openapi: 3.0.1 info: title: Optum Real-Time eContent Web services description: Optum® Real-Time eContent web services provides access to both ondemand medical coding data and Optum coding tool logic required by your applications. The information you or your clients need is delivered to your application in real time, when you need it, and customized to how you want it displayed. Optum Real-Time eContent service provides access to the content of 37 printed coding resources and proprietary data and offers the power of the Optum CodeLogic™ search engine. contact: name: Ken Kracker email: ken.kracker@optum.com version: 1.0.0 servers: - url: sandbox-apigw.optum.com/ci/rtec/v1/ws security: - bearerAuth: [] paths: /codetype/{codetype}/{code}/anesbaseunit: get: tags: - Code Information summary: Return base units for the given CPT Anesthesia {code} operationId: getAnesBaseUnit parameters: - name: codetype in: path description: The codetype needed to identify the type of code required: true schema: type: string enum: - cpt - name: code in: path description: The code value for the respective codetype required: true schema: type: string example: '00100' responses: '200': description: Successful Response content: application/json: schema: $ref: '#/components/schemas/Items' example: item: - '5' '400': description: Bad Request content: application/json: schema: $ref: '#/components/schemas/Items' example: error: - The code provided ('A0021') in this web service request is not a valid 'cpt' code. warning: [] info: [] '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: Not Found - the data was not found content: application/json: example: error: - The requested resource does not exist. warning: [] info: [] '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /codetype/{codetype}/{code}/{facNonFac}: get: tags: - Code Information summary: Return code range operationId: getColumnCci parameters: - name: code in: path description: The code for which you want CCI data required: true schema: type: string example: 13100 - name: codetype in: path description: The codetype needed to identify the type of code required: true schema: type: string enum: - cpt - hcpcs - name: facNonFac in: path description: One of required: true schema: type: string enum: - facility-cci - non-facility-cci - name: data in: query description: 'Comma seperated list of' schema: type: string example: reason,modifier-allowed - name: types in: query description: 'Comma seperated list of' schema: type: string default: cci-all example: cci-all,cci-column2,cci-column1 responses: '200': description: Successful Response content: application/json: schema: $ref: '#/components/schemas/Cci' example: cciColumn2: - code: 0213T href: /ws/codetype/cpt/0213T - code: 0216T href: /ws/codetype/cpt/0216T cciColumn1: [] '400': description: Unknown data element content: application/json: schema: $ref: '#/components/schemas/Cci' example: error: - 'Unknown data element : bad' warning: [] info: [] '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: Code does not exist content: application/json: schema: $ref: '#/components/schemas/Cci' example: error: - Code '13104' does not exist warning: [] info: [] '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /codetype/{codetype}/{code}/cdi: get: tags: - CDI Information summary: Return the list of CDI documents for the given code operationId: getCDICodeLinks parameters: - name: codetype in: path description: The codetype needed to identify the type of code required: true schema: type: string enum: - cpt - hcpcs - icd9v1 - icd9v3 - icd10cm - icd10pcs - name: code in: path description: The code value required: true schema: type: string example: 99213 - name: data in: query description: associatedcodes indicates will include a comma separated list of Codes associated to CDI. schema: type: string responses: '200': description: Successful Response content: application/json: schema: $ref: '#/components/schemas/Cdi' example: cdiDoc: - url: /documents/550392 pdftitle: 'Lower Extremity Endovascular Revascularization:' sourcetitle: Facility Documentation Improvement Instructions - url: /documents/59046 pdftitle: Percutaneous Coronary Interventions (PTCA and Atherectomy, with or without Stent Placement) sourcetitle: Facility Documentation Improvement Instructions '400': description: Wrong CodeType content: application/json: schema: $ref: '#/components/schemas/Cdi' example: error: - The code provided ('0019T') in this web service request is not a valid 'hcpcs' code. warning: [] info: [] '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: CDI Document not found content: application/json: schema: $ref: '#/components/schemas/Cdi' example: error: [] warning: [] info: - CDI Document not found for the code entered. '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /documents/{docId}: get: tags: - CDI and Coding Support PDF Information summary: Return the CDI and Coding Support PDF Document operationId: getCDIPDF parameters: - name: docId in: path description: The Document Id (max 6 chars) required: true schema: type: integer format: int32 example: 470866 responses: '200': description: Successful Response content: application/pdf: schema: type: string '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: CDI or Coding Support PDF Document not found content: application/pdf: schema: type: string example: CDI or Coding Support PDF Document not found '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /icd10physdoc/{docId}: get: tags: - CDI Information summary: Return the ICD10 Physician CDI PDF Document operationId: getCDIPDF_1 parameters: - name: docId in: path description: The Document Id (max 3 chars) required: true schema: type: integer format: int32 example: 638 responses: '200': description: Successful Response content: application/pdf: schema: type: string '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: CDI Document not found content: application/pdf: schema: type: string example: CDI Document not found '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /claims5x: get: tags: - Claim Review summary: Get Claims Information operationId: getClaims responses: '200': description: Successful Response content: application/xml: schema: type: string example: "\n\n \n \ \ \n 2009-07-16\n\ \ E10.9\n E10.19\n\ \ 21\n 51\n 13100\n\ \ \n \n 2009-07-16\n\ \ E10.9\n 250.01\n\ \ 21\n 51\n 13100\n\ \ 11\n 1\n \n\ \ 2009-07-16\n 2009-07-16\n\ \ M\n 10102\n 208600000X\n\ \ \n" '401': description: Not Authorised content: application/json: schema: $ref: '#/components/schemas/ClaimResponses' example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 post: tags: - Claim Review summary: Get Claims Responses operationId: process requestBody: description: Term Search Request. content: application/xml: schema: $ref: '#/components/schemas/ClaimResponses' examples: Claim Request: description: Claim Request value: "\n\n \n \ \ \n 2009-07-16\n\ \ E10.9\n E10.19\n\ \ 21\n 51\n 13100\n\ \ \n \n 2009-07-16\n\ \ E10.9\n 250.01\n\ \ 21\n 51\n 13100\n\ \ 11\n 1\n \n\ \ 2009-07-16\n 2009-07-16\n\ \ M\n 10102\n 208600000X\n\ \ \n" required: true responses: '200': description: Successful Response content: application/json: schema: $ref: '#/components/schemas/ClaimResponses' example: claimResponse: - edit: - description: '[Pattern 8400] The diagnosis code(s) E1019 and E109 are invalid.' editConflict: Invalid Diagnosis Code editType: Review mnemonic: ICD line: 1 - description: '[Pattern 13248] The modifier code(s) 21 are invalid.' editConflict: Invalid Modifier editType: Review mnemonic: IMO line: 1 - description: '[Pattern 8400] The diagnosis code(s) 25001 and E109 are invalid.' editConflict: Invalid Diagnosis Code editType: Review mnemonic: ICD line: 2 - description: '[Pattern 13248] The modifier code(s) 21 are invalid.' editConflict: Invalid Modifier editType: Review mnemonic: IMO line: 2 claimId: '1' '400': description: Bad Request content: application/json: schema: $ref: '#/components/schemas/ClaimResponses' example: "\n\n\ \ Unexpected close tag </servce-date>; expected </service-date>.\n\ \ at [row,col {unknown-source}]: [48,41]\n" '401': description: Not Authorised content: application/json: schema: $ref: '#/components/schemas/ClaimResponses' example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 /codetype/{codetype}/{code}/codehistory: get: tags: - Code Information summary: Return Code History for the given cpt/hcpcs/icd9v3/icd9v1/icd10cm/icd10pcs {code} operationId: getCodehistory parameters: - name: codetype in: path description: The codetype needed to identify the type of code required: true schema: type: string enum: - cpt - hcpcs - icd9v1 - icd9v3 - icd10cm - icd10pcs - name: code in: path description: The code for which you want CCI data required: true schema: type: string example: 99213 - name: yyyy-mm-dd in: header description: Historical Application Content(HAC) is not applicable here. This Code history webservice accepts Current date or future date only. For Current date, date is optional. For Future date, date must be provided schema: type: string responses: '200': description: Successful Response content: application/json: schema: $ref: '#/components/schemas/CompleteCodeHistory' example: codeHistory: - changeEffectiveDate: 01/01/2021 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 codeHistoryReferences: {} '400': description: Wrong codetype content: application/json: schema: $ref: '#/components/schemas/CompleteCodeHistory' example: error: - The code provided ('250.0') in this web service request is not a valid 'cpt' code. warning: [] info: [] '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: Code does not exist content: application/json: schema: $ref: '#/components/schemas/CompleteCodeHistory' example: error: - Code '13108' does not exist warning: [] info: [] '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /codetype/{codetype}/{code}/properties: get: tags: - Code Information summary: Show properties for the given {codetype} and {code} parameter operationId: getProperty parameters: - name: codetype in: path description: The codetype needed to identify the type of code required: true schema: type: string enum: - cpt - hcpcs - icd9v1 - icd9v3 - icd10cm - icd10pcs - name: code in: path description: The code to search required: true schema: type: string example: 99213 - name: yyyy-mm-dd in: header description: The Properties webservice accepts Current date or future date only. For Current date, date is optional. For Future date, date must be provided schema: type: string - name: data in: query description: 'Comma seperated list of any of the following

