdfr_cds': [],
}),
claim_line.ClaimLine({
'clm_line_hcpcs_cd': 'G9902',
'mdfr_cds': [],
}),
claim_line.ClaimLine({
'clm_line_hcpcs_cd': 'G9906',
'mdfr_cds': [],
}),
]
})
self.claim_irrelevant = claim.Claim({
'clm_from_dt':
datetime.date(2018, 1, 1),
'clm_ptnt_birth_dt':
datetime.date(2000, 1, 1),
'claim_lines': [
claim_line.ClaimLine({
'clm_line_hcpcs_cd': '90791',
'mdfr_cds': [],
}),
claim_line.ClaimLine({
'clm_line_hcpcs_cd': '4004F',
'mdfr_cds': ['8P'],
}),
]
})
self.claims = [
self.claim_0_1_performance_met, self.claim_2_eligible,
self.claim_irrelevant
]
def setup(self):
"""Initialisation of measure 46."""
self.measure = measure_mapping.get_measure_calculator('046')
self.senior_patient_claim_performance_met = claim.Claim({
'bene_sk':
'elderly_patient_id',
'clm_ptnt_birth_dt':
date(1920, 1, 1),
'clm_from_dt':
date(2017, 1, 1),
'claim_lines': [
claim_line.ClaimLine({'clm_line_hcpcs_cd': '1111F'},
{'mdfr_cds': []}),
claim_line.ClaimLine({'clm_line_hcpcs_cd': '99344'}, )
]
})
self.senior_patient_claim_not_performance_met = claim.Claim({
'bene_sk':
'elderly_patient_id',
'clm_ptnt_birth_dt':
date(1920, 1, 1),
'clm_from_dt':
date(2017, 1, 2),
'claim_lines': [
claim_line.ClaimLine({'clm_line_hcpcs_cd': '1111F'},
{'mdfr_cds': ['8P']}),
claim_line.ClaimLine({'clm_line_hcpcs_cd': '99344'}, )
]
})
self.borderline_senior_patient_claim_performance_met = claim.Claim({
'bene_sk':
'elderly_patient_id',
'clm_ptnt_birth_dt':
date(1953, 1, 30),
'clm_from_dt':
date(2017, 5, 20),
'claim_lines': [
claim_line.ClaimLine({'clm_line_hcpcs_cd': '1111F'},
{'mdfr_cds': []}),
claim_line.ClaimLine({'clm_line_hcpcs_cd': '99344'}, )
]
})
self.middle_aged_patient_claim_performance_not_met = claim.Claim({
'bene_sk':
'middle_aged_patient_id',
'clm_ptnt_birth_dt':
date(1977, 1, 1),
'clm_from_dt':
date(2017, 1, 1),
'claim_lines': [
claim_line.ClaimLine({'clm_line_hcpcs_cd': '1111F'},
{'mdfr_cds': ['8P']}),
claim_line.ClaimLine({'clm_line_hcpcs_cd': '99344'}, )
]
})
self.too_young_patient_claim_no_strata = claim.Claim({
'bene_sk':
'young_patient_id',
'clm_ptnt_birth_dt':
date(2010, 1, 1),
'clm_from_dt':
date(2017, 1, 1),
'claim_lines': [
claim_line.ClaimLine({'clm_line_hcpcs_cd': '1111F'},
{'mdfr_cds': []}),
claim_line.ClaimLine({'clm_line_hcpcs_cd': '99344'}, )
]
})
self.claims = [
self.senior_patient_claim_performance_met,
self.middle_aged_patient_claim_performance_not_met,
self.too_young_patient_claim_no_strata
]
def test_str_method():
"""Test that claim lines are represented in a readable format."""
line = claim_line.ClaimLine(
{'clm_line_hcpcs_cd': 'code', 'mdfr_cds': ['GQ'], 'clm_pos_code': '24', 'clm_line_num': 1}
)
assert line.__str__() == 'ClaimLine - line_number: 1'
def test_execute():
"""
Test for execute method.
Note that some patient process measures have multiple eligibility options.
"""
performance_options = [
PerformanceOption({
'optionType': 'performanceMet',
'qualityCodes': [{
'code': 'pn_code'
}]
}),
PerformanceOption({
'optionType': 'performanceNotMet',
'qualityCodes': [{
'code': 'pn_x_code'
}]
}),
PerformanceOption({
'optionType': 'eligiblePopulationExclusion',
'qualityCodes': [{
'code': 'pd_exl_code'
}]
}),
PerformanceOption({
'optionType': 'eligiblePopulationException',
'qualityCodes': [{
'code': 'pd_exe_code'
}]
})
]
eligibility_options = [
EligibilityOption(
{'procedureCodes': [MeasureCode({'code': 'enc_code'})]}),
EligibilityOption(
{'procedureCodes': [MeasureCode({'code': 'other_enc_code'})]})
]
measure = PatientProcessMeasure(measure_definition=MeasureDefinition(
{
'eligibility_options': eligibility_options,
'performance_options': performance_options
}))
best_line = claim_line.ClaimLine({'clm_line_hcpcs_cd': 'pn_code'})
second_best_line = claim_line.ClaimLine(
{'clm_line_hcpcs_cd': 'pd_exl_code'})
worst_claim_line = claim_line.ClaimLine({'clm_line_hcpcs_cd': 'pn_x_code'})
enc_line = claim_line.ClaimLine({'clm_line_hcpcs_cd': 'enc_code'})
exception_line = claim_line.ClaimLine({'clm_line_hcpcs_cd': 'pd_exe_code'})
other_enc_line = claim_line.ClaimLine(
{'clm_line_hcpcs_cd': 'other_enc_code'})
claim_best_a = claim.Claim({
'bene_sk': 'a',
'claim_lines': [second_best_line, enc_line]
})
claim_worst_a = claim.Claim({
'bene_sk': 'a',
'claim_lines': [worst_claim_line, enc_line]
})
claim_best_b = claim.Claim({
'bene_sk': 'b',
'claim_lines': [worst_claim_line, enc_line]
})
claim_best_c = claim.Claim({
'bene_sk': 'c',
'claim_lines': [best_line, enc_line]
})
claim_worst_c = claim.Claim({
'bene_sk': 'c',
'claim_lines': [second_best_line, enc_line]
})
claim_best_d = claim.Claim({
'bene_sk': 'd',
'claim_lines': [exception_line, enc_line]
})
claim_irrelevant_e = claim.Claim({
'bene_sk': 'e',
'claim_lines': [best_line]
})
claim_best_f = claim.Claim({
'bene_sk': 'f',
'claim_lines': [best_line, other_enc_line]
})
claims = [
claim_best_a, claim_worst_a, claim_best_b, claim_best_c, claim_worst_c,
claim_best_d, claim_irrelevant_e, claim_best_f
]
output = measure.execute(claims)
expected = {
'eligible_population_exclusion': 1,
'eligible_population_exception': 1,
'performance_met': 2,
'performance_not_met': 1,
'eligible_population': 5
}
assert output == expected