openapi: 3.0.1 info: title: Core Service description: Code Search Service provides the APIs for searching codes related information. contact: name: Ken Kracker email: ken.kracker@optum.com version: v1.0 servers: - url: /v1/codesearchms tags: - name: Filter Dictionary Terms description: Filter dictionary terms from a given string paths: /api/coding/code/{print-type}/print: post: tags: - Print Code Detail Summary API summary: Fetches the file content for print code summary operationId: printCodeSummary parameters: - name: print-type in: path required: true schema: type: string enum: - physician - facility - name: codes in: query description: Takes comma separated codes with minimum of 1 codes and maximum of 3 codes required: true schema: type: string example: 99213,99214 - name: yyyy-mm-dd in: header description: Date for which historical data is required required: false schema: type: string format: yyyy-mm-dd responses: '200': description: Fetches the file content in the form of byte array, response headers and media type as FileType content: application/pdf: schema: $ref: '#/components/schemas/Notification' example: " access-control-expose-headers: Content-Disposition\n cache-control: no-cache,no-store,max-age=0,must-revalidate\n\ \ connection: keep-alive\n content-disposition: attachment; filename=codesummary.pdf\n\ \ content-length: 254685\n content-type: application/pdf\n date: Thu,16 May 2024 06:49:56\ \ GMT\n expires: 0\n pragma: no-cache\n vary: Origin,Access-Control-Request-Method,Access-Control-Request-Headers\n\ \ x-content-type-options: nosniff\n x-frame-options: DENY\n x-xss-protection: 0\n" '404': description: 'Not found: Sub terms not found' content: application/json: schema: $ref: '#/components/schemas/Notification' example: timestamp: '2023-07-28T06:19:48.666+00:00' status: 404 error: Not Found message: Not Found path: /codesearchms/api/coding/code/physician/prints '500': description: Internal server error content: application/json: example: timestamp: '2023-07-28T06:19:48.666+00:00' path: /codesearchms/api/coding/code/physician/print status: 500 error: Internal Server Error requestId: a4796cc7-1 security: - bearerAuth: [] /api/coding/code/codetype: post: tags: - Code Information APIs summary: Fetches the code type for the requested code operationId: codeType parameters: - name: yyyy-mm-dd in: header description: Date for which historical data is required required: false schema: type: string format: yyyy-mm-dd requestBody: description: Fetch code types for given codes content: application/json: schema: type: array items: type: string examples: codes: description: codes value: - C9084 - 0097U - '718.60' - '84.58' - T40.7X1 - 30230AZ required: true responses: '200': description: Fetch code types for given codes content: application/json: schema: type: array items: $ref: '#/components/schemas/Code' example: - codeType: HCPCS code: C9084 - codeType: CPT codeStatus: DELETED code: 0097U - codeType: I9V1 code: '718.60' - codeType: I9V3 code: '84.58' - codeType: I10_CM code: T40.7X1 - codeType: I10_PCS code: 30230AZ '400': description: 'Bad request: Some parameters were invalid' content: application/json: schema: $ref: '#/components/schemas/Notification' example: error: - Number of codes limited to 100 warning: null info: null '500': description: Internal server error content: application/json: example: timestamp: '2022-07-06T07:22:01.017+00:00' path: /api/coding/code/codetype status: 500 error: Internal Server Error requestId: a4796cc7-1 security: - bearerAuth: [] /api/coding/i10_pcs/builder/{code}: get: tags: - I10PCS Code Builder APIs summary: Returns body system, section , options , code description and other tabular fields like Body Part, Approach, Device and Qualifier available for the I10 PCS code type operationId: searchCode parameters: - name: code in: path description: 'i10_pcs code ' required: true schema: type: string example: 0W02 - name: direction in: query description: 'i10_pcs next or prev code ' required: false schema: type: string example: nextCode - name: yyyy-mm-dd in: header description: Date for which historical data is required required: false schema: type: string format: yyyy-mm-dd responses: '200': description: Fetching section, body system, options, code description and other tabular fields like Body Part, Approach, Device and Qualifier content: application/json: example: tabCode: 0W02 sections: - ^0 Medical and Surgical - 1 Obstetrics - 2 Placement - 3 Administration - 4 Measurement and Monitoring - 5 Extracorporeal or Systemic Assistance and Performance - 6 Extracorporeal or Systemic Therapies - 7 Osteopathic - 8 Other Procedures - 9 Chiropractic - B Imaging - C Nuclear Medicine - D Radiation Therapy - F Physical Rehabilitation and Diagnostic Audiology - G Mental Health - H Substance Abuse Treatment - X New Technology bodySystems: - 0 Central Nervous System and Cranial Nerves - 1 Peripheral Nervous System - 2 Heart and Great Vessels - 3 Upper Arteries - 4 Lower Arteries - 5 Upper Veins - 6 Lower Veins - 7 Lymphatic and Hemic Systems - 8 Eye - 9 Ear, Nose, Sinus - B Respiratory System - C Mouth and Throat - D Gastrointestinal System - F Hepatobiliary System and Pancreas - G Endocrine System - H Skin and Breast - J Subcutaneous Tissue and Fascia - K Muscles - L Tendons - M Bursae and Ligaments - N Head and Facial Bones - P Upper Bones - Q Lower Bones - R Upper Joints - S Lower Joints - T Urinary System - U Female Reproductive System - V Male Reproductive System - ^W Anatomical Regions, General - X Anatomical Regions, Upper Extremities - Y Anatomical Regions, Lower Extremities operations: - ^0 Alteration - 1 Bypass - 2 Change - 3 Control - 4 Creation - 8 Division - 9 Drainage - B Excision - C Extirpation - F Fragmentation - H Insertion - J Inspection - M Reattachment - P Removal - Q Repair - U Supplement - W Revision - Y Transplantation description: Alteration / Face prevNextCode: 5 enableRangeButt: true enableDetailButt: false pcsTableRows: - tableRowId: 21770 tableHeaderId: 136114 char3Code: 0W0 rowNumber: 1 bodyPart: - 0 Head - ^2 Face - 4 Upper Jaw - 5 Lower Jaw - 6 Neck - 8 Chest Wall - F Abdominal Wall - K Upper Back - L Lower Back - M Perineum, Male - N Perineum, Female approach: - 0 Open - 3 Percutaneous - 4 Percutaneous Endoscopic device: - 7 Autologous Tissue Substitute - J Synthetic Substitute - K Nonautologous Tissue Substitute - Z No Device qualifier: - Z No Qualifier bodyPart: 2 Face approach: '' device: '' qualifier: '' tabFullCode: 0W02 builtCode: 0W02 '400': description: 'Bad request: Some parameters were invalid' content: application/json: schema: $ref: '#/components/schemas/Notification' example: error: - 'searchCode.searchCode: length must be between 3 and 7' warning: null info: null '500': description: Internal server error content: application/json: example: timestamp: '2023-01-01T07:22:01.017+00:00' path: /api/coding/i10_pcs/builder/0W02 status: 500 error: Internal Server Error requestId: a4796cc7-1 security: - bearerAuth: [] /api/coding/i10_pcs/builder/{code}/autocomplete: get: tags: - I10PCS Code Builder APIs summary: Returns I10 PCS codes that are started with searched code operationId: autoSuggest parameters: - name: code in: path description: 'i10_pcs code ' required: true schema: type: string example: 0W - name: yyyy-mm-dd in: header description: Date for which historical data is required required: false schema: type: string format: yyyy-mm-dd responses: '200': description: Fetching I10 PCS codes that are started with searched code content: application/json: example: - 0W0 - 0W1 - 0W2 - 0W3 - 0W4 - 0W8 - 0W9 - 0WB - 0WC - 0WF - 0WH - 0WJ - 0WM - 0WP - 0WQ - 0WU - 0WW - 0WY '500': description: Internal server error content: application/json: example: timestamp: '2023-01-01T07:22:01.017+00:00' path: /api/coding/i10_pcs/builder/0W/autocomplete status: 500 error: Internal Server Error requestId: a4796cc7-1 security: - bearerAuth: [] /api/coding/i10_pcs/builder/: get: tags: - I10PCS Code Builder APIs summary: Returns body system, section and options available for the I10 PCS code type operationId: fetchTabularList parameters: - name: body-system in: query required: false schema: type: string - name: section in: query required: false schema: type: string - name: operation in: query required: false schema: type: string - name: yyyy-mm-dd in: header description: Date for which historical data is required required: false schema: type: string format: yyyy-mm-dd responses: '200': description: 'Fetching section, body system and options ' content: application/json: example: sections: - 0 Medical and Surgical - 1 Obstetrics - 2 Placement - 3 Administration - 4 Measurement and Monitoring - 5 Extracorporeal or Systemic Assistance and Performance - 6 Extracorporeal or Systemic Therapies - 7 Osteopathic - 8 Other Procedures - 9 Chiropractic - B Imaging - C Nuclear Medicine - D Radiation Therapy - F Physical Rehabilitation and Diagnostic Audiology - G Mental Health - H Substance Abuse Treatment - X New Technology bodySystems: - 0 Central and Peripheral Nervous System - 0 Central Nervous System - 0 Central Nervous System and Cranial Nerves - 0 Circulatory - 0 Pregnancy - 0 Rehabilitation - 1 Diagnostic Audiology - 1 Peripheral Nervous System - 2 Cardiovascular System - 2 Heart - 2 Heart and Great Vessels - 3 Upper Arteries - 4 Lower Arteries - 5 Upper Veins - 5 Veins - 6 Lower Veins - 7 Lymphatic and Hematologic System - 7 Lymphatic and Hemic Systems - 7 Lymphatic System - 8 Eye - 9 Ear, Nose, Mouth and Throat - 9 Ear, Nose, Sinus - A Physiological Systems - B Physiological Devices - B Respiratory System - C Indwelling Device - C Mouth and Throat - D Gastrointestinal System - E Physiological Systems and Anatomical