' schema: type: string default: desc-full example: desc-full responses: '200': description: Successful Response content: application/json: schema: $ref: '#/components/schemas/CodeProperties' example: descFull: Central Nervous System and Cranial Nerves, Bypass '400': description: Wrong CodeType content: application/json: schema: $ref: '#/components/schemas/CodeProperties' example: error: - Bad data parameter 'bad' warning: [] info: [] '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: Code does not exist content: application/json: schema: $ref: '#/components/schemas/CodeProperties' example: error: - Code '13104' does not exist warning: [] info: [] '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /codetype/cpt/{code}/color-codes: get: tags: - Color Codes summary: Show Color Codes for the given CPT code operationId: getColorCodes parameters: - name: code in: path description: The code value required: true schema: type: string example: 13100 - name: data in: query description: desc schema: type: string responses: '200': description: Successful Response content: application/json: schema: $ref: '#/components/schemas/ColorCodes' example: modifier51Exempt: [] ascPaymentIndicator: ' A2' ascPaymentIndicatorDescription: ' Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight.' medicalUnlikelyEdits: '1' opsiCode: ' T' mulitplePxReductionGuidelinesApply: '' '400': description: Wrong CodeType content: application/json: schema: $ref: '#/components/schemas/ColorCodes' example: error: - The code provided ('250.02') in this web service request is not a valid 'cpt' code. warning: [] info: [] '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: Code does not exist content: application/json: schema: $ref: '#/components/schemas/ColorCodes' example: error: - Code 13104 does not exist warning: [] info: [] '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /codetype/{codetype}/{code}/{crosscodetype}: get: tags: - OPPS CrossCode Code summary: Show OPPS CrossCode for the Code operationId: getOPPSCrossCode parameters: - name: codetype in: path description: The codetype needed to identify the type of code required: true schema: type: string enum: - cpt - hcpcs - name: code in: path description: The code for which you want OPPS crosscode required: true schema: type: string - name: crosscodetype in: path description: The cross-code for the given codetype required: true schema: type: string example: icd9v1 responses: '200': description: Successful Response content: application/json: schema: $ref: '#/components/schemas/OPPSCrossCode' example: "{\n \"oppscrosscode\": [\n {\n \"Code\": 27096,\n \"Description\"\ : \"Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance\ \ (fluoroscopy or CT) including arthrography when performed,\"\n \"Reference\ \ Cross Code\": G0259,G0260,\n \"Effective Date\": \"\x01/01/2000\"\n \ \ }\n ]\n}" '400': description: Bad data parameter content: application/json: schema: $ref: '#/components/schemas/OPPSCrossCode' example: error: - Bad data parameter 'bad' warning: [] info: [] '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: OPPS crosscode was not found content: application/json: schema: $ref: '#/components/schemas/OPPSCrossCode' example: error: [] warning: [] info: - OPPS crosscode was not found. '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /codetype/hcpcs/{code}/color-codes: get: tags: - Color Codes summary: Show Color Codes for the given HCPCS code operationId: getColorCodes_1 parameters: - name: code in: path description: The code value required: true schema: type: string example: A0080 - name: data in: query description: desc schema: type: string responses: '200': description: Successful Response content: application/json: schema: $ref: '#/components/schemas/ColorCodes' example: modifier51Exempt: [] ascPaymentIndicator: ' IC' ascPaymentIndicatorDescription: ' Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight.' medicalUnlikelyEdits: '0' opsiCode: ' E1' notCoveredOrValidForMedicare: 01/01/2007 '400': description: Wrong CodeType content: application/json: schema: $ref: '#/components/schemas/ColorCodes' example: error: - The code provided ('250.02') in this web service request is not a valid 'hcpcs' code. warning: [] info: [] '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: Code does not exist content: application/json: schema: $ref: '#/components/schemas/ColorCodes' example: error: - Code A0000 does not exist warning: [] info: [] '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /codetype/icd10cm/{code}/color-codes: get: tags: - Color Codes summary: Show Color Codes for the given ICD10CM code operationId: getColorCodes_2 parameters: - name: code in: path description: The code value required: true schema: type: string example: S82.91XB responses: '200': description: Successful Response content: application/json: schema: $ref: '#/components/schemas/Icd10CmColorCodes' example: unspecifiedDiagnosisCode: OP comorbidityOrComplication: IP hospitalAcquiredCondition: - 'HAC 05: Falls and trauma (secondary diagnosis)' conditionalHospitalAcquiredCondition: [] '400': description: Wrong CodeType content: application/json: schema: $ref: '#/components/schemas/Icd10CmColorCodes' example: error: - The code provided ('13100') in this web service request is not a valid 'icd10cm' code. warning: [] info: [] '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: Code does not exist content: application/json: schema: $ref: '#/components/schemas/Icd10CmColorCodes' example: error: - ICD-10-CM code 'F90.7' not found warning: [] info: [] '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /codetype/icd10pcs/{code}/color-codes: get: tags: - Color Codes summary: Show Color Codes for the given ICD10PCS code operationId: getColorCodes_3 parameters: - name: code in: path description: The code value required: true schema: type: string example: 04LE0CV responses: '200': description: Successful Response content: application/json: schema: $ref: '#/components/schemas/Icd10pcsColorCodes' example: '{ "mappingToIcd9Code": "OP", "procedureInconsistentLOS": "IP", } ' '400': description: Wrong CodeType content: application/json: schema: $ref: '#/components/schemas/Icd10pcsColorCodes' example: error: - The code provided ('13100') in this web service request is not a valid 'icd10pcs' code. warning: [] info: [] '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: Code does not exist content: application/json: schema: $ref: '#/components/schemas/Icd10pcsColorCodes' example: error: - ICD-10-PCS code 'F90.7' not found warning: [] info: [] '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /codetype/icd9v1/{code}/color-codes: get: tags: - Color Codes summary: Show Color Codes for the given ICD9V1 code operationId: getColorCodes_4 parameters: - name: code in: path description: The code value required: true schema: type: string example: 253.1 responses: '200': description: Successful Response content: application/json: schema: $ref: '#/components/schemas/ColorCodes' example: modifier51Exempt: [] unspecifiedDiagnosisCode: OP otherSpecifiedDiagnosisCode: OP comorbidityOrComplication: IP '400': description: Wrong CodeType content: application/json: schema: $ref: '#/components/schemas/ColorCodes' example: error: - The code provided ('13100') in this web service request is not a valid 'icd9v1' code. warning: [] info: [] '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: Code does not exist content: application/json: schema: $ref: '#/components/schemas/ColorCodes' example: error: - CPT code '000.1' not found warning: [] info: [] '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /codetype/{codetype}/{code}/images: get: tags: - Code Information summary: Return image filename(s) for the given code {code} operationId: getCodeImageLinks parameters: - name: codetype in: path description: The codetype needed to identify the type of code required: true schema: type: string enum: - cpt - hcpcs - icd9v1 - icd9v3 - name: code in: path description: The code for which you want Image data required: true schema: type: string example: 61885 responses: '200': description: Successful Response content: application/json: schema: type: array items: $ref: '#/components/schemas/Link' example: - href: /ws/codetype/cpt/61885/images/61885-61886 ATNN.jpg value: '' '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: Not Found - the data was not found content: application/json: example: error: - The requested resource does not exist. warning: [] info: [] '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /codetype/{codetype}/{code}/images/{filename}: get: tags: - Code Information summary: Return image(s) for the given code {code} operationId: getImage parameters: - name: filename in: path description: The File Name required: true schema: type: string default: 61885-61886 ATNN.jpg - name: codetype in: path description: The codetype needed to identify the type of code required: true schema: type: string enum: - cpt - hcpcs - icd9v1 - icd9v3 - name: code in: path description: The code value required: true schema: type: string example: 61885 responses: '200': description: Successful Response content: image/*: schema: $ref: '#/components/schemas/Response' example: default image response '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: Not Found - the data was not found content: application/json: example: error: - The requested resource does not exist. warning: [] info: [] '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /codetype/icd10cm/{code}/code-specific-guidelines: get: tags: - Code Specific Guidelines summary: Show Color Codes for the given ICD10CM code operationId: getCodeSpecificGuidelines parameters: - name: code in: path description: The code value required: true schema: type: string example: A00.1 responses: '200': description: Successful Response content: application/json: schema: $ref: '#/components/schemas/Icd10CmColorCodes' example: "{\n \"mappingToIcd9Code\": \"OP\",\n \"procedureInconsistentLOS\": \"\ IP\",\n }\n" '400': description: Wrong CodeType content: application/json: schema: $ref: '#/components/schemas/Icd10CmColorCodes' example: error: - The code provided ('13100') in this web service request is not a valid 'icd10pcs' code. warning: [] info: [] '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: Code does not exist content: application/json: schema: $ref: '#/components/schemas/Icd10CmColorCodes' example: error: - ICD-10-PCS code 'F90.7' not found warning: [] info: [] '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /codetype/icd10pcs/{code}/code-specific-guidelines: get: tags: - Code Specific Guidelines summary: Show Code Specific Guidelines for the given ICD10PCS code operationId: getCodeSpecificGuidelines_1 parameters: - name: code in: path description: The code value required: true schema: type: string example: D0001ZZ responses: '200': description: Successful Response content: application/json: schema: $ref: '#/components/schemas/Icd10pcsCodeSpecificGuidelines' example: '{ "mappingToIcd9Code": "OP", "procedureInconsistentLOS": "IP", } ' '400': description: Wrong CodeType content: application/json: schema: $ref: '#/components/schemas/Icd10pcsCodeSpecificGuidelines' example: error: - The code provided ('13100') in this web service request is not a valid 'icd10pcs' code. warning: [] info: [] '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: Code does not exist content: application/json: schema: $ref: '#/components/schemas/Icd10pcsCodeSpecificGuidelines' example: error: - ICD-10-PCS code 'F90.7' not found warning: [] info: [] '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /codetype/{codetype}/{code}: get: tags: - Code Information summary: Return links to all the information available about a given 'code' belonging to the given 'codetype' operationId: getProperties parameters: - name: codetype in: path description: The codetype needed to identify the type of code required: true schema: type: string enum: - cpt - hcpcs - icd9v1 - icd9v3 - icd10cm - icd10pcs - name: code in: path description: The code value for the respective codetype required: true schema: type: string example: 13100 responses: '200': description: Successful Response - code 13100 , type - cpt content: application/json: schema: type: array items: $ref: '#/components/schemas/Link' example: - href: /ws/codetype/cpt/13100/icd9v3 value: icd9v3 crosscodes - href: /ws/codetype/cpt/13100/icd9v1 value: icd9v1 crosscodes - href: /ws/codetype/cpt/13100/icd10cm value: icd10cm crosscodes - href: /ws/codetype/cpt/13100/icd10pcs value: icd10pcs crosscodes '400': description: Wrong Code Type content: application/json: schema: type: array items: $ref: '#/components/schemas/Link' example: error: - The code provided ('250.02') in this web service request is not a valid 'cpt' code. warning: [] info: [] '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: Not Found - the data was not found content: application/json: example: error: - The requested resource does not exist. warning: [] info: [] '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /codetype/{codetype}: get: tags: - Reference Code summary: Return the first 100 codes for the given 'codetype' parameter operationId: getCodes parameters: - name: codetype in: path description: The codetype needed to identify the type of code required: true schema: type: string enum: - cpt - hcpcs - icd9v1 - icd9v3 - icd10cm - icd10pcs - name: start in: query description: The starting index for code list schema: type: integer format: int32 default: 0 responses: '200': description: Successful Response - codetype - cpt content: application/json: schema: type: array items: $ref: '#/components/schemas/Link' example: - href: /ws/codetype/cpt/0001A value: 0001A - href: /ws/codetype/cpt/0001F value: 0001F '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: Not Found - the data was not found content: application/json: example: error: - The requested resource does not exist. warning: [] info: [] '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /codetype: get: tags: - Code Information summary: Show HyperLinks to valid code types operationId: getCodeTypes responses: '200': description: Successful Response content: application/json: schema: type: array items: $ref: '#/components/schemas/Link' example: - href: /ws/codetype/icd9v3 value: icd9v3 - href: /ws/codetype/icd9v1 value: icd9v1 '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: Not Found - the data was not found content: application/json: example: error: - The requested resource does not exist. warning: [] info: [] '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /codetype/{codetype}/indexsearch/{terms}: get: tags: - Code Information summary: Return Index search results operationId: indexSearchResults parameters: - name: codetype in: path description: The codetype needed to identify the type of code required: true schema: type: string enum: - cpt - hcpcs - icd9v1 - icd9v3 - icd10cm - name: terms in: path description: Search Term (Starts with Character) to provide results required: true schema: pattern: '[^/]+' type: string example: reduction - name: maxresults in: query description: The number of rows be returned schema: type: integer format: int32 default: 100 responses: '200': description: Successful Response content: application/json: schema: $ref: '#/components/schemas/IndexSearchResults' example: indexSearchResult: - term: Reduction level: 1 - term: Blood Volume level: 2 codes: '86960' '400': description: The search term can contain maximum of 62 characters content: application/json: schema: $ref: '#/components/schemas/IndexSearchResults' example: error: - The search term can contain maximum of 62 characters. warning: [] info: [] '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: No search results found content: application/json: schema: $ref: '#/components/schemas/IndexSearchResults' example: error: [] warning: [] info: - No search results found for the term 'xyzfgdf' entered. '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /codetype/{codetype}/{code}/range: get: tags: - Reference Code summary: Return code range operationId: findRange parameters: - name: codetype in: path description: The codetype needed to identify the type of code required: true schema: type: string enum: - cpt - hcpcs - icd9v1 - icd9v3 - icd10cm - icd10pcs - name: code in: path description: Code to find the range required: true schema: pattern: '[^/]+' type: string example: 99213 - name: rangeId in: query description: 'Internal use: used for finding next/previous range' schema: type: integer format: int32 example: 1 - name: direction in: query description: 'Internal use: one of' schema: type: string example: next - name: data in: query description: 'Comma seperated list of any of the following' schema: type: string default: desc-full example: desc-full - name: yyyy-mm-dd in: header description: Historical Application Content(HAC) is not applicable here. This RangeResource webservice accepts Current or Future date only. For Current date, date is optional. For Future date, date must be provided schema: type: string responses: '200': description: Successful Response content: application/json: schema: $ref: '#/components/schemas/CodeRange' example: rangeId: 1 rangeItem: - code: '99202' description: 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. href: /ws/codetype/cpt/99202 - code: '99203' description: 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. href: /ws/codetype/cpt/99203 link: - href: /ws/codetype/cpt/99202/range?rangeId=1&direction=next&data=desc-full value: Next '400': description: Not a valid 'codetype' code content: application/json: schema: $ref: '#/components/schemas/CodeRange' example: error: - The code provided ('250.02') in this web service request is not a valid 'cpt' code. warning: [] info: [] '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: Not Found - the data was not found content: application/json: example: error: - The requested resource does not exist. warning: [] info: [] '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /codetype/{codetype}/termsearch/{terms}: get: tags: - Reference Code summary: Return codes that match given terms sorted by ranking operationId: termSearch parameters: - name: codetype in: path description: The codetype needed to identify the type of code required: true schema: type: string enum: - cpt - hcpcs - icd9v1 - icd9v3 - icd10cm - icd10pcs - all - name: terms in: path description: Terms to search for required: true schema: pattern: '[^/]+' type: string example: conjunctivitis - name: data in: query description: 'Comma seperated list of' schema: type: string example: desc,rank,desc-full - name: start in: query description: The zero relative row to start at schema: type: integer format: int32 default: 0 - name: maxresults in: query description: The number of rows be returned schema: type: integer format: int32 default: 100 - name: suggest in: query description: 'Suggest alternate spellings? : true/false' schema: type: boolean default: false responses: '200': description: Successful Response content: application/json: schema: $ref: '#/components/schemas/TermSearchResults' example: termSearchResult: - code: H10.89 rank: 6081463 href: /ws/codetype/icd10cm/H10.89 codeType: 16384 - code: H10.9 rank: 6076765 href: /ws/codetype/icd10cm/H10.9 codeType: 16384 link: [] '300': description: Multiple Choices content: application/json: schema: $ref: '#/components/schemas/TermSearchResults' example: target: - choice: - BROKEN - BRAKING - PROKINOGENASE - PROGEN - BARKAN'S - PREGNACY - PRKNS - BARKING input: BRIKEN - choice: - CHEST - CHEST4 - CHESTER - CHESTERMANI - SCHISTOCELIA - SCHISTOGLOSSIA - SCHISTOSOMA - SCHISTOSOME - SCHISTOSOMAL - SCHISTOSOMES - SCHISTOSOMIASIS - SCHIZOTHYMIA - SCHIZOTYPAL - SCHIZOID - SCHIZODONTIA input: CHIST '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: Not Found - the data was not found content: application/json: example: error: - The requested resource does not exist. warning: [] info: [] '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /codetype/{codetype}/termsearchgroups/{terms}: get: tags: - Reference Code summary: Return the terms by ranking for all the available code types operationId: termSearchGroups parameters: - name: codetype in: path description: The codetype needed to identify the type of code required: true schema: type: string enum: - cpt - hcpcs - icd9v1 - icd9v3 - icd10cm - icd10pcs - all - name: terms in: path description: Terms to search for required: true schema: pattern: '[^/]+' type: string example: conjunctivitis - name: data in: query description: 'Comma seperated list of' schema: type: string example: rank,desc,desc-full - name: maxresults in: query description: The number of results to be returned schema: type: string default: '100' - name: yyyy-mm-dd in: header description: Historical Application Content(HAC) is not applicable here. This Term Search Group webservice accepts Current or Future date only. For Current date, date is optional. For Future date, date must be provided schema: type: string responses: '200': description: Successful Response content: application/json: schema: $ref: '#/components/schemas/TermSearchGroups' example: termSearchGroup: - node: - node: [] code: V74.4 rank: 5050897 hrefBeg: /ws/codetype/icd9v1/V74.4 code: V74 rank: 5050897 hrefBeg: /ws/codetype/icd9v1/V74 - node: - node: [] code: '130.1' rank: 5028176 hrefBeg: /ws/codetype/icd9v1/130.1 code: '130' rank: 5028176 hrefBeg: /ws/codetype/icd9v1/130 '300': description: Multiple Choices content: application/json: schema: $ref: '#/components/schemas/TermSearchGroups' example: target: - choice: - BROKEN - BRAKING - PROKINOGENASE - PROGEN - BARKAN'S - PREGNACY input: BRIKEN - choice: - CHEST - CHEST4 - CHESTER - CHESTERMANI - SCHISTOCELIA - SCHISTOGLOSSIA - SCHISTOSOMA - SCHISTOSOME - SCHISTOSOMAL - SCHISTOSOMES - SCHISTOSOMIASIS - SCHIZOTHYMIA - SCHIZOTYPAL - SCHIZOID - SCHIZODONTIA input: CHIST '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: Not Found - the data was not found content: application/json: example: error: - The requested resource does not exist. warning: [] info: [] '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /codetype/{codetype}/{code}/coding-support: get: tags: - Coding Support summary: Show E&M Coding Assitant or Auditors Desk Reference documents operationId: getDocuments parameters: - name: code in: path description: The code value required: true schema: type: string example: 13100 - name: codetype in: path description: The code value required: true schema: type: string enum: - cpt responses: '200': description: Successful Response content: application/json: schema: $ref: '#/components/schemas/CodingSupportResources' example: "{\n\n \"code\": \"99213\",\n\n \"referenced_document_type\"\ : \"Evaluation and Management Coding Assistant\",\n\n \"title\": \"Chapter\ \ 6: Office or Other Outpatient Services\",\n\n \"referenced_content_example\"\ : \"Medically appropriate 10 min. 99213 Low Medically appropriate Medically appropriate\ \ 20 min. 99214 Moderate Optum360, LLC CPT © 2023 American Medical Association. All\ \ Rights Reserved. 