ecw-charge-validation/tests/test_conditions_medicare_billing_screening.py

r"""
conditions/medicare_billing_screening.py — document #14: on a Medicare claim
the depression screening codes G8510/G8431 are not billed (unchecked, Billed
Fee zeroed), and the depression-pointer process (#6) does not run. Only the
screening codes are touched; every other CPT line is left as it is.

    python tests\test_conditions_medicare_billing_screening.py

Uses hcfa_claim.html: 99213 (row 0), J7298 (row 1), and G8510 (row 2,
unchecked at 65.00 in the fixture — checked here where a case needs it).
"""

import sys
import pathlib
import inspect

ROOT = pathlib.Path(__file__).resolve().parent.parent
sys.path.insert(0, str(ROOT / "src"))

FIXTURE = pathlib.Path(__file__).resolve().parent / "fixtures" / "hcfa_claim.html"

from ecw_bot.conditions import medicare_billing_screening as mbs  # noqa: E402
from ecw_bot.conditions import depression_dx_pointer             # noqa: E402
from ecw_bot.conditions.base import run_all                        # noqa: E402
from ecw_bot.pages import claim_form                                 # noqa: E402
from ecw_bot.selectors import claim_form as sel                     # noqa: E402

CASES = []

MEDICARE = [{"Name": "HCFA Medicare"}]
MEDICARE_ADVANTAGE = [{"Name": "AARP Medicare Advantage"}]
MEDICAID = [{"Name": "APM2 Medicaid"}]


def case(fn):
    CASES.append(fn)
    return fn


def _check_row(page, index):
    page.evaluate(
        """(i) => {
            const rows = document.querySelectorAll('tr[id^="CPTROW_"]');
            const box = rows[i].querySelector('[ng-click*="updateBillToIns("]');
            box.checked = true;
            box.setAttribute('checked', '');
        }""", index)


def _row_state(page, index):
    row = page.locator(sel.SEL_CPT_ROWS).nth(index)
    return (row.locator(sel.SEL_CPT_ASSIGN_TO_PATIENT).first.is_checked(),
            row.locator(sel.SEL_CPT_BILLED_FEE).first.input_value())


def _remove_rows_except(page, keep_codes):
    page.evaluate(
        """(keep) => {
            for (const tr of document.querySelectorAll('tr[id^="CPTROW_"]')) {
                const c = tr.querySelector('[data-fieldname="claimCPTCode"]');
                if (c && !keep.includes(c.value)) tr.remove();
            }
        }""", keep_codes)


# ── detect ───────────────────────────────────────────────────────────────────

@case
def detect_true_for_medicare_with_g8510():
    data = {"insurance": MEDICARE, "cpt": [{"code": "99213"}, {"code": "G8510"}]}
    assert mbs.detect("C1", data) is True


@case
def detect_true_for_medicare_with_g8431():
    data = {"insurance": MEDICARE, "cpt": [{"code": "G8431"}]}
    assert mbs.detect("C1", data) is True


@case
def detect_false_for_a_medicare_advantage_plan():
    # Ruling 2026-10-21: the dashboard's Commercial Ins, not Medicare.
    data = {"insurance": MEDICARE_ADVANTAGE, "cpt": [{"code": "G8510"}]}
    assert mbs.detect("C1", data) is False


@case
def detect_false_for_a_non_medicare_payer():
    data = {"insurance": MEDICAID, "cpt": [{"code": "G8510"}]}
    assert mbs.detect("C1", data) is False


@case
def detect_false_for_an_unmapped_or_missing_payer():
    assert mbs.detect("C1", {"insurance": [{"Name": "Nobody Knows"}],
                             "cpt": [{"code": "G8510"}]}) is False
    assert mbs.detect("C1", {"cpt": [{"code": "G8510"}]}) is False


@case
def detect_false_for_medicare_without_screening_codes():
    data = {"insurance": MEDICARE, "cpt": [{"code": "99213"}]}
    assert mbs.detect("C1", data) is False


# ── the depression process (#6) stays off for Medicare ──────────────────────

_DEPRESSION_ICD = [{"#": "2", "Code": "Z13.31"}]


@case
def depression_process_does_not_run_for_medicare():
    data = {"insurance": MEDICARE, "icd": _DEPRESSION_ICD,
            "cpt": [{"code": "99213"}, {"code": "G8510"}]}
    assert depression_dx_pointer.detect("C1", data) is False


