openapi: 3.2.0 info: title: CMS Common Facility MCE Edits ICD9 and ICD10 API description: MicroService that contains CMS related information contact: name: Ken Kracker email: ken.kracker@optum.com version: v1.0 servers: - url: /v1/cmscommonms tags: - name: MCE Edits ICD9 and ICD10 API paths: /api/cms/facility/{codetype}/mce-edits: get: tags: - MCE Edits ICD9 and ICD10 API summary: Fetches MCE Edits data operationId: fetchMCEEdits parameters: - name: codetype in: path required: true schema: type: string enum: - icd9 - icd10 - name: sort in: query description: Any of these (code,-code) 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: 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 MCE edits data content: application/json: example: content: - code: '3' description: DUPLICATE OF PRINCIPAL DIAGNOSIS definition: Any secondary diagnosis that is the same code as the principal diagnosis is identified as a duplicate because the secondary code may cause an erroneous assignment to an MS-DRG with complications. The contractor will delete the duplicate secondary diagnosis and process the bill. - code: '4' description: AGE CONFLICT definition: This edit identifies inconsistencies between a patient's age and any diagnosis on the patient's record. The diagnosis is considered clinically impossible for a patient in the stated age. Either the diagnosis or the age is considered inaccurate. The contractor will return the claim for correction of this error. associatedCodeLink: value: '4' href: /api/cms/facility/mce/associated-icd9/4 totalCount: 19 '400': description: Bad request content: application/json: schema: $ref: '#/components/schemas/Notification' example: error: - sort parameter value should be from list of [code] warning: null info: null '404': description: Not found content: application/json: schema: $ref: '#/components/schemas/Notification' example: timestamp: '2024-04-12T13:52:54.478+00:00' status: 404 error: Not Found trace: 'org.springframework.web.servlet.resource.NoResourceFoundException: No static resource api/cms/facility/mce-edits.' '500': description: Internal server error content: application/json: example: timestamp: '2024-04-12T13:38:46.141+00:00' status: 500 error: Internal Server Error path: cmscommonms/api/cms/facility/icd10/mce-edits?limit=50&page=1 message: 'java.lang.IllegalArgumentException: Page size must not be less than one' security: - bearerAuth: [] /api/cms/facility/icd9/{code}/mce-edits: get: tags: - MCE Edits ICD9 and ICD10 API summary: Fetches MCE code edits for icd9 codes operationId: getMCEEditsICD9 parameters: - name: code in: path 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: Fetch MCE specific edit ICD9 codes content: application/json: example: - header: This edit detects an OR procedure code description: Valid operating room procedure - A procedure that triggers a change in DRG assignment. - header: This is a postpayment edit that detects a bilateral procedure. description: Bilateral Edit - Due to the lack of laterality in ICD-9-CM there are certain lower extremity joint procedure codes that do not accurately reflect procedures that are performed in one admission on two or more different bilateral joints. This edit identifies procedure codes that when coded twice, represent the same procedure performed on both of the same bilateral joints of the lower extremity. Otherwise, a code edit will instruct the fiscal intermediary to verify that the two different procedures were performed on two different bilateral joints. (MCE Edit 14). '404': description: Not found content: application/json: schema: $ref: '#/components/schemas/Notification' example: timestamp: '2023-07-14T06:37:03.741+00:00' status: 404 error: Not Found message: Not Found path: /cmscommonms/api/cms/facility/icd91/81.51/mce-edits '500': description: Internal server error content: application/json: example: timestamp: '2023-07-13T06:36:22.518+00:00' path: /cmscommonms/api/cms/facility/icd9/81.51/mce-edits status: 500 error: Internal Server Error requestId: e36d239e-324 security: - bearerAuth: [] /api/cms/facility/icd10/{icd10Code}/mce-edits: get: tags: - MCE Edits ICD9 and ICD10 API summary: Fetches MCE Edits data based on icd10code operationId: fetchMCEEditsICD10 parameters: - name: icd10Code in: path required: true schema: type: string - 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: 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 MCE Edits Data based on icd10code content: application/json: example: content: - code: '3' description: DUPLICATE OF PRINCIPAL DIAGNOSIS definition: Any secondary diagnosis that is the same code as the principal diagnosis is identified as a duplicate because the secondary code may cause an erroneous assignment to an MS-DRG with complications. The contractor will delete the duplicate secondary diagnosis and process the bill. - code: '4' description: AGE CONFLICT definition: This edit identifies inconsistencies between a patient's age and any diagnosis on the patient's record. The diagnosis is considered clinically impossible for a patient in the stated age. Either the diagnosis or the age is considered inaccurate. The contractor will return the claim for correction of this error. associatedCodeLink: value: '4' href: /api/cms/facility/mce/associated-icd9/4 totalCount: 19 '404': description: Not found content: application/json: schema: $ref: '#/components/schemas/Notification' example: timestamp: '2024-04-12T13:52:54.478+00:00' status: 404 error: Not Found path: /cmscommonms/api/cms/facility/icd1/02BK0ZZ/mce-edits '500': description: Internal server error content: application/json: example: timestamp: '2024-04-12T13:38:46.141+00:00' status: 500 error: Internal Server Error path: cmscommonms/api/cms/facility/icd10/02BK0ZZ/mce-edits?limit=0&page=1 message: 'java.lang.IllegalArgumentException: Page size must not be less than one' security: - bearerAuth: [] components: schemas: Notification: type: object properties: error: type: array items: type: string warning: type: array items: type: string info: type: array items: type: string securitySchemes: bearerAuth: type: http scheme: bearer bearerFormat: JWT x-readme: explorer-enabled: true proxy-enabled: true