75 99213 DOCUMENTATION Medical Association. All Rights Reserved. Sample\ \ Documentation-99213 S: A 59-year-old male to Low MDM and code 99213. • Final E/M\ \ Level of Service: CPT code 99213 is assigned. Level III\",\n\n \"document\"\ : \"documents/506800\",\n\n}" '400': description: Bad data parameter content: application/json: schema: $ref: '#/components/schemas/CodingSupportResources' example: error: - Bad data parameter 'bad' warning: [] info: [] '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: No E&M or auditor desk reference doucuments were found content: application/json: schema: $ref: '#/components/schemas/CodingSupportResources' example: error: [] warning: [] info: - No E&M or auditor desk reference doucuments were found. '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /contractors: get: tags: - LCD summary: List of medicare contractors who have policies operationId: getContractors parameters: - name: contractor-type in: query description: 'Comma seperated list of ' schema: type: string default: CA,FI,MA,MB - name: contractor-part in: query description: 'Comma seperated list of ' schema: type: string default: A,B - name: region-code in: query description: The region code for policies schema: type: string default: ALL responses: '200': description: Successful Response content: application/json: schema: $ref: '#/components/schemas/ContractorList' example: contractor: - regionCode: AK regionName: Alaska contractorName: BlueCross BlueShield of Tennessee (Riverbend Government Benefits Administrator) contractorPart: A contractorType: FI contractorNumber: 00390 - regionCode: AK regionName: Alaska contractorName: Noridian Administrative Services contractorPart: A contractorType: FI contractorNumber: '00322' '400': description: Not a valid 'codetype' code content: application/json: schema: $ref: '#/components/schemas/ContractorList' example: error: - Invalid value 'X' for parameter 'contractor-part'. Valid values are a comma seperated list of ALL,A,B,DME,HM,MP,NR,PI,RI warning: [] info: [] '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: Not Found - the data was not found content: application/json: example: error: - The requested resource does not exist. warning: [] info: [] '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /contractors/{contractorNum}/policies: get: tags: - LCD summary: Policies of a Medicare Contractor operationId: getPolicies parameters: - name: contractorNum in: path description: The Contractor number (max 5 chars) required: true schema: type: string example: '04111' - name: cms-id in: query description: The CMS Policy ID (Max 10 characters) schema: type: string - name: contractor-part in: query description: 'Comma seperated list of ' schema: type: string default: ALL example: ALL - name: contractor-type in: query description: 'Comma seperated list of ' schema: type: string default: ALL example: ALL responses: '200': description: Successful Response content: application/json: schema: $ref: '#/components/schemas/ContractorPolicies' example: policy: - title: 'Billing and Coding: Acute Care: Inpatient, Observation and Treatment Room Services' effectiveDate: '2015-10-01T00:00:00.000Z' url: https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=52985&ver=44&bc=0 cmsId: A52985 contractorNum: '04111' contractorPart: A contractorType: MA - title: 'Billing and Coding: Information Regarding Uses, Including Off-Label Uses, of Anti-Vascular Endothelial Growth Factor (anti-VEGF), for The Treatment of Ophthalmological Diseases' effectiveDate: '2016-07-11T00:00:00.000Z' url: https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=53121&ver=35&bc=0 cmsId: A53121 contractorNum: '04111' contractorPart: A contractorType: MA '400': description: ContractorNum is larger than 5 characters content: application/json: schema: $ref: '#/components/schemas/ContractorPolicies' example: error: - ContractorNum is larger than 5 characters warning: [] info: [] '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: Not Found - the data was not found content: application/json: example: error: - The requested resource does not exist. warning: [] info: [] '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /contractors/{contractorNum}/policy/{cmspolicyid}: get: tags: - LCD summary: Medicare Policiy Details operationId: getPolicyDetails parameters: - name: contractorNum in: path description: The Contractor number (max 5 chars) required: true schema: type: string example: '04111' - name: cmspolicyid in: path description: The CMS Policy ID (Max 10 characters) required: true schema: type: string example: A52985 - name: categories in: query description: 'Comma seperated list of ' schema: type: string default: all example: all - name: icdtypes in: query description: 'Comma seperated list of ' schema: type: string default: all example: all - name: maxproc in: query description: The maximum number of procedure codes to be returned schema: type: integer format: int32 default: 200 - name: maxcov in: query description: The maximum number of diagnostic codes to be returned under 'covered' for ncd policies schema: type: integer format: int32 default: 200 - name: maxnots in: query description: The maximum number of diagnostic codes to be returned under 'not-supporting-medical-necessity' for ncd/lcd policies schema: type: integer format: int32 default: 200 - name: maxdeny in: query description: The maximum number of diagnostic codes to be returned under 'denied' schema: type: integer format: int32 default: 200 - name: maxtob in: query description: The maximum number of codes to be returned under 'type-of-bill-codes' for lcd policies schema: type: integer format: int32 default: 200 - name: maxrev in: query description: The maximum number of codes to be returned under 'revenue-codes for lcd policies' schema: type: integer format: int32 default: 200 - name: maxsupp in: query description: The maximum number of diagnostic codes to be returned under 'supporting-medical-necessity' for lcd policies schema: type: integer format: int32 default: 200 - name: contractor-part in: query description: 'Comma seperated list of ' schema: type: string default: ALL example: ALL - name: contractor-type in: query description: 'Comma seperated list of ' schema: type: string default: ALL example: ALL responses: '200': description: Successful Response content: application/json: schema: $ref: '#/components/schemas/ContractorPolicyDetails' example: policyInfo: title: NCD for Injection Sclerotherapy for Esophageal Variceal Bleeding (100.10) effectiveDate: '1984-10-29T00:00:00.000Z' url: http://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?ncdid=95&ver=1 contractorNum: '0' cmsId: '100.10' contractorPart: A contractorType: NA icpPolicyId: 258971 policyType: NCD ncdCodingInformation: procedureCodes: codeInfo: - code: '43204' description: Esophagoscopy, flexible, transoral; with injection sclerosis of esophageal varices type: cpt - code: '43243' description: Esophagogastroduodenoscopy, flexible, transoral; with injection sclerosis of esophageal/gastric varices type: cpt numcodes: 2 toomanycodes: false diagnosticCodes: covered: codeInfo: [] denied: codeInfo: [] notSupportingMedicalNecessity: codeInfo: [] '400': description: ContractorNum is larger than 5 characters content: application/json: schema: $ref: '#/components/schemas/ContractorPolicyDetails' example: error: - ContractorNum is larger than 5 characters warning: [] info: [] '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: Policy 'A9999' does not exist for Contractor '%04111' content: application/json: schema: $ref: '#/components/schemas/ContractorPolicyDetails' example: error: - Policy 'A9999' does not exist for Contractor '04111' warning: [] info: [] '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /contractors/regions: get: tags: - LCD summary: Medicare contractor region list operationId: getRegions responses: '200': description: Successful Response content: application/json: schema: $ref: '#/components/schemas/Regions' example: region: - value: Alaska regionCode: AK - value: Alabama regionCode: AL '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: Not Found - the data was not found content: application/json: example: error: - The requested resource does not exist. warning: [] info: [] '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /datafile/list: get: tags: - Data File summary: Data File List operationId: getDatafileList responses: '200': description: Successful Response content: application/json: schema: type: array items: $ref: '#/components/schemas/Link' example: - href: /ws/datafile/file/optum_cpc_base_2017_07 value: OPTUM_CPC_BASE_2017_07, Effective on 04/01/2018 - href: /ws/datafile/file/optum_cpc_base_2017_10_update value: OPTUM_CPC_BASE_2017_10_update, Effective on 04/01/2018 '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: Not Found - the data was not found content: application/json: example: error: - The requested resource does not exist. warning: [] info: [] '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /datafile/file/{fileReqName}: get: tags: - Data File summary: Data File operationId: getFile parameters: - name: fileReqName in: path description: The name of the file required: true schema: type: string example: optum_cpc_base_2017_07 - name: If-Modified-Since in: header description: The date last modified schema: type: string responses: '200': description: Successful Response content: application/octet-stream: schema: $ref: '#/components/schemas/Response' example: default response '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: Not Found - the data was not found content: application/json: example: error: - The requested resource does not exist. warning: [] info: [] '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /dictionary/coders/{startswith}: get: tags: - Code Information summary: Optum Coders Dictionary Search operationId: searchStedmans parameters: - name: startswith in: path description: The term to start with required: true schema: type: string example: diabetes responses: '200': description: Successful Response content: application/json: schema: $ref: '#/components/schemas/IngenixCodersDictionary' example: entry: - definition: 'Endocrine disease manifested by high blood glucose levels and resulting in the inability to successfully metabolize