Regions - F Hepatobiliary System and Pancreas - G Endocrine System - H Skin - H Skin and Breast - H Skin, Subcutaneous Tissue and Breast - H Skin, Subcutaneous Tissue, Fascia and Breast - J Subcutaneous Tissue and Fascia - K Muscles - K Muscles, Tendons, Bursae and Ligaments - L Connective Tissue - L Tendons - M Breast - M Bursae and Ligaments - N Bones - N Head and Facial Bones - N Skull and Facial Bones - P Musculoskeletal System - P Non-Axial Upper Bones - P Upper Bones - Q Lower Bones - Q Non-Axial Lower Bones - R Axial Skeleton, Except Skull and Facial Bones - R Joints - R Upper Joints - S Lower Joints - T Urinary System - U Female Reproductive System - V Male Reproductive System - W Anatomical Regions - W Anatomical Regions, General - X Anatomical Regions, Upper Extremities - X Physiological Systems - Y Anatomical Orifices - Y Anatomical Regions, Lower Extremities - Y Extracorporeal - Y Fetus and Obstetrical - Z None operations: - 0 Alteration - 0 Assistance - 0 Atmospheric Control - 0 Beam Radiation - 0 Change - 0 Introduction - 0 Measurement - 0 Other Procedures - 0 Plain Radiography - 0 Speech Assessment - 0 Treatment - 1 Brachytherapy - 1 Bypass - 1 Compression - 1 Decompression - 1 Fluoroscopy - 1 Irrigation - 1 Monitoring - 1 Motor and/or Nerve Function Assessment - 1 Performance - 1 Planar Nuclear Medicine Imaging - 1 Psychological Tests - 1 Transfusion - 2 Activities of Daily Living Assessment - 2 Change - 2 Computerized Tomography (CT Scan) - 2 Crisis Intervention - 2 Detoxification Services - 2 Dressing - 2 Electromagnetic Therapy - 2 Monitoring - 2 Restoration - 2 Stereotactic Radiosurgery - 2 Tomographic (Tomo) Nuclear Medicine Imaging - 2 Transfusion - 3 Control - 3 Hearing Assessment - 3 Hyperthermia - 3 Immobilization - 3 Individual Counseling - 3 Magnetic Resonance Imaging (MRI) - 3 Medication Management - 3 Positron Emission Tomographic (PET) Imaging - 4 Creation - 4 Group Counseling - 4 Hearing Aid Assessment - 4 Hypothermia - 4 Nonimaging Nuclear Medicine Uptake - 4 Packing - 4 Ultrasonography - 5 Destruction - 5 Individual Psychotherapy - 5 Nonimaging Nuclear Medicine Probe - 5 Other Imaging - 5 Pheresis - 5 Removal - 5 Vestibular Assessment - 6 Counseling - 6 Detachment - 6 Family Counseling - 6 Nonimaging Nuclear Medicine Assay - 6 Phototherapy - 6 Speech Treatment - 6 Traction - 7 Dilation - 7 Family Psychotherapy - 7 Motor Treatment - 7 Systemic Nuclear Medicine Therapy - 7 Ultrasound Therapy - 8 Activities of Daily Living Treatment - 8 Division - 8 Medication Management - 8 Ultraviolet Light Therapy - 9 Drainage - 9 Hearing Treatment - 9 Pharmacotherapy - 9 Shock Wave Therapy - A Abortion - A Assistance - B Cochlear Implant Treatment - B Electroconvulsive Therapy - B Excision - B Manipulation - B Perfusion - C Biofeedback - C Extirpation - C Vestibular Treatment - D Device Fitting - D Extraction - E Delivery - E Measurement - F Caregiver Training - F Fragmentation - F Hypnosis - G Fusion - G Narcosynthesis - H Group Psychotherapy - H Insertion - J Inspection - J Light Therapy - K Map - L Occlusion - M Reattachment - N Release - P Removal - Q Repair - R Replacement - S Reposition - T Resection - U Supplement - V Restriction - W Revision - X Transfer - Y Other Radiation - Y Transplantation prevNextCode: 0 enableRangeButt: false enableDetailButt: false '500': description: Internal server error content: application/json: example: timestamp: '2023-01-01T07:22:01.017+00:00' path: /api/coding/i10_pcs/builder status: 500 error: Internal Server Error requestId: a4796cc7-1 security: - bearerAuth: [] /api/coding/filter-dictionary-terms: get: tags: - Filter Dictionary Terms operationId: dictTerms parameters: - name: value in: query required: true schema: type: string - name: yyyy-mm-dd in: header description: Date for which historical data is required required: false schema: type: string format: yyyy-mm-dd responses: '200': description: Successfully retrieved dictionary terms. This response returns a list of terms extracted from the provided value. content: application/json: schema: type: string example: '["Debridement","skin"]' '400': description: 'Bad request: Invalid parameters provided' content: application/json: example: timestamp: '2025-07-10T08:10:07.573+00:00' status: 400 error: Bad Request message: Invalid search term provided path: codesearchms/api/coding/filter-dictionary-terms '401': description: Not Authorized content: application/json: example: Jwt is expired or invalid '404': description: Not Found - the endpoint was not found '405': description: Method Not Allowed - Request method not supported '500': description: Internal server error content: application/json: example: timestamp: '2023-07-28T06:36:22.518+00:00' path: codesearchms/api/coding/filter-dictionary-terms status: 500 error: Internal Server Error requestId: e36d239e-324 '503': description: Service Unavailable security: - bearerAuth: [] /api/coding/code/{modifier}/modifier-crosscodes: get: tags: - Modifiers APIs summary: Returns the list of codes associated with a modifier operationId: allModifierCodeList parameters: - name: codetype in: query required: false schema: type: string enum: - cpt - hcpcs - name: modifier in: path required: true schema: type: string - name: modifier-type in: query required: true schema: type: string enum: - PHYSICIAN - FACILITY - MPFS - DME - AMBULANCE - name: include-asc-modifier in: query required: false schema: type: boolean - name: sort in: query description: Any of combination (code,-code,description,-description) are allowed values, default is +code. required: false schema: type: array items: type: string default: - code - name: page in: query required: false schema: type: integer format: int32 default: 1 - name: limit in: query required: false schema: type: integer format: int32 default: 150 - name: filter in: query required: false schema: type: string - name: yyyy-mm-dd in: header description: Date for which historical data is required required: false schema: type: string format: yyyy-mm-dd responses: '200': description: OK content: '*/*': schema: $ref: '#/components/schemas/OptumPageImplCode' security: - bearerAuth: [] /api/coding/code/{code}/{modifier-type}/{mod-code}/{prod-code}/modifier-download: get: tags: - Modifiers APIs summary: Generates the pdf format file with the details of selected modifier code operationId: printModCodesReport parameters: - name: code in: path description: 'cpt OR hcpcs code ' required: true schema: type: string example: 99213 - name: modifier-type in: path required: true schema: type: string enum: - PHYSICIAN - FACILITY - name: mod-code in: path description: 'modifier code ' required: true schema: type: string example: 24 - name: prod-code in: path description: Product code C/M i.e Commercial/ Medicare required: true schema: type: string example: C - name: yyyy-mm-dd in: header description: Date for which historical data is required required: false schema: type: string format: yyyy-mm-dd responses: '200': description: Generates the PDF and return the content in the format of byte array, response headers and media type as PDF content: application/pdf: schema: $ref: '#/components/schemas/Notification' example: " access-control-expose-headers: Content-Disposition \n cache-control: no-cache,no-store,max-age=0,must-revalidate\ \ \n connection: keep-alive \n content-disposition: attachment; filename=PHYSICIAN.pdf\ \ \n content-length: 3663 \n content-type: application/pdf \n date: Wed,26 Apr 2023 12:17:11\ \ GMT \n expires: 0 \n pragma: no-cache \n strict-transport-security: max-age=31536000\ \ ; includeSubDomains \n vary: Origin,Access-Control-Request-Method,Access-Control-Request-Headers\ \ \n x-content-type-options: nosniff \n x-frame-options: DENY \n x-xss-protection: 1;\ \ mode=block \n" '404': description: Not found- No Data Found. content: application/json: schema: $ref: '#/components/schemas/Notification' example: error: - No Data Found. warning: null info: null '500': description: Internal server error content: application/json: example: timestamp: '2023-02-08T06:19:48.666+00:00' path: 99213/PHYSICIAN/24/C/modifier-download status: 500 error: Internal Server Error requestId: a4796cc7-1 security: - bearerAuth: [] /api/coding/code/{code}/{modifier-type}/modifier-crosswalk: get: tags: - Modifiers APIs summary: Returns the list of modifierCrosswalk based on the selected code operationId: modifierCrosswalk parameters: - name: code in: path description: 'cpt OR hcpcs code ' required: true schema: type: string example: 99213 - name: modifier-type in: path required: true schema: type: string enum: - PHYSICIAN - FACILITY - name: limit in: query required: false schema: type: integer format: int32 default: 50 example: 150 - name: page in: query required: false schema: type: integer format: int32 default: 1 - name: filter in: query required: false schema: type: string - name: yyyy-mm-dd in: header description: Date for which historical data is required required: false schema: type: string format: yyyy-mm-dd responses: '200': description: fetch available list of modifier crosswalk for the selected code content: application/json: example: content: - modifierLink: value: '24' href: /api/coding/code/24/modifier-crosscodes iconName: null effectiveDate: '2003-10-01 00:00:00.0' description: Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative Period definition: The physician or other qualified health care professional may need to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) unrelated to the original procedure. This circumstance may be reported by adding modifier 24 to the appropriate level of E/M service. code: '99213' sourcingRationaleNum: 'Sourcing Rationale: 589' sourcingRationale: "Current Procedural Terminology (CPT) Level I modifiers and Healthcare\ \ Common Procedure Coding System (HCPCS) Level II modifiers are appended to Level\ \ I or Level II codes based on information from the Centers for Medicare and Medicaid\ \ Services (CMS). The identified modifiers are: the ambulance specific modifiers,\ \ 1P, 24, 25, 2P, 3P, 50, 51, 52, 54, 55, 56, 57, 58, 59, 76, 77, 78, 79, 8P, 90,\ \ 91, AA, AD, AQ, AR, AT, AU, AV, AW, AX, AY, BA, BL, BP, BR, BU, CB, CD, CE, CF,\ \ CH, CI, CJ, CK, CL, CM, CN, CS, CT, EA, EB, EC, EM, EY, G7-G9, GE, GG, GK, GL, GM,\ \ GN, GO, GP, GQ, GT, J4, KB, KC, KF, KI, KJ, KM, KN, KZ, LR, NR, NU, PI, PS, PT,\ \ Q7-Q9, QA, QB, QE, QF, QG, QK, QR, QS, QW, QX, QY, QZ, RR,TS, UE, UN, UP, UQ, UR,\ \ US, VM, XE, XP, XS, XU, ZA, ZB,ZC. \r\nThe above identified CPT/HCPCS modifier\ \ to procedure relationships are supported by CMS information from the Medicare Claims\ \ Processing Manual, program transmittals, National Physician Fee Schedule (NPFS),\ \ Clinical Laboratory Fee Schedule, DME/PEN fee schedules, Ambulance fee schedule,\ \ and claims adjudication policies.