@case
def depression_process_still_runs_for_other_payers():
    for ins in (MEDICAID, [{"Name": "Nobody Knows"}], []):
        data = {"insurance": ins, "icd": _DEPRESSION_ICD,
                "cpt": [{"code": "99213"}, {"code": "G8510"}]}
        assert depression_dx_pointer.detect("C1", data) is True, ins


# ── apply ────────────────────────────────────────────────────────────────────

@case
def apply_unchecks_and_zeroes_g8510_and_leaves_other_codes(page):
    page.goto(FIXTURE.as_uri())
    _check_row(page, 2)
    before = [_row_state(page, i) for i in (0, 1)]
    data = {"insurance": MEDICARE, "cpt": claim_form.extract(page)["cpt"]}

    result = mbs.apply(page, "C1", data)
    assert result.changed is True
    assert result.review == "", result.review
    assert result.changes == [{"row": 2, "code": "G8510", "unchecked": True,
                               "fee": {"before": "65.00", "after": "0.00"}}], \
        result.changes
    assert _row_state(page, 2) == (False, "0.00")
    assert [_row_state(page, i) for i in (0, 1)] == before, \
        "99213 and J7298 must be left exactly as they were"


@case
def apply_zeroes_an_already_unchecked_priced_g8510(page):
    page.goto(FIXTURE.as_uri())
    data = {"insurance": MEDICARE, "cpt": claim_form.extract(page)["cpt"]}
    result = mbs.apply(page, "C1", data)
    assert result.changed is True
    assert result.changes == [{"row": 2, "code": "G8510",
                               "fee": {"before": "65.00", "after": "0.00"}}], \
        result.changes


@case
def apply_screening_only_zeroes_it_and_asks_for_provider_clarification(page):
    page.goto(FIXTURE.as_uri())
    _remove_rows_except(page, ["G8510"])
    _check_row(page, 0)
    data = {"insurance": MEDICARE, "cpt": claim_form.extract(page)["cpt"]}

    result = mbs.apply(page, "C1", data)
    assert result.changed is True
    assert _row_state(page, 0) == (False, "0.00")
    assert result.review == mbs.SCREENING_ONLY, result.review


@case
def apply_is_a_no_op_once_screening_is_already_excluded(page):
    page.goto(FIXTURE.as_uri())
    page.evaluate("""() => {
        const rows = document.querySelectorAll('tr[id^="CPTROW_"]');
        rows[2].querySelector('[data-fieldname="ClaimCPTBilledFee"]').value = '0.00';
    }""")
    data = {"insurance": MEDICARE, "cpt": claim_form.extract(page)["cpt"]}
    result = mbs.apply(page, "C1", data)
    assert result.changed is False
    assert result.changes == []


def _set_row(page, index, *, checked=None, fee=None, drop_checkbox=False):
    page.evaluate(
        """(a) => {
            const tr = document.querySelectorAll('tr[id^="CPTROW_"]')[a.i];
            const box = tr.querySelector('[ng-click*="updateBillToIns("]');
            if (a.drop) box.remove();
            else if (a.checked !== null) {
                box.checked = a.checked;
                if (a.checked) box.setAttribute('checked', '');
                else box.removeAttribute('checked');
            }
            if (a.fee !== null)
                tr.querySelector('[data-fieldname="ClaimCPTBilledFee"]').value = a.fee;
        }""", {"i": index, "checked": checked, "fee": fee,
               "drop": drop_checkbox})


@case
def screening_only_is_judged_on_the_grid_after_the_other_conditions(page):
    """
    Review finding 1 (2026-10-12): the read said 99213 was billed, but an
    earlier condition (zero_fee_uncheck, a dummy/J-code exclusion) has
    unchecked it since — once G8510 is gone too, nothing is billed.
    """
    page.goto(FIXTURE.as_uri())
    _remove_rows_except(page, ["99213", "G8510"])
    _check_row(page, 1)
    data = {"insurance": MEDICARE, "cpt": claim_form.extract(page)["cpt"]}
    assert data["cpt"][0]["billed"] is True
    _set_row(page, 0, checked=False, fee="0.00")

    result = mbs.apply(page, "C1", data)
    assert result.changed is True
    assert result.review == mbs.SCREENING_ONLY, result.review