carbohydrates, proteins, and fats, due to defects in insulin production and secretion, insulin action, or both. Type I results from the autoimmune or other destruction of the pancreatic beta cells, which cease producing insulin. This type is commonly seen at a young age and requires regular insulin injections. Type II is caused by the body''s inability to respond to insulin that is produced, called insulin resistance. The pancreas gradually loses the ability to produce insulin. Type II is usually seen in adulthood and can often be treated with diet, exercise, and oral medications. Type II may also require insulin, however, and is also diagnosed among juvenile patients. Synonym(s): DM.' icd9: 249, 249.4, 250, 250.4, 581.81, 775.1, 40.1 synonyms: diabetes mellitus hypertension-nephrosis syndrome, diabetes mellitus in newborn infant syndrome term: diabetes mellitus - definition: High blood pressure and kidney failure resulting from diabetes in which carbohydrate utilization is reduced and lipid and protein use are enhanced. icd9: 249.40 - 249.41, 250.40 - 250.43, 581.81 term: diabetes mellitus hypertension-nephrosis syndrome - definition: Newborn that has the inability to metabolize carbohydrates, proteins, and fats with insufficient secretion of insulin. icd9: '775.1' term: diabetes mellitus in newborn infant syndrome - definition: Educational and training services furnished by a certified provider in an outpatient setting. The physician managing the individual's diabetic condition must certify that the services are needed under a comprehensive plan of care and provide the patient with the skills and knowledge necessary for therapeutic program compliance (including skills related to the self-administration of injectable drugs). The provider must meet applicable standards established by the National Diabetes Advisory or be recognized by an organization that represents individuals with diabetes as meeting standards for furnishing the services. term: diabetes outpatient self-management training services - definition: Endocrine dysfunction causing diabetes and affecting growth and weight. icd9: '258.1' term: diabetes-dwarfism-obesity syndrome - definition: High blood pressure and kidney failure resulting from diabetes in which carbohydrate utilization is reduced and lipid and protein use are enhanced. icd9: 249.40, 249.40 - 249.41, 249.41, 250.40 - 250.43, 250.41, 250.42, 250.43, 581.81 term: diabetes-nephrosis syndrome '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: Not Found - the data was not found content: application/json: example: error: - The requested resource does not exist. warning: [] info: [] '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /codetype/{codetype}/all: get: tags: - Revenue Code summary: Show properties for Revenue Code operationId: getReveunueCodesList parameters: - name: codetype in: path description: The type needed to identify required: true schema: type: string enum: - revenue responses: '200': description: Successful Response content: application/json: schema: $ref: '#/components/schemas/RevCodeDesc' example: item: - '0000' - '0001' - '0002' - '0003' '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: Not Found - the data was not found content: application/json: example: error: - The requested resource does not exist. warning: [] info: [] '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /codetype/drg/{code}/properties: get: tags: - DRG Codes summary: Return Index search results operationId: getProperty_1 parameters: - name: code in: path description: The code value required: true schema: type: string example: '021' - name: data in: query description: 'Comma seperated list of any of the following' schema: type: string default: desc-full example: desc-full responses: '200': description: Successful Response content: application/json: schema: $ref: '#/components/schemas/DrgCodeDesc' example: descFull: Intracranial Vascular Procedures with Principal Diagnosis of Hemorrhage with CC codeType: icd9 '400': description: Bad data parameter content: application/json: schema: $ref: '#/components/schemas/DrgCodeDesc' example: error: - Bad data parameter 'bad' warning: [] info: [] '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: No Drg code description found content: application/json: schema: $ref: '#/components/schemas/DrgCodeDesc' example: error: [] warning: [] info: - No Drg code description found for the given Drg code you entered. '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /hcctype/{hccType}/{hccCode}: get: tags: - HCC Information summary: Returns all the Diagnosis Codes for the supplied HCC Code operationId: getDiagList parameters: - name: hccType in: path description: Value for hccType required: true schema: type: string enum: - cms-hcc - cms-hcc-esrd-pace - rx-hcc - name: hccCode in: path description: Value for hccCode required: true schema: type: string example: HCC1 - name: modelCategory in: query description: cms-hcccms-hcc-esrd-pace
rx-hcc
schema: type: string responses: '200': description: Successful Response content: application/json: schema: $ref: '#/components/schemas/DiagnosisCodeList' example: cmsHccV22: - code: '042' desc: Human immunodeficiency virus [HIV] - code: '079.53' desc: Human immunodeficiency virus, type 2 (HIV 2), in conditions classified elsewhere and of unspecified site cmsHccV12: - code: '042' desc: Human immunodeficiency virus [HIV] - code: '079.53' desc: Human immunodeficiency virus, type 2 (HIV 2), in conditions classified elsewhere and of unspecified site - code: V08 desc: Asymptomatic human immunodeficiency virus (HIV) infection status cmsHccEsrdPace: [] rxHccV04: [] rxHcc: [] '400': description: The provided code is not a valid HCC code content: application/json: schema: $ref: '#/components/schemas/DiagnosisCodeList' example: error: - Not a valid HCC Code for the cms-hcc type warning: [] info: [] '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: No Drg code description found content: application/json: schema: $ref: '#/components/schemas/DiagnosisCodeList' example: error: [] warning: [] info: - No Drg code description found for the given Drg code you entered. '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /codetype/{codetype}/{code}/hcc: get: tags: - HCC Information summary: Returns the HCC Data for I9V1/I10CM Code operationId: getI9I10HccData parameters: - name: codetype in: path description: The codetype needed to identify the type of code required: true schema: type: string enum: - icd9v1 - icd10cm - name: code in: path description: The value of the code required: true schema: type: string example: '042' - name: yyyy-mm-dd in: header description: Date needed for HCC Web Services schema: type: string responses: '200': description: Successful Response content: application/json: schema: $ref: '#/components/schemas/Hcc' example: cmsHccV22: - hccCode: HCC1 desc: HIV/AIDS cmsHccV12: - hccCode: HCC1 desc: HIV/AIDS cmsHccEsrdPace: - hccCode: HCC1 desc: HIV/AIDS rxHccV04: [] rxHcc: - hccCode: RXHCC1 desc: HIV/AIDS '400': description: The provided code is not a valid icd9v1/icd10cm code content: application/json: schema: $ref: '#/components/schemas/Hcc' example: error: - The provided code is not a valid icd9v1/icd10cm code warning: [] info: [] '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: HCC Data does not exist for the particular icd9v1/icd10cm code content: application/json: schema: $ref: '#/components/schemas/Hcc' example: error: - HCC Data does not exist for the particular icd9v1/icd10cm code warning: [] info: [] '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /hcctype/{hccType}: get: tags: - HCC Information summary: Returns all the HCC Codes for the supplied HCC Type operationId: getHccData parameters: - name: hccType in: path description: Value for hccType required: true schema: type: string enum: - cms-hcc - cms-hcc-esrd-pace - rx-hcc - name: modelCategory in: query description: cms-hcccms-hcc-esrd-pace
rx-hcc
schema: type: string responses: '200': description: Successful Response content: application/json: schema: $ref: '#/components/schemas/Hcc' example: cmsHccV22: - hccCode: HCC1 desc: HIV/AIDS href: /ws/hcctype/cms-hcc/HCC1 cmsHccV12: - hccCode: HCC1 desc: HIV/AIDS href: /ws/hcctype/cms-hcc/HCC1 cmsHccEsrdPace: [] rxHccV04: [] rxHcc: [] '400': description: Not a valid HCC Code for the cms-hcc type content: application/json: schema: $ref: '#/components/schemas/Hcc' example: error: - Not a valid HCC Code for the cms-hcc type warning: [] info: [] '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: No Diagnosis Code found for the HCC Code entered content: application/json: schema: $ref: '#/components/schemas/Hcc' example: error: [] warning: [] info: - No Diagnosis Code found for the HCC Code entered. '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /hcctype: get: tags: - HCC Information summary: Show HyperLinks to valid HCC types operationId: getHCCTypes responses: '200': description: Successful Response content: application/json: schema: type: array items: $ref: '#/components/schemas/Link' example: - href: /ws/hcctype/cms-hcc value: cms-hcc - href: /ws/hcctype/cms-hcc-esrd-pace value: cms-hcc-esrd-pace - href: /ws/hcctype/rx-hcc value: rx-hcc '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: Not Found - the data was not found content: application/json: example: error: - The requested resource does not exist. warning: [] info: [] '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /codetype/{codetype}/{code}/instructional-notes: get: tags: - Code Information summary: Return instructional Notes for the given icd9v1 {code} operationId: getInstructions parameters: - name: codetype in: path description: The codetype needed to identify the type of code required: true schema: pattern: icd9v1 type: string example: icd9v1 - name: code in: path description: The code value for the respective codetype required: true schema: type: string example: 295 responses: '200': description: Successful Response content: application/json: schema: $ref: '#/components/schemas/InstructionalNotes' example: instructionalNote: - header: 5. Mental, Behavioral and Neurodevelopmental Disorders (290-319) note: - ~5. MENTAL, BEHAVIORAL AND NEURODEVELOPMENTAL DISORDERS (290-319) - header: Psychoses (290-299) note: - '~PSYCHOSES (290-299)~Excludes: intellectual disabilities (317-319)~' - header: Other Psychoses (295-299) note: - '~PSYCHOSES (290-299)~Excludes: mental retardation (317-319)~OTHER PSYCHOSES (295-299)~Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298' '400': description: The provided code is not a valid icd9v1 code content: application/json: schema: $ref: '#/components/schemas/InstructionalNotes' example: error: - The code provided ('99213') in this web service request is not a valid 'icd9v1' code. warning: [] info: [] '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: Code 'code' does not exist content: application/json: schema: $ref: '#/components/schemas/InstructionalNotes' example: error: - Code '999.99' does not