\r\nModifiers that are covered by other Medicare\ \ rules; therefore are excluded from this rule are:\r\n22, 26, 62, 66, 80-82, AS,\ \ and TC.\r\nModifiers that do not have a specific national CMS source or a source\ \ that addresses specific codes that these modifiers should be appended to; therefore\ \ are excluded from this rule are:\r\n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r\nModifiers that\ \ have a coverage indicator of I, M, or S on the HCPCS file. These indicators state\ \ that they are noncovered or nonpayable by Medicare. These modifiers are excluded\ \ from this rule are:\r\nAZ, FB, GY, GZ, H9, HA-HZ, PA-PC, SA-SB, SD-SE, SH-SN, SQ,\ \ SS-SV, SY, TD-TH, TJ-TN, TP-TR, TT-TW, U1-U9, UA-UD, UF-UH and UK.\r\nModifiers\ \ that have facility related only national CMS sources; therefore are not included\ \ in this professional rule:\r\n27, 73, 74, CA, ED, EE, ET, FC, G1-G6, GF, GS, JG,\ \ L1, Q2, QM, and QN." source: CMS Policy productCode: M commercialMedicare: Medicare - modifierLink: value: '24' href: /api/coding/code/24/modifier-crosscodes iconName: null effectiveDate: '1990-01-01 00:00:00.0' description: Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative Period definition: The physician or other qualified health care professional may need to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) unrelated to the original procedure. This circumstance may be reported by adding modifier 24 to the appropriate level of E/M service. code: '99213' sourcingRationaleNum: 'Sourcing Rationale: 34' sourcingRationale: "Modifier 24 edit relationships follow CPT(R) , the American Medical\ \ Association (AMA), the Centers for Medicare and Medicaid (CMS) and specialty society\ \ guidelines that indicate modifier 24 is appended to evaluation and management (E/M)\ \ service codes rendered during the postoperative period that are unrelated to the\ \ surgical procedure. Modifier 24 is not applicable to E/M codes designated as solely\ \ new patient codes. \r\nThe CPT(R) modifier 24 descriptor in the current CPT(R) Professional\ \ Edition states, ''Unrelated Evaluation and Management Service by the Same Physician\ \ or Other Qualified Health Care Professional During a Postoperative Period: The\ \ physician or other qualified health care professional may need to indicate that\ \ an evaluation and management service was performed during a postoperative period\ \ for a reason(s) unrelated to the original procedure. This circumstance may be reported\ \ by adding modifier 24 to the appropriate level of E/M service.'' \r\nA CPT(R) Assistant\ \ article from May 1997 states that, ''Modifier -24 is used when a physician provides\ \ a surgical service related to one problem and then during the period of follow-up\ \ care for the surgery provides an evaluation and management service unrelated to\ \ the problem requiring the surgery. '' An example provided illustrates a patient\ \ who fell and sprained her wrist during the postoperative period of a hip replacement\ \ surgery provided by the same surgeon. ''The orthopedic surgeon reports the E/M service\ \ (related to the sprained wrist) performed in the office using the established patient,\ \ office or other outpatient service codes.'' Modifier 24 is appended to the unrelated\ \ established patient E/M service code. The Principles of CPT(R) Coding guidelines,\ \ published by the AMA, further states, ''The diagnosis code selection is critical\ \ when indicating the reason for the additional E/M service.'' The publication, Coding\ \ with Modifiers, also published by the AMA, reiterate the CPT(R) Assistant and Principles\ \ of CPT(R) Coding guidelines.\r\nGuidelines in the July 2004 and the November 2006\ \ CPT(R) Assistants state, ''E/M services following Mohs micrographic surgery may\ \ be reported depending on the global period of any surgical reconstruction services\ \ done with Mohs surgery... If reconstruction is performed with Mohs surgery, the\ \ 10- or 90-day global period of the reconstruction applies and no E/M service related\ \ to the reconstruction procedure is allowable during the global period. However,\ \ an E/M service may be reported if it is for an unrelated service, in which case\ \ modifier 24, Unrelated evaluation and management service by the same physician during\ \ a postoperative period, would be appended.''\r\nGuidelines in the CPT(R) Reference\ \ Guide for Cardiovascular Coding 2013 further support this rationale by indicating\ \ modifier 24 should be appended to the E/M service if it is unrelated and performed\ \ during the postoperative period by the same physician that performed the procedure.\ \ \r\nThe CMS' Medicare Claims Processing Manual mirrors CPT guidelines and states,\ \ ''The physician may need to indicate that an evaluation and management service was\ \ performed during the postoperative period of an unrelated procedure. This circumstance\ \ is reported by adding the modifier ''-24'' to the appropriate level of evaluation\ \ and management service.'' \r\nThe CMS National Correct Coding Initiative Policy\ \ Manual general guidelines for E/M services states, ''For major and minor surgical\ \ procedures, postoperative E&M services related to recovery from the surgical procedure\ \ during the postoperative period are included in the global surgical package as are\ \ E&M services related to complications of the surgery. Postoperative visits unrelated\ \ to the diagnosis for which the surgical procedure was performed unless related to\ \ a complication of surgery may be reported separately on the same day as a surgical\ \ procedure with modifier 24 (''Unrelated Evaluation and Management Service by the\ \ Same Physician or Other Qualified Health Care Professional During a Postoperative\ \ Period'').''\r\nModifier 24 is used to indicate that an established E/M service\ \ is unrelated to procedure during the postoperative period by the same physician.\ \ The CPT(R) codebook states ''An established patient is one who has received professional\ \ services from the physician/qualified health care professional or another physician/qualified\ \ health care professional [QHP] of the exact same specialty and subspecialty who\ \ belongs to the same group practice, within the past three years.'' The Principles\ \ of CPT(R) state ''Physicians/QHPs who are part of a group practice with the same\ \ specialty code and tax identi�cation number are considered the same; even if,\ \ for example, a surgeon in the practice performs surgery and another surgeon in the\ \ same practice that meets the criteria above manages postoperative care, it does\ \ not meet the requirements for reporting modi�er 24.'' Therefore, modifier 24 is\ \ used in conjunction with an established patient E/M code to indicate the service\ \ is unrelated to the procedure performed by the same physician/qualified health care\ \ professional, or a physician/qualified health care professional of the same specialty\ \ that belongs to the same group practice, during the postoperative period. It would\ \ not be appropriate to append modifier 24 to a new patient E/M code.\r\nIt is also\ \ indicated in in the American Academy of Pediatrics October 2010 Pediatric Coding\ \ Newsletter to append modifier 24 to established E/M codes 99211-99215 for unrelated\ \ E/M services reported during the postoperative period. \r\nBased on the information\ \ from the CPT(R) codebook, the AMA, the CMS and specialty societies, appending modifier\ \ 24 to an established patient E/M code indicates circumstances where the same physician\ \ or qualified health care professional performs an unrelated E/M service during the\ \ postoperative period of a prior surgery. Modifier 24 is not applicable to E/M codes\ \ designated as solely new patient codes.