lookup_code
Look up medical codes (CPT, HCPCS, ICD-10, NDC) to get descriptions, RVU values, and Medicare coverage policies for billing and compliance verification.
Instructions
Look up a medical code (CPT, HCPCS, ICD-10, or NDC) and get coverage information. Returns code details, descriptions, RVU values, and related Medicare policies. Use this to understand what a code means and whether it's covered.
Examples:
lookup_code("76942") - ultrasound guidance
lookup_code("J0585") - Botox injection
lookup_code("M54.5") - low back pain diagnosis
Input Schema
TableJSON Schema
| Name | Required | Description | Default |
|---|---|---|---|
| code | Yes | The medical code to look up (e.g., 76942, J0585, M54.5) | |
| code_system | No | Code system hint - auto-detected if not provided | |
| jurisdiction | No | MAC jurisdiction code to filter policies (e.g., JM, JH) | |
| include | No | Additional data: 'rvu', 'policies', or 'rvu,policies' | |
| fuzzy | No | Enable fuzzy matching for typos/partial codes |
Implementation Reference
- src/index.ts:254-286 (handler)The asynchronous handler function that executes the lookup_code tool. It makes an API request to Verity's /codes/lookup endpoint, handles the response, formats it using formatCode, and returns structured content or error messages.async ({ code, code_system, jurisdiction, include, fuzzy }) => { try { const result = await verityRequest<any>("/codes/lookup", { params: { code, code_system, jurisdiction, include: include || "rvu,policies", fuzzy: fuzzy ? "true" : "false", }, }); if (!result.data.found && (!result.data.suggestions || result.data.suggestions.length === 0)) { return { content: [ { type: "text", text: `Code "${code}" not found. Try:\n- Check spelling\n- Use a different code system\n- Search for the procedure name using search_policies`, }, ], }; } return { content: [{ type: "text", text: formatCode(result.data) }], }; } catch (error) { return { content: [{ type: "text", text: `Error looking up code: ${error instanceof Error ? error.message : String(error)}` }], }; } } );
- src/index.ts:243-252 (schema)Zod input schema defining the parameters for the lookup_code tool: code (required), code_system (optional enum), jurisdiction (optional), include (optional), fuzzy (optional boolean).inputSchema: { code: z.string().min(1).max(20).describe("The medical code to look up (e.g., 76942, J0585, M54.5)"), code_system: z .enum(["CPT", "HCPCS", "ICD10CM", "ICD10PCS", "NDC"]) .optional() .describe("Code system hint - auto-detected if not provided"), jurisdiction: z.string().max(10).optional().describe("MAC jurisdiction code to filter policies (e.g., JM, JH)"), include: z.string().optional().describe("Additional data: 'rvu', 'policies', or 'rvu,policies'"), fuzzy: z.boolean().default(true).describe("Enable fuzzy matching for typos/partial codes"), },
- src/index.ts:231-233 (registration)Registration of the 'lookup_code' tool on the MCP server using server.registerTool, including description, inputSchema, and handler function.// 1. lookup_code - Look up medical codes server.registerTool( "lookup_code",
- src/index.ts:69-105 (helper)Helper function formatCode used by the lookup_code handler to format the API response into a readable string, including code details, RVU data, related policies, and suggestions.function formatCode(code: any): string { const lines: string[] = []; lines.push(`Code: ${code.code} (${code.code_system})`); if (code.description) lines.push(`Description: ${code.description}`); if (code.short_description) lines.push(`Short: ${code.short_description}`); if (code.category) lines.push(`Category: ${code.category}`); if (code.is_active !== undefined) lines.push(`Active: ${code.is_active ? "Yes" : "No"}`); if (code.rvu) { lines.push("\nRVU Data:"); if (code.rvu.work_rvu) lines.push(` Work RVU: ${code.rvu.work_rvu}`); if (code.rvu.total_rvu_facility) lines.push(` Total RVU (Facility): ${code.rvu.total_rvu_facility}`); if (code.rvu.total_rvu_nonfacility) lines.push(` Total RVU (Non-Facility): ${code.rvu.total_rvu_nonfacility}`); if (code.rvu.facility_price) lines.push(` Facility Price: $${code.rvu.facility_price}`); if (code.rvu.non_facility_price) lines.push(` Non-Facility Price: $${code.rvu.non_facility_price}`); if (code.rvu.global_days) lines.push(` Global Days: ${code.rvu.global_days}`); } if (code.policies && code.policies.length > 0) { lines.push("\nRelated Policies:"); code.policies.forEach((p: any) => { lines.push(` - ${p.policy_id}: ${p.title}`); lines.push(` Type: ${p.policy_type}, Disposition: ${p.disposition}`); if (p.jurisdiction) lines.push(` Jurisdiction: ${p.jurisdiction}`); }); } if (code.suggestions && code.suggestions.length > 0) { lines.push("\nSuggested Codes:"); code.suggestions.slice(0, 5).forEach((s: any) => { lines.push(` - ${s.code} (${s.code_system}): ${s.description || "No description"}`); lines.push(` Match: ${s.match_type}, Score: ${(s.score * 100).toFixed(0)}%`); }); } return lines.join("\n"); }