exist warning: [] info: [] '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /codetype/{codetype}/{code}/instructions: get: tags: - Code Information summary: Return instructions for the given cpt {code} operationId: getInstructions_1 parameters: - name: codetype in: path description: The codetype needed to identify the type of code required: true schema: type: string enum: - cpt - name: code in: path description: The code value for the respective codetype required: true schema: type: string example: 99213 responses: '200': description: Successful Response content: application/json: schema: $ref: '#/components/schemas/Items' example: item: - 'Excludes Services provided in:' - Excludes Hospital observation or inpatient with same day admission and discharge (99234-99236) - Excludes Hospital observation (99217-99220 [99224, 99225, 99226]) - 'Includes New patients: have not received professional services from the physician or qualified health care professional or any other physician or qualified health care professional in the same practice in the exact same specialty and subspecialty in the previous three years (99201-99205)' - Includes Office visits - 'Includes Established patients: received prior professional services from the physician or qualified health care professional or another physician or qualified health care professional in the practice of the exact same specialty and subspecialty in the previous three years (99211-99215)' - Includes Outpatient services (including services prior to a formal admission to a facility) - Excludes Emergency department (99281-99285) '400': description: The provided code is not a valid icd9v1 code content: application/json: schema: $ref: '#/components/schemas/Items' example: error: - The code provided ('250.0') in this web service request is not a valid 'cpt' code. warning: [] info: [] '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: Code 'code' does not exist content: application/json: schema: $ref: '#/components/schemas/Items' example: error: - Code '13108' does not exist warning: [] info: [] '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /codetype/{codetype}/{code}/icd10mapping: get: tags: - ICD10 Mapping summary: Return ICD-10 Mapping for the given ICD-9-V1 or ICD-9-V3 {code} operationId: getI10Mapping parameters: - name: codetype in: path description: The codetype needed to identify the type of code required: true schema: type: string enum: - icd9v1 - icd9v3 - name: code in: path description: The code value for the respective codetype required: true schema: type: string example: 314.2 responses: '200': description: Successful Response content: application/json: schema: $ref: '#/components/schemas/Icd10Mapping' example: node: - code: 08J0XZZ desc: Inspection of Right Eye, External Approach tips: GEM premierPick: N billTogether: N href: /ws/codetype/icd10pcs/08J0XZZ '400': description: Wrong codetype content: application/json: schema: $ref: '#/components/schemas/Icd10Mapping' example: error: - The code provided ('5.31') in this web service request is not a valid 'icd9v1' code. warning: [] info: [] '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: Code does not have ICD-10 Mapping content: application/json: schema: $ref: '#/components/schemas/Icd10Mapping' example: error: - The Code '315.3' does not have ICD-10 Mapping warning: [] info: [] '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /codetype/{codetype}/{code}/icd9mapping: get: tags: - ICD9 Mapping summary: Backward Mapping to ICD-9-CM Vol-1 or ICD-9-CM Vol-3 Codes operationId: getI9Mapping parameters: - name: codetype in: path description: The codetype needed to identify the type of code required: true schema: type: string enum: - icd10cm - icd10pcs - name: code in: path description: The code value for the respective codetype required: true schema: type: string example: F90.9 responses: '200': description: Successful Response content: application/json: schema: $ref: '#/components/schemas/Icd9Mapping' example: node: - code: '314.00' desc: Attention deficit disorder of childhood without mention of hyperactivity tips: GEM premierPick: N billTogether: N href: /ws/codetype/icd9v1/314.00 - code: '314.01' desc: Attention deficit disorder of childhood with hyperactivity tips: GEM premierPick: Y billTogether: N href: /ws/codetype/icd9v1/314.01 '400': description: Wrong codetype content: application/json: schema: $ref: '#/components/schemas/Icd9Mapping' example: error: - The code provided ('5.31') in this web service request is not a valid 'icd10pcs' code. warning: [] info: [] '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: Not Found - the data was not found content: application/json: example: error: - The requested resource does not exist. warning: [] info: [] '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /codetype/{codetype}/{code}/medicarepolicy/{policytype}{contractortype}: get: tags: - Medicare Policy summary: Get Medicare contractors info operationId: getContractorLinks parameters: - name: codetype in: path description: The codetype needed to identify the type of code required: true schema: type: string enum: - cpt - hcpcs - icd9v1 - icd10cm - name: code in: path description: The code value for the respective codetype required: true schema: type: string example: 99213 - name: policytype in: path description: Type of policy required: true schema: type: string enum: - lcd - ncd - name: contractortype in: path description: '
LCD policy contractor types:
''fi'' - Part A Contractors (e.g. Fiscal Intermediary)
''ca'' - Part B Contractors (e.g. Carrier)
''all'' - list of all contractors
NCD policy contractor types:
''na'' - part A
''nb'' - part B
''all'' - includes part A and part B
' required: true schema: pattern: (/([all|fi|ca|nb|na],*)+)? type: string default: all responses: '200': description: Successful Response content: application/json: schema: $ref: '#/components/schemas/Contractors' example: type: link: - href: /ws/codetype/cpt/99213/medicarepolicy/lcd/all value: ALL - href: /ws/codetype/cpt/99213/medicarepolicy/lcd/ca value: CA - href: /ws/codetype/cpt/99213/medicarepolicy/lcd/fi value: FI '400': description: Code does not exist content: application/json: schema: $ref: '#/components/schemas/Contractors' example: error: - Code '99999' does not exist warning: [] info: [] '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: 'Wrong codetype ' content: application/json: schema: $ref: '#/components/schemas/Contractors' example: error: - The code provided ('250.01') in this web service request is not a valid 'cpt' code. warning: [] info: [] '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /codetype/{codetype}/{code}/medicarepolicy/{policytype}/{contractortype}/{contractornum}: get: tags: - Medicare Policy summary: Medicare Policies Data operationId: getPolicies_1 parameters: - name: codetype in: path description: The codetype needed to identify the type of code required: true schema: type: string enum: - cpt - hcpcs - icd9v1 - icd10cm - name: code in: path description: The code value for the respective codetype required: true schema: type: string example: 83550 - name: policytype in: path description: Type of policy required: true schema: type: string enum: - ncd - lcd - name: contractornum in: path description: A Valid 5 digit contractor number for LCD contractors or '0' for NCD contractors required: true schema: type: string example: 0 - name: contractortype in: path description: 'Local Coverage Determination(LCD)National Coverage Determination(NCD)' required: true schema: pattern: fi|ca|da|nb|na|nd type: string default: nb - name: data in: query description: 'One of ' schema: type: string default: active - name: start in: query description: The index to start with schema: type: integer format: int32 default: 0 - name: maxresults in: query description: The maximum number od results to be returned schema: type: integer format: int32 default: 100 responses: '200': description: Successful Response content: application/json: schema: $ref: '#/components/schemas/Policies' example: type: link: - href: /ws/codetype/cpt/99213/medicarepolicy/lcd/all value: ALL - href: /ws/codetype/cpt/99213/medicarepolicy/lcd/ca value: CA - href: /ws/codetype/cpt/99213/medicarepolicy/lcd/fi value: FI '400': description: '''Start'' value is negative' content: application/json: schema: $ref: '#/components/schemas/Policies' example: error: - '''start'' value is negative.' warning: [] info: [] '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: Code does not exist content: application/json: schema: $ref: '#/components/schemas/Policies' example: error: - Code '99999' does not exist warning: [] info: [] '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /codetype/{codetype}/{code}/medicarepolicy: get: tags: - Medicare Policy summary: Medicare Policies operationId: getPolicyLinks parameters: - name: codetype in: path description: The codetype needed to identify the type of code required: true schema: type: string enum: - cpt - hcpcs - icd9v1 - icd10cm - name: code in: path description: The code value for the respective codetype required: true schema: type: string example: 99213 responses: '200': description: Successful Response content: application/json: schema: type: array items: $ref: '#/components/schemas/Link' example: - href: /ws/codetype/cpt/99213/medicarepolicy/lcd/all value: All LCD contractors - href: /ws/codetype/cpt/99213/medicarepolicy/lcd/fi value: FI (part A) '400': description: Wrong codetype content: application/json: schema: type: array items: $ref: '#/components/schemas/Link' example: error: - The code provided ('250.00') in this web service request is not a valid 'cpt' code. warning: [] info: [] '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: Code does not exist content: application/json: schema: type: array items: $ref: '#/components/schemas/Link' example: error: - Code '99999' does not exist warning: [] info: [] '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /codetype/{codetype}/allmodifiers: get: tags: - Modifiers summary: Return all the Modifiers for the supplied {codeype} operationId: getModifiers parameters: - name: codetype in: path description: The codetype needed to identify the type of code required: true schema: type: string enum: - cpt - hcpcs responses: '200': description: Successful Response content: application/json: schema: type: array items: $ref: '#/components/schemas/Link' example: - href: /ws/codetype/cpt/modifier/1P?types=all&data=all value: 1P - href: /ws/codetype/cpt/modifier/22?types=all&data=all value: '22' '400': description: Invalid parameter passed content: application/json: schema: type: array items: $ref: '#/components/schemas/Link' example: error: - The code provided ('ALLMODIFIERS=CMS2') in this web service request is not a valid 'hcpcs' code. warning: [] info: [] '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: Not Found - the data was not found content: application/json: example: error: - The requested resource does not exist. warning: [] info: [] '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /modifier-51-exempt: get: tags: - Modifiers summary: Returns the list of Optum/AMA Modifier -51 Exempt codes operationId: getOptumAmaMod51Exempt parameters: - name: types in: query description: 'Comma seperated list of' schema: type: string default: optum,ama example: optum,ama responses: '200': description: Successful Response content: application/json: schema: $ref: '#/components/schemas/Modifier51Exempt' example: optum360: - code: '90281' description: Immune globulin (Ig), human, for intramuscular use - code: '90283' description: Immune globulin (IgIV), human, for intravenous use '400': description: Bad Types Parameter content: application/json: schema: type: array items: $ref: '#/components/schemas/Modifier51Exempt' example: error: - Bad types parameter 'bad' warning: [] info: [] '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: Not Found - the data was not found content: application/json: example: error: - The requested resource does not exist. warning: [] info: [] '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /codetype/{codetype}/modifier/{modifier}: get: tags: - Modifiers summary: Return codes and properties for the supplied {modifier} and {codetype} operationId: getProperty_2 parameters: - name: codetype in: path description: The codetype needed to identify the type of code required: true schema: type: string enum: - cpt - hcpcs - name: modifier in: path description: The modifier for a particular code required: true schema: type: string example: 24 - name: data in: query description: 'Comma seperated list of' schema: type: string default: desc example: desc,usage - name: types in: query description: 'comma seperated list of' schema: type: string default: physician example: physician,facility responses: '200': description: Successful Response content: application/json: schema: $ref: '#/components/schemas/ModifierProperty' example: description: Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative Period physician: link: - href: /ws/codetype/cpt/92002 value: '92002' - href: /ws/codetype/cpt/92004 value: '92004' '400': description: Unknown Type Element content: application/json: schema: $ref: '#/components/schemas/ModifierProperty' example: error: - 'Unknown types element : faccility' warning: [] info: [] '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: Code not found for modifier entered content: application/json: schema: $ref: '#/components/schemas/ModifierProperty' example: error: [] warning: [] info: - Code not found for the modifier entered. '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /codetype/modifier/{code}/properties: get: tags: - Modifiers summary: Show properties for modifier Code operationId: getProperty_3 parameters: - name: code in: path description: The modifier code to search required: true schema: type: string example: 22 - name: data in: query description: 'desc-full : full description' schema: type: string default: desc-full example: desc-full responses: '200': description: Successful Response content: application/json: schema: $ref: '#/components/schemas/ModifierDesc' example: descFull: Increased Procedural Services '400': description: Bad data parameter content: application/json: schema: $ref: '#/components/schemas/ModifierDesc' example: error: - Bad data parameter 'bad' warning: [] info: [] '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: No modifier code description found content: application/json: schema: $ref: '#/components/schemas/ModifierDesc' example: error: [] warning: [] info: - No modifier code description found for the given modifier code you entered. '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /codetype/{codetype}/{code}/modifiers: get: tags: - Modifiers summary: Return Modifiers for the supplied {code}. If you want additional information please supply additional query parameters operationId: getModifiers_1 parameters: - name: codetype in: path description: The codetype needed to identify the type of code required: true schema: type: string enum: - cpt - hcpcs - name: code in: path description: The code value for the respective codetype required: true schema: type: string example: 93886 - name: types in: query description: 'Comma seperated list of' schema: type: string default: physician example: physician responses: '200': description: Successful Response content: application/json: schema: $ref: '#/components/schemas/Modifiers' example: physician: link: - href: /ws/codetype/cpt/modifier/93886 value: '22' - href: /ws/codetype/cpt/modifier/93886 value: '23' '400': description: Bad data parameter content: application/json: schema: $ref: '#/components/schemas/Modifiers' example: error: - 'Unknown data element : faccility' warning: [] info: [] '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: Modifiers not found for the code entered content: application/json: schema: $ref: '#/components/schemas/Modifiers' example: error: [] warning: [] info: - Modifiers not found for the code entered. '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /codetype/{codetype}/{code}/mpfs: get: tags: - Code Fee summary: List of Medicare Localities and links to them. This can be used to get MPFS data operationId: getCarriers parameters: - name: codetype in: path description: The codetype needed to identify the type of code required: true schema: type: string enum: - cpt - hcpcs - name: code in: path description: The code value for the respective codetype required: true schema: type: string example: 13100 responses: '200': description: Successful Response content: application/json: schema: $ref: '#/components/schemas/Modifiers' example: - href: /ws/codetype/cpt/13100/mpfs/global-info value: Medicare Global Information - href: /ws/codetype/cpt/13100/mpfs/00000-00 value: NATIONAL '400': description: Wrong codetype content: application/json: schema: $ref: '#/components/schemas/Modifiers' example: error: - The code provided ('250.02') in this web service request is not a valid 'cpt' code. warning: [] info: [] '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: Modifiers not found for the code entered content: application/json: schema: $ref: '#/components/schemas/Modifiers' example: error: - Code '13104' does not exist warning: [] info: [] '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /codetype/{codetype}/{code}/mpfs/{carrier-locality}/non-facility: get: tags: - Code Fee summary: Return all Medicare Physician non facility Fees operationId: getFee parameters: - name: code in: path description: The code value for the respective codetype required: true schema: type: string example: 13100 - name: codetype in: path description: The codetype needed to identify the type of code required: true schema: type: string enum: - cpt - hcpcs - name: carrier-locality in: path description: The carrier-localty value required: true schema: type: string example: 00000-00 - name: types in: query description: 'Comma seperated list of' schema: type: string default: fee example: fee,rvu responses: '200': description: Successful Response content: application/json: schema: $ref: '#/components/schemas/Modifiers' example: mpfsFee: global: '352.98' mpfsRvu: global: totalRvu: '10.2000' workRvu: '3.0000' peRvu: '6.8500' mpRvu: '0.3500' '400': description: Wrong codetype content: application/json: schema: $ref: '#/components/schemas/Modifiers' example: error: - The code provided ('250.02') in this web service request is not a valid 'cpt' code. warning: [] info: [] '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: Carrier/Locality length is incorrect content: application/json: schema: $ref: '#/components/schemas/Modifiers' example: error: [] warning: [] info: - Carrier/Locality length is incorrect. Please use the Carriers web service to check your entry. '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /codetype/{codetype}/{code}/mpfs/global-info: get: tags: - Code Fee summary: Return all Medicare Global information for the supplied {code} operationId: getGlobal parameters: - name: code in: path description: The code value for the respective codetype required: true schema: type: string example: G0168 - name: codetype in: path description: The codetype needed to identify the type of code required: true schema: type: string enum: - hcpcs - cpt responses: '200': description: Successful Response content: application/json: schema: $ref: '#/components/schemas/Modifiers' example: preoperative: '0.10' intraoperative: '0.80' postoperative: '0.10' global: '010' '400': description: Wrong codetype content: application/json: schema: $ref: '#/components/schemas/Modifiers' example: error: - The code provided ('250.02') in this web service request is not a valid 'cpt' code. warning: [] info: [] '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: The requested resource does not exist content: application/json: schema: $ref: '#/components/schemas/Modifiers' example: error: - The requested resource does not exist. warning: [] info: [] '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /codetype/{codetype}/{code}/mpfs/{locality}: get: tags: - Code Fee summary: Links to data available for the locality operationId: getMpfsLinks parameters: - name: codetype in: path description: The codetype needed to identify the type of code required: true schema: type: string enum: - cpt - hcpcs - name: code in: path description: The code value for the respective codetype required: true schema: type: string example: 13100 - name: locality in: path description: The value for locality required: true schema: pattern: '[0-9][0-9][0-9][0-9][0-9]-[0-9][0-9]' type: string example: 10102-00 responses: '200': description: Successful Response content: application/json: schema: $ref: '#/components/schemas/Modifiers' example: - href: /ws/codetype/cpt/13100/mpfs/10102-00/non-facility value: Medicare Physician Fees/RVUs '400': description: Wrong codetype content: application/json: schema: $ref: '#/components/schemas/Modifiers' example: error: - The code provided ('250.02') in this web service request is not a valid 'cpt' code. warning: [] info: [] '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: Code {code} does not exist content: application/json: schema: $ref: '#/components/schemas/Modifiers' example: error: - Code '13104' does not exist warning: [] info: [] '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /cci-check/{facNonFac}/{codes}: get: tags: - Code Information summary: Return the billing relationships between the given codes operationId: getMultiCCIData parameters: - name: facNonFac in: path description: One of required: true schema: type: string enum: - facility-cci - non-facility-cci - name: codes in: path description: Comma seperated list of codes required: true schema: type: string example: 99213,13152,11000 responses: '200': description: Successful Response content: application/json: schema: $ref: '#/components/schemas/Multicci' example: conflict: - code1: description: Debridement of extensive eczematous or infected skin; up to 10% of body