\r\nNOTE: An individual Edit Rationale Statement\ \ (ERS) often addresses multiple edits. Each of those edits is sourced to at least\ \ one national industry source. There may be multiple national industry sources involved\ \ across the whole set of edits that are addressed by a given ERS. Therefore, a specific\ \ source may apply to only a subset of the edits addressed by a given ERS. The specific\ \ sourcing that supports an individual edit may be viewed at the edit level in the\ \ application or in the Edit Rationale Module." source: CPT productCode: C commercialMedicare: Commercial - modifierLink: value: '25' href: /api/coding/code/25/modifier-crosscodes iconName: null effectiveDate: '2003-10-01 00:00:00.0' description: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service usage: '(Under OPPS, modifier may be used only with E/M visit codes (with status indicator V) within the following code ranges: 92002-92014, 99201-99285, 99431, G0101, G0175, G0245, G0246, G0344 G0380-G0384 ~~Modifier used on an E/M code when it is reported with a procedure code that has a outpatient payment status indicator (OPSI) of "S" or "T." However, this does not preclude the provider from reporting this modifier with E/M codes that are assigned to an OPSI other than the "S" or "T" as long as the procedure meets the definition of "significant, separately identifiable E/M service" (Medicare Claims Processing Manual, chapter 4, section 20.6, Medicare transmittal 1045, September 1, 2006.)' definition: 'It may be necessary to indicate that on the day a procedure or service identified by a CPT code was performed, the patient''s condition required a significant, separately identifiable E/M service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. A significant, separately identifiable E/M service is defined or substantiated by documentation that satisfies the relevant criteria for the respective E/M service to be reported (see Evaluation and Management Services Guidelines for instructions on determining level of E/M service). The E/M service may be prompted by the symptom or condition for which the procedure and/or service was provided. As such, different diagnoses are not required for reporting of the E/M services on the same date. This circumstance may be reported by adding modifier 25 to the appropriate level of E/M service. Note: This modifier is not used to report an E/M service that resulted in a decision to perform surgery. See modifier 57. For significant, separately identifiable non-E/M services, see modifier 59.' code: '99213' sourcingRationaleNum: 'Sourcing Rationale: 589' sourcingRationale: "Current Procedural Terminology (CPT) Level I modifiers and Healthcare\ \ Common Procedure Coding System (HCPCS) Level II modifiers are appended to Level\ \ I or Level II codes based on information from the Centers for Medicare and Medicaid\ \ Services (CMS). The identified modifiers are: the ambulance specific modifiers,\ \ 1P, 24, 25, 2P, 3P, 50, 51, 52, 54, 55, 56, 57, 58, 59, 76, 77, 78, 79, 8P, 90,\ \ 91, AA, AD, AQ, AR, AT, AU, AV, AW, AX, AY, BA, BL, BP, BR, BU, CB, CD, CE, CF,\ \ CH, CI, CJ, CK, CL, CM, CN, CS, CT, EA, EB, EC, EM, EY, G7-G9, GE, GG, GK, GL, GM,\ \ GN, GO, GP, GQ, GT, J4, KB, KC, KF, KI, KJ, KM, KN, KZ, LR, NR, NU, PI, PS, PT,\ \ Q7-Q9, QA, QB, QE, QF, QG, QK, QR, QS, QW, QX, QY, QZ, RR,TS, UE, UN, UP, UQ, UR,\ \ US, VM, XE, XP, XS, XU, ZA, ZB,ZC. \r\nThe above identified CPT/HCPCS modifier\ \ to procedure relationships are supported by CMS information from the Medicare Claims\ \ Processing Manual, program transmittals, National Physician Fee Schedule (NPFS),\ \ Clinical Laboratory Fee Schedule, DME/PEN fee schedules, Ambulance fee schedule,\ \ and claims adjudication policies.\r\nModifiers that are covered by other Medicare\ \ rules; therefore are excluded from this rule are:\r\n22, 26, 62, 66, 80-82, AS,\ \ and TC.\r\nModifiers that do not have a specific national CMS source or a source\ \ that addresses specific codes that these modifiers should be appended to; therefore\ \ are excluded from this rule are:\r\n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r\nModifiers that\ \ have a coverage indicator of I, M, or S on the HCPCS file. These indicators state\ \ that they are noncovered or nonpayable by Medicare. These modifiers are excluded\ \ from this rule are:\r\nAZ, FB, GY, GZ, H9, HA-HZ, PA-PC, SA-SB, SD-SE, SH-SN, SQ,\ \ SS-SV, SY, TD-TH, TJ-TN, TP-TR, TT-TW, U1-U9, UA-UD, UF-UH and UK.\r\nModifiers\ \ that have facility related only national CMS sources; therefore are not included\ \ in this professional rule:\r\n27, 73, 74, CA, ED, EE, ET, FC, G1-G6, GF, GS, JG,\ \ L1, Q2, QM, and QN." source: CMS Policy productCode: M commercialMedicare: Medicare totalCount: 43 '404': description: 'Not found: Only CPT and HCPCS code types are applicable for modifier crosswalk' content: application/json: schema: $ref: '#/components/schemas/Notification' example: timestamp: '2023-03-27T12:23:36.422+00:00' status: 404 error: Not Found message: Not Found path: /codesearchms/api/coding/code/i10cm/99213/PHYSICIAN/modifier-crosswalk security: - bearerAuth: [] /api/coding/code/{code}/validate: get: tags: - Code Information APIs summary: Validate if the given code is valid or deleted or invalid operationId: validateCode parameters: - name: code in: path required: true schema: type: string example: 99213 - name: codeType in: query required: false schema: type: array items: type: string enum: - cpt - hcpcs - i10_pcs - i10_cm - i9v1 - i9v3 - name: yyyy-mm-dd in: header description: Date for which historical data is required required: false schema: type: string format: yyyy-mm-dd responses: '200': description: Fetch lay descriptions for given code and codetype content: application/json: example: - fullDescription: Code "0001t" is a deleted code. Deleted date "01/01/05". To report, see code 34803 codeStatus: DELETED code: 0001t '404': description: Not Found - lay descriptions were not found for given code and codetype content: application/json: schema: $ref: '#/components/schemas/Notification' example: timestamp: '2024-02-05T12:40:33.399+00:00' status: 404 error: Not Found path: /codesearchms/api/coding/code/0001t/validat '500': description: Internal server error content: application/json: example: timestamp: '2024-02-05T07:22:01.017+00:00' path: /codesearchms/api/coding/code/0001t/validate status: 500 error: Internal Server Error requestId: a4796cc7-1 security: - bearerAuth: [] /api/coding/code/{code}/ama-section-guidelines-doc: get: tags: - Notes Information APIs operationId: fetchSectionGuidelinesPDF parameters: - name: code in: path description: code required: true schema: type: string example: 17000 - name: yyyy-mm-dd in: header description: Date for which historical data is required required: false schema: type: string format: yyyy-mm-dd responses: '200': description: OK content: '*/*': schema: $ref: '#/components/schemas/PDFDocument' security: - bearerAuth: [] /api/coding/code/{codetype}/{code}/mapping/i10_pcs: get: tags: - Mapping APIs summary: ' Fetches I10PCS to I9V3 mappings on requested codetype and code' operationId: i9v3Toi10pcsMapping parameters: - name: codetype in: path required: true schema: type: string enum: - i9v3 - name: code in: path description: 'i9v3 code ' required: true schema: type: string example: 87.01 - name: yyyy-mm-dd in: header description: Date for which historical data is required required: false schema: type: string format: yyyy-mm-dd responses: '200': description: Fetching I10PCS to I9V3 mappings content: application/json: example: code: fullDescription: Pneumoencephalogram code: '87.01' mappedCodes: - fullDescription: Computerized Tomography (CT Scan) of Brain using Other Contrast, Unenhanced and Enhanced codeId: 3638761 mappingInformation: [] backwardMappingCodes: - '87.01' - '87.03' code: B020Y0Z - fullDescription: Computerized Tomography (CT Scan) of Brain using Other Contrast codeId: 3638762 mappingInformation: [] backwardMappingCodes: - '87.01' - '87.03' code: B020YZZ - fullDescription: Computerized Tomography (CT Scan) of Cerebral Ventricle(s) using Other Contrast, Unenhanced and Enhanced codeId: 3638775 mappingInformation: [] backwardMappingCodes: - '87.03' code: B028Y0Z - fullDescription: Computerized Tomography (CT Scan) of Cerebral Ventricle(s) using Other Contrast codeId: 3638776 mappingInformation: [] backwardMappingCodes: - '87.03' code: B028YZZ - fullDescription: Computerized Tomography (CT Scan) of Cerebral Ventricle(s) codeId: 3638777 mappingInformation: [] backwardMappingCodes: - '87.03' code: B028ZZZ - fullDescription: Computerized Tomography (CT Scan) of Sella Turcica/Pituitary Gland using Other Contrast, Unenhanced and Enhanced codeId: 3638782 mappingInformation: [] backwardMappingCodes: - '87.01' - '87.03' code: B029Y0Z - fullDescription: Computerized Tomography (CT Scan) of Sella Turcica/Pituitary Gland using Other Contrast codeId: 3638783 mappingInformation: [] backwardMappingCodes: - '87.01' - '87.03' code: B029YZZ - fullDescription: Magnetic Resonance Imaging (MRI) of Brain using Other Contrast, Unenhanced and Enhanced codeId: 3638792 mappingInformation: [] backwardMappingCodes: - '88.91' - '88.96' code: B030Y0Z - fullDescription: Magnetic Resonance Imaging (MRI) of Brain using Other Contrast codeId: 3638793 mappingInformation: [] backwardMappingCodes: - '88.91' - '88.96' code: B030YZZ - fullDescription: Magnetic Resonance Imaging (MRI) of Sella Turcica/Pituitary Gland using Other Contrast, Unenhanced and Enhanced codeId: 3638795 mappingInformation: [] backwardMappingCodes: - '88.97' code: B039Y0Z - fullDescription: Magnetic Resonance Imaging (MRI) of Sella Turcica/Pituitary Gland using Other Contrast codeId: 3638796 mappingInformation: [] backwardMappingCodes: - '88.97' code: B039YZZ '400': description: 'Bad Request: Some parameters were invalid' content: application/json: schema: $ref: '#/components/schemas/Notification' example: error: - The code provided '99213' in this web service request is not a valid 'i9v3' code. warning: null info: null '500': description: Internal server error content: application/json: example: timestamp: '2023-01-01T07:22:01.017+00:00' path: api/coding/code/i9v3/87.01/mapping/i10_pcs status: 500 error: Internal Server Error requestId: a4796cc7-1 security: - bearerAuth: [] /api/coding/code/{codetype}/{code}/mapping/i10_cm: get: tags: - Mapping APIs summary: ' Fetches I9v1 To I10CM CodeMapping on requested codetype and code' operationId: i9v1Toi10cmMapping parameters: - name: codetype in: path