Split PT/OT/ST into separate service_category_3 values (#1016)#1352
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) Previously the therapy service-category models set both service_category_2 and service_category_3 to the same 'pt/ot/st' umbrella, so PT, OT and ST could not be distinguished at the most granular level. service_category_2 stays the 'outpatient pt/ot/st' / 'office-based pt/ot/st' umbrella; service_category_3 now resolves to the individual discipline: physical therapy, occupational therapy, or speech therapy. Discipline is determined by the HCPCS therapy modifiers Medicare requires on therapy lines (GP = physical, GO = occupational, GN = speech), surfaced once as a therapy_modifier_discipline column in service_category__stg_medical_claim. The professional and office-based models fall back to the rendering provider specialty when no modifier is present, and all three fall back to the existing pt/ot/st umbrella when neither signal is conclusive (so category membership is unchanged - only service_category_3 is refined). Adds a unit test covering modifier precedence, specialty fallback, and the umbrella default, and updates the service-categories docs.
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Closes #1016
What changed
The therapy service-category models set both
service_category_2andservice_category_3to the same umbrella value (outpatient pt/ot/st/office-based pt/ot/st), so the individual disciplines couldn't be told apart.service_category_2is unchanged — it stays thept/ot/stumbrella.service_category_3now resolves tophysical therapy,occupational therapy, orspeech therapy.This mirrors how
service_category_2 = 'outpatient radiology'already fans out intoct/general/mri/petinservice_category_3.How the discipline is determined
GP= physical,GO= occupational,GN= speech. This is surfaced once as atherapy_modifier_disciplinecolumn inservice_category__stg_medical_claim(works for institutional claims too, which carry no rendering specialty).Physical Therapist→ physical therapy.pt/ot/stvalue, so category membership is unchanged; onlyservice_category_3is refined.Files
service_category__stg_medical_claim.sql— addtherapy_modifier_discipline(additive).service_category__outpatient_physical_therapy_institutional.sql,...outpatient_physical_therapy_professional.sql,...office_based_physical_therapy_professional.sql— setservice_category_3from the discipline.core-platform/service-categories.mdandknowledge/claims-groupers-and-algos/service-categories.mdupdated to list the new values.Testing
Added
service_category__pt_ot_st_unit_tests.ymlcovering modifier precedence, specialty fallback, and the umbrella default. Passes locally on DuckDB:The modifier
IN-list expression was also verified directly on DuckDB (including NULL handling). No downstream model filters onservice_category_3 = '...pt/ot/st', and there is noaccepted_valuestest on the column, so nothing downstream breaks.Note
Discipline assignment depends on therapy modifiers / provider specialty being populated in the source data. Lines lacking both stay in the
pt/ot/stumbrella rather than being misclassified.