@case
def a_ub_line_with_no_checkbox_at_zero_is_not_billed(page):
    """UB: no Assign-To-Patient checkbox (billed None) at 0.00."""
    page.goto(FIXTURE.as_uri())
    _remove_rows_except(page, ["99213", "G8510"])
    _check_row(page, 1)
    _set_row(page, 0, drop_checkbox=True, fee="0.00")
    data = {"insurance": MEDICARE, "cpt": claim_form.extract(page)["cpt"]}
    result = mbs.apply(page, "C1", data)
    assert result.review == mbs.SCREENING_ONLY, result.review


@case
def a_billed_line_left_on_the_grid_is_not_screening_only(page):
    page.goto(FIXTURE.as_uri())
    _remove_rows_except(page, ["99213", "G8510"])
    _check_row(page, 1)
    _set_row(page, 0, drop_checkbox=True, fee="210.00")
    data = {"insurance": MEDICARE, "cpt": claim_form.extract(page)["cpt"]}
    result = mbs.apply(page, "C1", data)
    assert result.changed is True and result.review == "", result.review


@case
def an_empty_live_grid_declines_instead_of_passing(page):
    """Review finding 2: the grid did not re-render after the tab click."""
    page.goto(FIXTURE.as_uri())
    _check_row(page, 2)
    data = {"insurance": MEDICARE, "cpt": claim_form.extract(page)["cpt"]}
    _remove_rows_except(page, [])
    result = mbs.apply(page, "C1", data)
    assert result.changed is False
    assert result.review == mbs.CPT_GRID_NOT_READ, result.review


@case
def summary_comment_says_fee_zeroed_when_no_checkbox_was_unchecked():
    """
    Review finding 3, operator 2026-10-12 (option A): on a UB form with no
    Assign-To-Patient checkbox, zeroing the fee is the fix — the comment
    must not claim "unchecked".
    """
    fee_only = mbs.ConditionResult(
        condition_name=mbs.NAME, changed=True,
        changes=[{"row": 0, "code": "G8510",
                  "fee": {"before": "65.00", "after": "0.00"}}])
    text = mbs.summary_comment(fee_only)
    assert "fee zeroed" in text and "unchecked" not in text, text

    both = mbs.ConditionResult(
        condition_name=mbs.NAME, changed=True,
        changes=[{"row": 0, "code": "G8510", "unchecked": True,
                  "fee": {"before": "65.00", "after": "0.00"}}])
    text = mbs.summary_comment(both)
    assert "unchecked" in text and "fee zeroed" in text, text


@case
def describe_names_the_code_and_the_fee(page):
    page.goto(FIXTURE.as_uri())
    _check_row(page, 2)
    data = {"insurance": MEDICARE, "cpt": claim_form.extract(page)["cpt"]}
    text = mbs.describe(mbs.apply(page, "C1", data))
    assert "G8510" in text and "Medicare" in text, text
    assert "65.00" in text and "0.00" in text, text


@case
def run_all_on_medicare_runs_this_and_not_the_depression_process(page):
    """
    Against the REAL registry: on a Medicare claim with Z13.31, only this
    condition fires — depression_dx_pointer would otherwise re-check the
    G8510 this one just excluded.
    """
    page.goto(FIXTURE.as_uri())
    _check_row(page, 2)
    data = claim_form.extract(page)
    data["insurance"] = MEDICARE
    data["icd"] = _DEPRESSION_ICD

    report = {}
    results = run_all(page, "C1", data, report=report)
    assert "depression_dx_pointer" not in report["fired"], report
    assert [r.condition_name for r in results] == ["medicare_billing_screening"], \
        results
    assert _row_state(page, 2) == (False, "0.00")


def main() -> int:
    if not FIXTURE.exists():
        print(f"  FAIL  fixture missing: {FIXTURE}")
        return 1
    try:
        from playwright.sync_api import sync_playwright
    except ImportError:
        print("  SKIP  playwright is not installed")
        return 0

    failures = 0
    with sync_playwright() as pw:
        browser = pw.chromium.launch(headless=True)
        page = browser.new_page()

        for fn in CASES:
            name = fn.__name__.replace("_", " ")
            try:
                if len(inspect.signature(fn).parameters) == 0:
                    fn()
                else:
                    fn(page)
                print(f"  ok    {name}")
            except AssertionError as exc:
                print(f"  FAIL  {name}: {exc}")
                failures += 1
            except Exception as exc:
                print(f"  ERROR {name}: {type(exc).__name__}: {exc}")
                failures += 1
        browser.close()

    print(f"\n{len(CASES) - failures}/{len(CASES)} passed")
    return 1 if failures else 0


if __name__ == "__main__":
    sys.exit(main())