required: true schema: type: string enum: - i9v1 - name: code in: path description: 'i9v1 to i10_cm mapped codes ' required: true schema: type: string example: 999.9 - name: yyyy-mm-dd in: header description: Date for which historical data is required required: false schema: type: string format: yyyy-mm-dd responses: '200': description: Fetching I9V1 to I10CM mappings content: application/json: example: code: fullDescription: Other and unspecified complications of medical care, not elsewhere classified code: '999.9' mappedCodes: - fullDescription: Complication of inhalation therapy, initial encounter codeId: 3548956 mappingInformation: - value: Gem Map href: '#' backwardMappingCodes: - '999.9' code: T81.81XA - fullDescription: Failed or difficult intubation, initial encounter codeId: 3551039 mappingInformation: - value: Gem Map href: '#' backwardMappingCodes: - '999.9' code: T88.4XXA - fullDescription: Unspecified adverse effect of drug or medicament, initial encounter codeId: 3551051 mappingInformation: - value: Gem Map href: '#' backwardMappingCodes: - '995.20' - '999.9' code: T88.7XXA - shortDescription: Best code alternative based on exact code description match fullDescription: Other specified complications of surgical and medical care, not elsewhere classified, initial encounter codeId: 3551138 mappingInformation: - value: Gem Map href: '#' - value: Premier Pick href: '#' backwardMappingCodes: - '998.13' - '998.2' - '999.9' code: T88.8XXA - fullDescription: Complication of surgical and medical care, unspecified, initial encounter codeId: 3551141 mappingInformation: - value: Gem Map href: '#' backwardMappingCodes: - '999.9' code: T88.9XXA '400': description: 'Bad request: Some parameters were invalid' content: application/json: schema: $ref: '#/components/schemas/Notification' example: error: - The code provided '99213' in this web service request is not a valid 'i9v1' code. warning: null info: null '500': description: Internal server error content: application/json: example: timestamp: '2023-01-01T07:22:01.017+00:00' path: /api/coding/code/i9v1/999/mapping/i10_cm status: 500 error: Internal Server Error requestId: a4796cc7-1 security: - bearerAuth: [] /api/coding/code/{codetype}/color-codes/sex: get: tags: - Color codes APIs summary: Fetches I9v1 or I9v3 sex color codes operationId: fetchI9SexCodes parameters: - name: codetype in: path required: true schema: type: string enum: - i9v1 - i9v3 - name: sort in: query description: Any of these (code,-code) are allowed values. required: false schema: type: array items: type: string default: [] - name: limit in: query required: false schema: type: integer format: int32 default: 150 example: 150 - name: page in: query required: false schema: type: integer format: int32 default: 1 - name: filter in: query required: false schema: type: string - name: yyyy-mm-dd in: header description: Date for which historical data is required required: false schema: type: string format: yyyy-mm-dd responses: '200': description: OK content: '*/*': schema: $ref: '#/components/schemas/OptumPageImplColorCodes' security: - bearerAuth: [] /api/coding/code/{codetype}/{code}/image: get: tags: - Code Image APIs summary: Fetches the I9v1 ,I9v3 ,CPT ,HCPCS ,I10_pcs ,I10_cm image operationId: imageLinkResource parameters: - name: codetype in: path required: true schema: type: string enum: - cpt - hcpcs - i10_pcs - i10_cm - i9v1 - i9v3 - name: code in: path description: Code for which image info is required required: true schema: type: string example: 50605 - name: yyyy-mm-dd in: header description: Date for which historical data is required required: false schema: type: string format: yyyy-mm-dd responses: '200': description: Returns image associated to code content: application/json: example: value: 50605 ATUN.jpg href: /codesearchms/api/coding/code/image/50605 ATUN.jpg '400': description: 'Bad Request: Some parameters were invalid' content: application/json: schema: $ref: '#/components/schemas/Notification' example: error: - The code provided 'zzzz' in this web service request is not a valid 'cpt' code. warning: null info: null '500': description: Internal server error content: application/json: example: timestamp: '2022-07-06T07:22:01.017+00:00' path: /api/coding/code/cpt/17000/image status: 500 error: Internal Server Error requestId: a4796cc7-1 security: - bearerAuth: [] /api/coding/code/{codetype}/{code}/history: get: tags: - Code History APIs summary: Fetches the complete history for a code. operationId: codeHistory parameters: - name: codetype in: path required: true schema: type: string enum: - cpt - hcpcs - i10_pcs - i10_cm - i9v1 - i9v3 - name: code in: path description: Code for which history is required required: true schema: type: string example: 99213 - name: yyyy-mm-dd in: header description: Date for which historical data is required required: false schema: type: string format: yyyy-mm-dd responses: '200': description: Complete code history of code content: application/json: example: - changeEffectiveDate: '2021-01-01 00:00:00' status: Changed changeSummary: Officially recognized, Other, Changed fullInfo:
Office or other outpatient visit for the evaluation and
management of an established patient, which requires a medically appropriate history
and/or examination and low level of medical decision making. When using time for code
selection, 20-29 minutes of total time is spent on the date of the encounter.EST OUTPT L3 EXP PROB H&E LOW COMPLX MED DEC
char48Info:
OFFICEOFC/OUTPATIENT ESTABLISHED LOWOUTPT VISIT E&M
EST MDM 20-29MOD
SEVERITY 15 MIN
char35Info:
OFFICE OOFC/P EST LOWOUTPT E&M ESTAB 20-29MOD 15
MIN
- changeEffectiveDate: '2013-01-01 00:00:00'
status: Changed
changeSummary: Officially recognized, Other, Changed
fullInfo: '
Office or other outpatient visit for the evaluation and
management of an established patient, which requires at least 2 of these 3 key components:
An expanded problem focused history; An expanded problem focused examination; Medical
decision making of low complexity. Counseling and coordination of care with other physicians,
other qualified health care professionals, or agencies are provided consistent with
the nature of the problem(s) and the patient''s and/or family''s needs. Usually, the
presenting problem(s) are of low to moderate severity. Typically, 15 minutes are spent
face-to-face with the patient and/or family.EST OUTPT
L3 EXP PROB H&E LOW COMPLX MED DEC'
char48Info:
OFFICE OUTPATIENT VISITOFC/OUTPT
15 MINUTESMIN
char35Info:
OFFICEOFC/OUTPATIENT VISIT ESTOUTPT E&M ESTAB LOW-MOD
15 MIN
- changeEffectiveDate: '2004-01-01 00:00:00'
status: Changed
changeSummary: Officially recognized, Other, Changed
fullInfo: '
Office or other outpatient visit for the evaluation and
management of an established patient, which requires at least 2 of these 3 key components:
An expanded problem focused history; An expanded problem focused examination; Medical
decision making of low complexity. Counseling and coordination of care with other providers
or agencies are provided consistent with the nature of the problem(s) and the patient''s
and/or family''s needs. Usually, the presenting problem(s) are of low to moderate severity.
Physicians typically spend 15 minutes face-to-face with the patient and/or family.EST OUTPT L3 EXP PROB H&E LOW COMPLX MED DEC'
char48Info:
OFFICE OUTPATIENT VISITOFC/OUTPT
15 MINUTESMIN
char35Info:
OFFICEOFC/OUTPATIENT VISIT ESTOUTPT E&M ESTAB LOW-MOD
15 MIN
- changeEffectiveDate: '2003-01-01 00:00:00'
status: Changed
changeSummary: Officially recognized, Other, Changed
fullInfo: '
Office or other outpatient visit for the evaluation and
management of an established patient, which requires at least two of these three key
components: an expanded problem focused history; an expanded problem focused examination;
medical decision making of low complexity. Counseling and coordination of care with
other providers or agencies are provided consistent with the nature of the problem(s)
and the patient''s and/or family''s needs. Usually, the presenting problem(s) are of
low to moderate severity. PhEST OUTPT L3 EXP PROB H&E
LOW COMPLX MED DEC'
char48Info: There are no differences in these versions.
char35Info: There are no differences in these versions.
- changeEffectiveDate: '2000-01-01 00:00:00'
status: Changed
changeSummary: Officially recognized, Other, Changed
fullInfo: '
Office or other outpatient visit for the evaluation and
management of an established patient, which requires at least two of these three key
components: an expanded problem focused history; an expanded problem focused examination;
medical decision making of low complexity. Counseling and coordination of care with
other providers or agencies are provided consistent with the nature of the problem(s)
and the patient''s and/or family''s needs. Usually, the presenting problem(s) are of
low to moderate severity. Physicians typically spend 15 minutes face-to-face with the
patient and/or family.EST OUTPT L3 EXP PROB H&E LOW COMPLX
MED DEC'
char48Info: There are no differences in these versions.
char35Info: There are no differences in these versions.
- changeEffectiveDate: '1994-01-01 00:00:00'
status: Changed
changeSummary: Officially recognized, Other, Changed
fullInfo:
OFFIC/OUTPT VISIT E&M ESTOUTPT
L3 EXP PROB H&E LOW-MOD SEVERITY 15MINCOMPLX MED DEC
char48Info: There are no differences in these versions.
char35Info: There are no differences in these versions.
- changeEffectiveDate: '1993-01-01 00:00:00'
status: New
changeSummary: Officially recognized, Other, New
fullInfo: There are no differences in these versions.
char48Info: There are no differences in these versions.
char35Info: There are no differences in these versions.
