Pertinência de Anestesia em Procedimentos Endoscópicos
Overview
Deny endoscopy anesthesia when its type does not match procedures on the same date. Evaluates anesthesia TUSS codes 31602231 (diagnostic) and 31602240 (interventional) against endoscopy procedure families on the same id_fatura and calendar day. Anatomopathology/cytopathology billing on that date is treated as evidence of interventional activity when only diagnostic endoscopy codes are present.
Architecture
| Field | Value |
|---|---|
| Name | Pertinência de Anestesia em Procedimentos Endoscópicos |
| Agent ID | AI020 |
| Version | 0.0.0 |
| Nature | tech |
| Layer | — |
Inheritance
EndoscopyAnesthesiaPertinenceRule → BaseAgent → BaseAgent
Core Functionality
- load_artifacts
- prepare_data
- rule_assessment
Business Rules
Pertinência da cobrança
Constantes:
MOTIVO_GLOSA_ARVO_TEMPLATE = (SCORE_ARVO = 0.5
Usage
from agents.endoscopyanesthesiapertinencerule import EndoscopyAnesthesiaPertinenceRule
rule = EndoscopyAnesthesiaPertinenceRule()
violations_df = rule.rule_assessment(claims_df)
Configuration
Sem parâmetros configuráveis identificados.
Input Requirements
| Column | Type | Description |
|---|---|---|
EVENT_COLUMNS.id |
- | - |
EVENT_COLUMNS.id_fatura |
- | - |
EVENT_COLUMNS.id_evento |
- | - |
EVENT_COLUMNS.evento |
- | - |
EVENT_COLUMNS.vl_pago |
- | - |
EVENT_COLUMNS.qt_paga |
- | - |
EVENT_COLUMNS.dt_atendimento |
- | - |
Output Format
Glosa DataFrame Columns
| Column | Description |
|---|---|
agent_id |
AI020 |
version |
0.0.0 |
id_arvo |
Original record ID |
vl_glosa_arvo |
Glosa value |
qt_glosa_arvo |
Glosa quantity |
score_arvo |
Confidence score |
motivo_glosa_arvo |
Detailed reason in Portuguese |
motivo_glosa_ANS |
ANS standard code |
data_dict |
JSON metadata with calculation details |
Error Handling
- DataFrames vazios retornam estrutura vazia com colunas obrigatórias.
- Colunas ausentes geram warning mas não causam crash.
- Conversões numéricas usam
errors="coerce"para evitar falhas.