'400':
description: 'Bad Request: Some parameters were invalid'
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
error:
- The code provided '999' in this web service request is not a valid 'cpt' code.
warning: null
info: null
'500':
description: Internal server error
content:
application/json:
example:
timestamp: '2022-07-06T07:22:01.017+00:00'
path: /api/coding/code/cpt/11000/history
status: 500
error: Internal Server Error
requestId: a4796cc7-1
security:
- bearerAuth: []
/api/coding/code/{codetype}/{code}/detail:
get:
tags:
- Code Information APIs
summary: Fetches the details of the code based on codetype
operationId: codeDetail
parameters:
- name: codetype
in: path
required: true
schema:
type: string
enum:
- cpt
- hcpcs
- i10_pcs
- i10_cm
- i9v1
- i9v3
- name: code
in: path
required: true
schema:
type: string
example: 99213
- name: direction
in: query
required: false
schema:
type: string
enum:
- prev
- next
- name: data
in: query
description: 'Allows to request only specific attributes data. Available specific data to request
are "fullDescription,edits,references,char48Desc". eg: To get only full description, add "fullDescription"
in the list'
required: false
schema:
type: array
items:
type: string
default: []
- name: yyyy-mm-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-mm-dd
responses:
'200':
description: Fetch code details for given code and codetype
content:
application/json:
schema:
$ref: '#/components/schemas/Code'
example:
fullDescription: Office or other outpatient visit for the evaluation and management of
an established patient, which requires a medically appropriate history and/or examination
and low level of medical decision making. When using time for code selection, 20-29
minutes of total time is spent on the date of the encounter.
image:
value: null
href: null
notes:
- value: range-notes
href: /codesearchms/api/coding/code/cpt/99213/range-notes
- value: section-notes
href: /codesearchms/api/coding/code/cpt/99213/section-notes
prev:
value: prev
href: api/coding/code/cpt/99213/detail?direction=prev
next:
value: next
href: api/coding/code/cpt/99213/detail?direction=next
indent1: 0
indent2: 0
code: '99213'
'400':
description: 'Bad request: Some parameters were invalid'
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
error:
- The code provided '992131' in this web service request is not a valid 'cpt' code.
warning: null
info: null
'500':
description: Internal server error
content:
application/json:
example:
timestamp: '2022-07-06T07:22:01.017+00:00'
path: codesearchms/api/coding/code/cpt/17000/detail
status: 500
error: Internal Server Error
requestId: a4796cc7-1
security:
- bearerAuth: []
/api/coding/code/{codetype}/{code}/range:
get:
tags:
- Code Information APIs
summary: Returns the complete code range
operationId: range
parameters:
- name: codetype
in: path
required: true
schema:
type: string
enum:
- i9v1
- i9v3
- cpt
- hcpcs
- i10_cm
- name: code
in: path
description: Code for which range is required
required: true
schema:
type: string
example: 804.45
- name: rangeid
in: query
required: false
schema:
type: integer
format: int32
default: 0
- name: direction
in: query
required: false
schema:
type: string
- name: yyyy-mm-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-mm-dd
responses:
'200':
description: Complete code range for code
content:
application/json:
example:
countInRange: 9
rangeId: 1
rangeHeader: Evaluation and Management^Outpatient and Other Visits
rangeCodeBeg: '99202'
rangeCodeEnd: '99215'
next:
value: next
href: api/coding/code/cpt/99202/range?rangeid=1&direction=next
codes:
- codeType: cpt
fullDescription: Office or other outpatient visit for the evaluation and management
of a new patient, which requires a medically appropriate history and/or examination
and straightforward medical decision making. When using time for code selection, 15-29
minutes of total time is spent on the date of the encounter.
edits:
- value: MUE_PRACTITIONER set to 1 FROM MUE_1 ICON_TYPE_ID = 165
href: ''
- value: CCI_1 set to 1 FROM CCI_1 COMP
href: ''
- value: ANSWER BOOK set to 1 FROM ARTICLE CODE_X_ARTICLETYPR ID 3
href: ''
- value: ASC_INDICATOR SET FROM ASC_INDICATOR AND FED_REG
href: ''
indent1: 0
indent2: 0
codeNotes: {}
code: '99202'
- codeType: cpt
fullDescription: Office or other outpatient visit for the evaluation and management
of a new patient, which requires a medically appropriate history and/or examination
and low level of medical decision making. When using time for code selection, 30-44
minutes of total time is spent on the date of the encounter.
edits:
- value: MUE_PRACTITIONER set to 1 FROM MUE_1 ICON_TYPE_ID = 165
href: ''
- value: CCI_1 set to 1 FROM CCI_1 COMP
href: ''
- value: ANSWER BOOK set to 1 FROM ARTICLE CODE_X_ARTICLETYPR ID 3
href: ''
- value: ASC_INDICATOR SET FROM ASC_INDICATOR AND FED_REG
href: ''
indent1: 0
indent2: 0
codeNotes: {}
code: '99203'
- codeType: cpt
fullDescription: Office or other outpatient visit for the evaluation and management
of a new patient, which requires a medically appropriate history and/or examination
and moderate level of medical decision making. When using time for code selection,
45-59 minutes of total time is spent on the date of the encounter.
edits:
- value: MUE_PRACTITIONER set to 1 FROM MUE_1 ICON_TYPE_ID = 165
href: ''
- value: CCI_1 set to 1 FROM CCI_1 COMP
href: ''
- value: ANSWER BOOK set to 1 FROM ARTICLE CODE_X_ARTICLETYPR ID 3
href: ''
- value: ASC_INDICATOR SET FROM ASC_INDICATOR AND FED_REG
href: ''
indent1: 0
indent2: 0
codeNotes: {}
code: '99204'
- codeType: cpt
fullDescription: Office or other outpatient visit for the evaluation and management
of a new patient, which requires a medically appropriate history and/or examination
and high level of medical decision making. When using time for code selection, 60-74
minutes of total time is spent on the date of the encounter.
edits:
- value: MUE_PRACTITIONER set to 1 FROM MUE_1 ICON_TYPE_ID = 165
href: ''
- value: CCI_1 set to 1 FROM CCI_1 COMP
href: ''
- value: ANSWER BOOK set to 1 FROM ARTICLE CODE_X_ARTICLETYPR ID 3
href: ''
- value: ASC_INDICATOR SET FROM ASC_INDICATOR AND FED_REG
href: ''
indent1: 0
indent2: 0
codeNotes:
notes:
- noteType: CPT Excludes Header
content:
- Excludes Prolonged services (lasting 75 minutes or more) ([99417])
code: '99205'
- codeType: cpt
fullDescription: Office or other outpatient visit for the evaluation and management
of an established patient that may not require the presence of a physician or other
qualified health care professional
edits:
- value: MUE_PRACTITIONER set to 1 FROM MUE_1 ICON_TYPE_ID = 165
href: ''
- value: CCI_1 set to 1 FROM CCI_1 COMP
href: ''
- value: ANSWER BOOK set to 1 FROM ARTICLE CODE_X_ARTICLETYPR ID 3
href: ''
- value: ASC_INDICATOR SET FROM ASC_INDICATOR AND FED_REG
href: ''
indent1: 0
indent2: 0
codeNotes: {}
code: '99211'
- codeType: cpt
fullDescription: Office or other outpatient visit for the evaluation and management
of an established patient, which requires a medically appropriate history and/or examination
and straightforward medical decision making. When using time for code selection, 10-19
minutes of total time is spent on the date of the encounter.
edits:
- value: MUE_PRACTITIONER set to 1 FROM MUE_1 ICON_TYPE_ID = 165
href: ''
- value: CCI_1 set to 1 FROM CCI_1 COMP
href: ''
- value: ANSWER BOOK set to 1 FROM ARTICLE CODE_X_ARTICLETYPR ID 3
href: ''
- value: ASC_INDICATOR SET FROM ASC_INDICATOR AND FED_REG
href: ''
indent1: 0
indent2: 0
codeNotes: {}
code: '99212'
- codeType: cpt
fullDescription: Office or other outpatient visit for the evaluation and management
of an established patient, which requires a medically appropriate history and/or examination
and low level of medical decision making. When using time for code selection, 20-29
minutes of total time is spent on the date of the encounter.
edits:
- value: MUE_PRACTITIONER set to 1 FROM MUE_1 ICON_TYPE_ID = 165
href: ''
- value: CCI_1 set to 1 FROM CCI_1 COMP
href: ''
- value: ANSWER BOOK set to 1 FROM ARTICLE CODE_X_ARTICLETYPR ID 3
href: ''
- value: ASC_INDICATOR SET FROM ASC_INDICATOR AND FED_REG
href: ''
indent1: 0
indent2: 0
codeNotes: {}
code: '99213'
- codeType: cpt
fullDescription: Office or other outpatient visit for the evaluation and management
of an established patient, which requires a medically appropriate history and/or examination
and moderate level of medical decision making. When using time for code selection,
30-39 minutes of total time is spent on the date of the encounter.
edits:
- value: MUE_PRACTITIONER set to 1 FROM MUE_1 ICON_TYPE_ID = 165
href: ''
- value: CCI_1 set to 1 FROM CCI_1 COMP
href: ''
- value: ANSWER BOOK set to 1 FROM ARTICLE CODE_X_ARTICLETYPR ID 3
href: ''
- value: ASC_INDICATOR SET FROM ASC_INDICATOR AND FED_REG
href: ''
indent1: 0
indent2: 0
codeNotes: {}
code: '99214'
- codeType: cpt
fullDescription: Office or other outpatient visit for the evaluation and management
of an established patient, which requires a medically appropriate history and/or examination
and high level of medical decision making. When using time for code selection, 40-54
minutes of total time is spent on the date of the encounter.
edits:
- value: MUE_PRACTITIONER set to 1 FROM MUE_1 ICON_TYPE_ID = 165
href: ''
- value: CCI_1 set to 1 FROM CCI_1 COMP
href: ''
- value: ANSWER BOOK set to 1 FROM ARTICLE CODE_X_ARTICLETYPR ID 3
href: ''
- value: ASC_INDICATOR SET FROM ASC_INDICATOR AND FED_REG
href: ''
indent1: 0
indent2: 0
codeNotes:
notes:
- noteType: CPT Excludes Header
content:
- Excludes Prolonged services (lasting 55 minutes or more) ([99417])
code: '99215'
'400':
description: Bad Request - some parameters were invalid
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
error:
- The code provided '99' in this web service request is not a valid 'cpt' code.
warning: null
info: null
'500':
description: Internal server error
content:
application/json:
example:
timestamp: '2022-07-06T07:22:01.017+00:00'
path: /api/coding/code/cpt/99213/range
status: 500
error: Internal Server Error
requestId: a4796cc7-1
security:
- bearerAuth: []
/api/coding/code/{codetype}/{term}/root-operation-definition-term:
get:
tags:
- Code Information APIs
summary: Fetches the root operation definition for a code and term.
operationId: rootOperationDefinitionTerm
parameters:
- name: codetype
in: path
required: true
schema:
type: string
enum:
- i10_pcs
- name: code
in: query
description: Code for which root operation definition is optional
required: false
schema:
type: string
example: '001'
- name: term
in: path
description: Term for which root operation definition is required
required: true
schema:
type: string
example: Bypass
- name: yyyy-mm-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-mm-dd
responses:
'200':
description: Complete root operation definition of the code and term
content:
application/json:
example:
- definition: Altering the route of passage of the contents of a tubular body part
explanation: Rerouting contents of a body part to a downstream area of the normal route,
to a similar route and body part, or to an abnormal route and dissimilar body part.
Includes one or more anastomoses, with or without the use of a device
includesExamples: Coronary artery bypass, colostomy formation
'400':
description: 'Bad request: some parameters were invalid'
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
error:
- 'rootOperationDefinition.code: length must be between 3 and 7'
warning: null
info: null
'500':
description: Internal server error
content:
application/json:
example:
timestamp: '2022-07-06T07:22:01.017+00:00'
path: /api/coding/code/cpt/Bypass/rootOperationDefinition-term
status: 500
error: Internal Server Error
requestId: a4796cc7-1
security:
- bearerAuth: []
/api/coding/code/{codetype}/{code}/root-operation-definition:
get:
tags:
- Code Information APIs
summary: Fetches the root operation definition for a code.
operationId: rootOperationDefinition
parameters:
- name: codetype
in: path
required: true
schema:
type: string
enum:
- i10_pcs
- name: code
in: path
description: Code for which root operation definition is required
required: true
schema:
type: string
example: 0QPP04Z
- name: yyyy-mm-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-mm-dd
responses:
'200':
description: Complete root operation definition of the code
content:
application/json:
example:
- definition: Taking out or off a device from a body part
explanation: If a device is taken out and a similar device put in without cutting or puncturing
the skin or mucous membrane, the procedure is coded to the root operation CHANGE. Otherwise,
the procedure for taking out a device is coded to the root operation REMOVAL
includesExamples: Drainage tube removal, cardiac pacemaker removal
'400':
description: 'Bad Request: some parameters were invalid'
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
error:
- 'rootOperationDefinition.code: length must be between 3 and 7'
warning: null
info: null
'500':
description: Internal server error
content:
application/json:
example:
timestamp: '2022-07-06T07:22:01.017+00:00'
path: /api/coding/code/cpt/11000/rootOperationDefinition
status: 500
error: Internal Server Error
requestId: a4796cc7-1
security:
- bearerAuth: []
/api/coding/code/{codetype}/{code}/mapping/i9v3:
get:
tags:
- Mapping APIs
summary: ' Fetches I10PCS to I9V3 mappings on requested Codetype and code'
operationId: i10pcsToi9v3Mapping
parameters:
- name: codetype
in: path
required: true
schema:
type: string
enum:
- i10_pcs
- name: code
in: path
description: 'i10pcs code '
required: true
schema:
type: string
example: 4A13053
- name: yyyy-mm-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-mm-dd
responses:
'200':
description: Fetching I10PCS to I9V3 mappings
content:
application/json:
example:
code:
fullDescription: Biofeedback
code: GZC9ZZZ
mappedCodes:
- shortDescription: Single code alternative based in GEMs - approximate
fullDescription: Other individual psychotherapy
mappingInformation:
- value: Gem Map
href: '#'
- value: Premier Pick
href: '#'
backwardMappingCodes:
- GZ50ZZZ
- GZ52ZZZ
- GZ53ZZZ
- GZC9ZZZ
code: '94.39'
'400':
description: 'Bad Request: Some parameters were invalid'
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
error:
- The code provided 'T43.221A' in this web service request is not a valid 'i10_pcs' code.
warning: null
info: null
'500':
description: Internal server error
content:
application/json:
example:
timestamp: '2023-01-01T07:22:01.017+00:00'
path: /api/coding/code/i10_pcs/T43.221A/mapping/i9v3
status: 500
error: Internal Server Error
requestId: a4796cc7-1
security:
- bearerAuth: []
/api/coding/code/{codetype}/{code}/mapping/i9v1:
get:
tags:
- Mapping APIs
summary: ' Fetches I10CM to I9V1 mappings on requested Codetype and code'
operationId: i10cmToi9v1Mapping
parameters:
- name: codetype
in: path
required: true
schema:
type: string
enum:
- i10_cm
- name: code
in: path
description: 'i10cm code '
required: true
schema:
type: string
example: E11.01
- name: yyyy-mm-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-mm-dd
responses:
'200':
description: Fetching I10CM to I9V1 mappings
content:
application/json:
example:
code:
fullDescription: Poisoning by selective serotonin reuptake inhibitors, accidental (unintentional),
initial encounter
code: T43.221A
mappedCodes:
- shortDescription: Single code alternative based on Forward and Backward GEM
fullDescription: Poisoning by selective serotonin reuptake inhibitors
mappingInformation:
- value: Combo Map
href: '#'
- value: Gem Map
href: '#'
- value: Premier Pick
href: '#'
backwardMappingCodes:
- T43.221A
- T43.222A
- T43.223A
- T43.224A
code: '969.03'
- fullDescription: Accidental poisoning by antidepressants
mappingInformation:
- value: Combo Map
href: '#'
- value: Gem Map
href: '#'
backwardMappingCodes:
- T43.011A
- T43.021A
- T43.1X1A
- T43.201A
- T43.211A
- T43.221A
- T43.291A
code: E854.0
'400':
description: 'Bad request: Some parameters were invalid'
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
error:
- The code provided '99213' in this web service request is not a valid 'i10_cm' code.
warning: null
info: null
'500':
description: Internal server error
content:
application/json:
example:
timestamp: '2023-01-01T07:22:01.017+00:00'
path: /api/coding/code/i10_cm/T43.221A/mapping/i9v1
status: 500
error: Internal Server Error
requestId: a4796cc7-1
security:
- bearerAuth: []
/api/coding/code/{codetype}/{code}/chapter-notes:
get:
tags:
- Notes Information APIs
summary: ' Fetches I10CM chapter notes'
operationId: chapterNotes
parameters:
- name: codetype
in: path
required: true
schema:
type: string
enum:
- i10_cm
- name: code
in: path
required: true
schema:
type: string
example: E11
- name: yyyy-mm-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-mm-dd
responses:
'200':
description: Fetch chapter notes
content:
application/json:
example:
notes:
- noteType: Note header (red box) left align
noteTypeId: 126
content:
- All neoplasms, whether functionally active or not, are classified in Chapter 2. Appropriate
codes in this chapter (i.e. E05.8, E07.0, E16-E31, E34.-) may be used as additional
codes to indicate either functional activity by neoplasms and ectopic endocrine tissue
or hyperfunction and hypofunction of endocrine glands associated with neoplasms and
other conditions classified elsewhere.
sectionTitle: Chapter 4. Endocrine, Nutritional and Metabolic Diseases (E00-E89)
- noteType: Excludes 1 header
noteTypeId: 80
content:
- transitory endocrine and metabolic disorders specific to newborn (P70-P74)
sectionTitle: Chapter 4. Endocrine, Nutritional and Metabolic Diseases (E00-E89)
- noteType: AHA reference
noteTypeId: 243
content:
- 2018, 2Q, 6
sectionTitle: Chapter 4. Endocrine, Nutritional and Metabolic Diseases (E00-E89)
- noteType: Chapter contains blocks
noteTypeId: 70
content:
- 'This chapter contains the following blocks:'
- E00-E07|Disorders of thyroid gland
- E08-E13|Diabetes mellitus
- E15-E16|Other disorders of glucose regulation and pancreatic internal secretion
- E20-E35|Disorders of other endocrine glands
- E36|Intraoperative complications of endocrine system
- E40-E46|Malnutrition
- E50-E64|Other nutritional deficiencies
- E65-E68|Overweight, obesity and other hyperalimentation
- E70-E88|Metabolic disorders
- E89|Postprocedural endocrine and metabolic complications and disorders, not elsewhere
classified
sectionTitle: Chapter 4. Endocrine, Nutritional and Metabolic Diseases (E00-E89)
'400':
description: 'Bad request: Some parameters were invalid'
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
error:
- The code provided 'E111' in this web service request is not a valid 'i10_cm' code.
warning: null
info: null
'500':
description: Internal server error
content:
application/json:
example:
timestamp: '2022-07-06T07:22:01.017+00:00'
path: /api/coding/code/i10_cm/E11/chapter-notes
status: 500
error: Internal Server Error
requestId: a4796cc7-1
security:
- bearerAuth: []
/api/coding/code/{codetype}/color-codes/sex/{sex-code-type}:
get:
tags:
- Color codes APIs
summary: 'Fetches the I10CM for the requested SEX code type '
operationId: getSexColorCodes
parameters:
- name: codetype
in: path
required: true
schema:
type: string
enum:
- i10_cm
- name: sex-code-type
in: path
required: true
schema:
type: string
enum:
- GENDER_FEMALE_PHYSICIAN
- GENDER_MALE_PHYSICIAN
- GENDER_FEMALE_FACILITY
- GENDER_MALE_FACILITY
- name: sort
in: query
description: Any of these (code,-code,fullDescription,-fullDescription) are allowed values, default
is +code
required: false
schema:
type: array
items:
type: string
default:
- code
- name: page
in: query
required: false
schema:
type: integer
format: int32
default: 1
- name: limit
in: query
required: false
schema:
type: integer
format: int32
default: 250
- name: filter
in: query
required: false
schema:
type: string
- name: yyyy-mm-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-mm-dd
responses:
'200':
description: OK
content:
'*/*':
schema:
$ref: '#/components/schemas/OptumPageImplColorCodes'
security:
- bearerAuth: []
/api/coding/code/{codetype}/color-codes/post-acute-care/{pac-icon-type}:
get:
tags:
- Color codes APIs
summary: Fetches the I10CM for the requested PAC code type
operationId: getPacColorCodes
parameters:
- name: codetype
in: path
required: true
schema:
type: string
enum:
- i10_cm
- name: pac-icon-type
in: path
required: true
schema:
type: string
enum:
- IRF_COMORBID_CONDITION
- HOME_HEALTH_COMORBIDITY_HIGH
- HOME_HEALTH_COMORBIDITY_LOW
- NON_THERAPY_ANCILLARY
- NONCANCER_DX
- IRF_ETIOLOGIC_DIAGNOSIS
- RETURN_TO_PROVIDER_HOME_HEALTH
- RETURN_TO_PROVIDER_SNF
- SPEECH_LANGUAGE_PATHOLOGY
- Z_CODE_AS_PRIMARY_DIAGNOSIS_PHYSICIAN_BILLING_ONLY
- name: sort
in: query
description: Any of these (code,-code,fullDescription,-fullDescription) are allowed values, default
is +code
required: false
schema:
type: array
items:
type: string
default:
- code
- name: page
in: query
required: false
schema:
type: integer
format: int32
default: 1
- name: limit
in: query
required: false
schema:
type: integer
format: int32
default: 250
- name: filter
in: query
required: false
schema:
type: string
- name: yyyy-mm-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-mm-dd
responses:
'200':
description: OK
content:
'*/*':
schema:
$ref: '#/components/schemas/OptumPageImplColorCodes'
security:
- bearerAuth: []
/api/coding/code/{codetype}/color-codes/other-color-codes/{other-color-code-type}:
get:
tags:
- Color codes APIs
summary: Fetches the I10CM for the requested other color code type
operationId: getOtherColorCodeType
parameters:
- name: codetype
in: path
required: true
schema:
type: string
enum:
- i10_cm
- name: other-color-code-type
in: path
required: true
schema:
type: string
enum:
- FOURTH_CHARACTER_REQUIRED
- FIFTH_CHARACTER_REQUIRED
- SIXTH_CHARACTER_REQUIRED
- SEVENTH_CHARACTER_REQUIRED
- COMORBIDITY_OR_COMPLICATION_INPATIENT_ONLY
- HIV_RELATED_DX_INPATIENT_ONLY
- NEW_CODE_MID_YEAR
- OTHER_SPECIFIED_CODE
- PHYSICIAN_DOCUMENTATION
- QUESTIONABLE_PDX_INPATIENT_ONLY
- REVISED_CODE_MID_YEAR
- UNACCEPTABLE_PRINCIPAL_DX_INPATIENT_ONLY
- UNACCEPTABLE_PRINCIPAL_DX_OUTPATIENT_ONLY
- UNSPECIFIED_DIAGNOSIS
- UNSPECIFIED_SITE
- WRONG_SURGERY_INPATIENT_ONLY
- X7TH_CHARACTER_REQUIRED
- MENTAL_HEALTH_DIAGNOSIS
- Z_CODE_INDICATOR
- CONDITIONAL_HOSPITAL_ACQUIRED_CONDITION_FACILITY
- HOSPITAL_ACQUIRED_CONDITION_FACILITY
- MCC_MAJOR_COMPLICATION_INPATIENT_ONLY
- MCC_IF_DISCHARGE_ALIVE
- NON_COVERED_BY_MEDICARE
- CODE_EXEMPT_FROM_PRESENT_ON_ADMISSION_POA
- UNACCEPTABLE_PDX_UNLESS_SEC_DX_IS_PRESENT
- name: sort
in: query
description: Any of these (code,-code,fullDescription,-fullDescription) are allowed values, default
is +code
required: false
schema:
type: array
items:
type: string
default:
- code
- name: page
in: query
required: false
schema:
type: integer
format: int32
default: 1
- name: limit
in: query
required: false
schema:
type: integer
format: int32
default: 250
- name: filter
in: query
required: false
schema:
type: string
- name: yyyy-mm-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-mm-dd
responses:
'200':
description: OK
content:
'*/*':
schema:
$ref: '#/components/schemas/OptumPageImplColorCodes'
security:
- bearerAuth: []
/api/coding/code/{codetype}/color-codes/manifestation/{manifestation-type}:
get:
tags:
- Color codes APIs
summary: 'Fetches manifestation color codes of facility and physician '
operationId: fetchManifestationCodes
parameters:
- name: codetype
in: path
required: true
schema:
type: string
enum:
- i10_cm
- name: manifestation-type
in: path
required: true
schema:
type: string
enum:
- MANIFESTATION_PHYSICIAN
- MANIFESTATION_FACILITY
- name: sort
in: query
description: Any of these (code,-code,effectiveDate,-effectiveDate) are allowed values, default
is +code
required: false
schema:
type: array
items:
type: string
default:
- code
- name: limit
in: query
required: false
schema:
type: integer
format: int32
default: 150
example: 150
- name: page
in: query
required: false
schema:
type: integer
format: int32
default: 1
- name: filter
in: query
required: false
schema:
type: string
- name: yyyy-mm-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-mm-dd
responses:
'200':
description: OK
content:
'*/*':
schema:
$ref: '#/components/schemas/OptumPageImplColorCodes'
security:
- bearerAuth: []
/api/coding/code/{codetype}/color-codes/age/{age-code-type}:
get:
tags:
- Color codes APIs
summary: Fetches I10CM AGE color codes
operationId: getColorCodes
parameters:
- name: codetype
in: path
required: true
schema:
type: string
enum:
- i10_cm
- name: age-code-type
in: path
required: true
schema:
type: string
enum:
- AGE_PEDIATRIC_PHYSICIAN
- AGE_NEWBORN_PHYSICIAN
- AGE_MATERNITY_PHYSICIAN
- AGE_ADULT_PHYSICIAN
- AGE_PEDIATRIC_FACILITY
- AGE_NEWBORN_FACILITY
- AGE_MATERNITY_FACILITY
- AGE_ADULT_FACILITY
- name: sort
in: query
description: Any of these (code,-code,fullDescription,-fullDescription) are allowed values, default
is +code
required: false
schema:
type: array
items:
type: string
default:
- code
- name: page
in: query
required: false
schema:
type: integer
format: int32
default: 1
- name: limit
in: query
required: false
schema:
type: integer
format: int32
default: 250
- name: filter
in: query
required: false
schema:
type: string
- name: yyyy-mm-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-mm-dd
responses:
'200':
description: OK
content:
'*/*':
schema:
$ref: '#/components/schemas/OptumPageImplColorCodes'
security:
- bearerAuth: []
/api/coding/code/{codetype}/{code}/code-notes:
get:
tags:
- Notes Information APIs
summary: ' Fetches CPT or I10CM notes'
operationId: codeNotes
parameters:
- name: codetype
in: path
required: true
schema:
type: string
enum:
- cpt
- i10_cm
- name: code
in: path
description: Code for which code notes is required
required: true
schema:
type: string
example: 29581
- name: yyyy-mm-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-mm-dd
responses:
'200':
description: Returns code notes associated to code
content:
application/json:
example:
notes:
- noteType: CPT Excludes Header
content:
- 'Excludes For treatment in same extremity:'
- noteType: CPT Excludes A
content:
- Excludes Endovenous ablation therapy incompetent vein (36473-36479, [36482, 36483])
- noteType: CPT Excludes A
content:
- Excludes Sclerosal injection for incompetent vein(s) ([36465], [36466], 36468-36471)
- noteType: CPT Excludes A
content:
- Excludes Strapping (29540, 29580)
'400':
description: 'Bad request: No code notes found for this code and codetype'
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
error:
- The code provided '295811' in this web service request is not a valid 'cpt' code.
warning: null
info: null
'500':
description: Internal server error
content:
application/json:
example:
timestamp: '2022-07-06T07:22:01.017+00:00'
path: /api/coding/code/i10_cm/29581/code-notes
status: 500
error: Internal Server Error
requestId: a4796cc7-1
security:
- bearerAuth: []
/api/coding/code/{codetype}/{code}/range-notes:
get:
tags:
- Notes Information APIs
summary: ' Fetches CPT ,I10CM ,I9v1 range notes'
operationId: rangeNotes
parameters:
- name: codetype
in: path
required: true
schema:
type: string
enum:
- cpt
- i9v1
- i10_cm
- name: code
in: path
required: true
schema:
type: string
example: 99213
- name: yyyy-mm-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-mm-dd
responses:
'200':
description: Fetch code range notes
content:
application/json:
example:
notes:
- noteType: INCLUDES
content:
- 'Established patients: received prior professional services from physician or qualified
health care professional or another physician or qualified health care professional
in exact same specialty practice and subspecialty in previous three years (99211-99215)'
- 'New patients: have not received professional services from physician or qualified
health care professional or any other physician or qualified health care professional
in same practice in exact same specialty and subspecialty in previous three years
(99202-99205)'
- Office visits
- Outpatient services (including services prior to formal admission to facility)
- noteType: EXCLUDES
content:
- 'Services provided in:'
-