surface reason: CPT Manual or CMS manual coding instructions modifier: Allowed primarysecondary: Primary value: '11000' code2: description: 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 reason: CPT Manual or CMS manual coding instructions modifier: Allowed primarysecondary: Secondary value: '99213' name: CCI Conflict Code 11000(Column 1) conflicts with Code 99213(Column 2). message: 'Warning: These codes may not be billed together. Check to see if a modifier is allowed and supported by documentation' '400': description: Wrong codetype content: application/json: schema: $ref: '#/components/schemas/Multicci' example: error: - The provided code is not a valid cpt/hcpcs code warning: [] info: [] '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: CCI relationship was not found content: application/json: schema: $ref: '#/components/schemas/Multicci' example: error: [] warning: [] info: - CCI relationship was not found. '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /codetype/{codetype}/{code}/annotations: get: tags: - Reference Code summary: Return Annotations for the given hcpcs/icd9v1 {code} operationId: getAnnotations parameters: - name: codetype in: path description: The codetype needed to identify the type of code required: true schema: type: string enum: - hcpcs - icd9v1 - name: code in: path description: The code value for the respective codetype required: true schema: type: string example: A0021 responses: '200': description: Successful Response content: application/json: schema: $ref: '#/components/schemas/Items' example: item: - This code represents a per mile charge for ambulance transportation outside of the state where the ambulance provider is based and is reported only for Medicaid claims. Consult the local Medicaid office in the state that the provider is located for further definition and usage requirements. '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: Not Found - the data was not found content: application/json: example: error: - The requested resource does not exist. warning: [] info: [] '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /codetype/{codetype}/{code}/includesexcludesnotes: get: tags: - Reference Code summary: Return includes/excludes notes for the given code {code} operationId: getIncludesExcludesNotes parameters: - name: codetype in: path description: The codetype needed to identify the type of code required: true schema: type: string enum: - icd9v1 - icd9v3 - icd10cm - name: code in: path description: The code value for the respective codetype required: true schema: type: string example: 210 responses: '200': description: Successful Response content: application/json: schema: $ref: '#/components/schemas/IncludesExcludesNotes' example: includesNotes: note: [] excludesNotes: excludesHeader: 'cyst (of):' note: - content: oral soft tissue (528.4) indentation: 1 - content: radicular (522.8) indentation: 1 '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: Not Found - the data was not found content: application/json: example: error: - The requested resource does not exist. warning: [] info: [] '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /codetype/{codetype}/{code}/sectionnotes: get: tags: - Code Information summary: Return section notes for the given cpt/hcpcs {code} operationId: getSectionNotes parameters: - name: codetype in: path description: The codetype needed to identify the type of code required: true schema: type: string enum: - cpt - hcpcs - name: code in: path description: The code value for the respective codetype required: true schema: type: string example: 99213 - name: data in: query description: indent indicates notes will include <indent> tags, only for CPT Code schema: type: string responses: '200': description: Successful Response content: application/json: schema: $ref: '#/components/schemas/Items' example: item: - 'INCLUDES:' - '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) - 'EXCLUDES:' - 'Services provided in:' - Emergency department (99281-99285) - Hospital observation (99217-99220 [99224, 99225, 99226]) - Hospital observation or inpatient with same day admission and discharge (99234-99236) '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: Not Found - the data was not found content: application/json: example: error: - The requested resource does not exist. warning: [] info: [] '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /codetype/{codetype}/{code}/optum-specialty-articles: get: tags: - Optum Specialty Articles summary: Show Articles for Optum Specialty operationId: getCodes_1 parameters: - name: code in: path description: The code value required: true schema: type: string example: 13100 - name: codetype in: path description: The code value required: true schema: type: string enum: - cpt - hcpcs - icd10cm - icd10pcs responses: '200': description: Successful Response content: application/json: schema: $ref: '#/components/schemas/OptumSpecialtyArticles' example: " {\n \"code\": \"99213\",\n \"year\": \"2024\",\n \ \ \"issue\": \"January\",\n \"source\": \"1995 and 1997 Documentation\ \ Guidelines www.cms.gov and the Marshfield E/M Scoring tool used by Novitas-Solutions\ \ (http://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyd?_afrLoop=142131956577316&_adf.ctrl-state=qolq8oej1_63&contentId=00004968#)\"\ ,\n \"article_title\": \"What Is the Risk In Medical Decision-Making Scoring?\"\ ,\n \"date\": \"\t02/23/2024\",\n \"abstract\": \"Medical decision-making\ \ is another key component used to document an E/M level of service. This component includes\ \ three areas of which two must be met to satisfy the appropriate level of service, One\ \ of which is the level of risk.\",\n \"article_text\": \"

The third key\ \ component of an evaluation and management (E/M) service is medical decision-making (MDM).\ \ This is often the information found in the assessment and plan portion of a SOAP note\ \ (Subjective, Objective, Assessment, and Plan). The SOAP format is familiar to physicians\ \ as this is how they will often format their notes when documenting their patient visits.\ \ .

\",\n } " '400': description: Bad data parameter content: application/json: schema: $ref: '#/components/schemas/OptumSpecialtyArticles' example: error: - Bad data parameter 'bad' warning: [] info: [] '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: No Optum Specialty Article Codes were found content: application/json: schema: $ref: '#/components/schemas/OptumSpecialtyArticles' example: error: [] warning: [] info: - No Optum Specialty Article Codes were found. '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /codetype/{codetype}/{code}/physician-docs: get: tags: - Code Information summary: Return physician document for the given icd10cm {code} operationId: getPhysicianDocs parameters: - name: codetype in: path description: The codetype needed to identify the type of code required: true schema: type: string enum: - icd10cm - name: code in: path description: The code value for the respective codetype required: true schema: type: string example: S52 responses: '200': description: Successful Response content: application/json: schema: $ref: '#/components/schemas/PhysicianDocs' example: physicianDoc: - title: Fracture 7th characters text: "

The 7th character in fractures is based on the Gustillo classification.   \ \ The following information is important to assign the appropriate 7th character:

\r\ \n
    \r\n
  1. Episode of care - Initial, subsequent, sequela
  2. \r\n
      \r\n
    • Initial\ \ encounter - patient is receiving active treatment for the fracture
    • \r\n
        \r\ \n
      • Examples - surgical treatment, emergency department encounter, evaluation by\ \ new physician
      \r\n
    • Subsequent encounter - patient has completed active\ \ treatment for the condition
    • \r\n
        \r\n
      • Examples - cast change/removal,\ \ medication adjustment, followup visits
      \r\n
    • Sequela - complications\ \ or conditions that arise as a direct result of a condition
    • \r\n
        \r\n\
      • Example - scar from a burn.   The scar would be coded separately, but\ \ the burn would be assigned the \"S\" seventh character as the injury responsible\ \ for the scar. 
    \r\n
  3. Open or closed fracture
  4. \r\n
      \r\ \n
    • If open, Type I or Type II (Gustillo classification)
    • \r\n
    • If open, Type\ \ IIIA, IIIB, or IIIC
    \r\n
  5. Healing
  6. \r\n
      \r\n
    • Routine healing
    • \r\ \n
    • Delayed healing
    • \r\n
    • Malunion
    • \r\n
    • Nonunion
\r\n\

 

" '400': description: Wrong codetype content: application/json: schema: $ref: '#/components/schemas/PhysicianDocs' example: error: - The code provided ('33213') in this web service request is not a valid 'icd10cm' code. warning: [] info: [] '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: Code {code} does not exist content: application/json: schema: $ref: '#/components/schemas/PhysicianDocs' example: error: - Code 'J00.99' does not exist warning: [] info: [] '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /codetype/revenue/{code}/properties: get: tags: - Revenue Code summary: Show properties for Revenue Code operationId: getProperty_4 parameters: - name: code in: path description: The code value for the respective codetype required: true schema: type: string example: '0250' - name: data in: query description: 'Comma seperated list of any of the following
  • desc-35 : up to 35 character description
  • desc-48 : up to 48 character description
  • desc-255 : up to 255 character description
  • desc-full : full description
' schema: type: string default: desc-full example: desc-full responses: '200': description: Successful Response content: application/json: schema: $ref: '#/components/schemas/RevCodeDesc' example: desc35: Pharmacy-General Classification '400': description: Bad data parameter content: application/json: schema: $ref: '#/components/schemas/RevCodeDesc' example: error: - Bad data parameter 'bad' warning: [] info: [] '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: No revenue code description found content: application/json: schema: $ref: '#/components/schemas/RevCodeDesc' example: error: [] warning: [] info: - No revenue code description found for the given revenue code you entered. '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /codetype/{codetype}/{code}/revenuecodes: get: tags: - Revenue Code summary: Return CPT/HCPCS to Revenue code crosswalk for the given cpt/hcpcs {code} operationId: getRevenueCodes parameters: - name: codetype in: path description: The codetype needed to identify the type of code required: true schema: type: string enum: - cpt - hcpcs - name: code in: path description: The code value for the respective codetype required: true schema: type: string example: 99213 responses: '200': description: Successful Response content: application/json: schema: $ref: '#/components/schemas/PhysicianDocs' example: item: - revCode: '0456' revCodeDesc: Emergency Room-Urgent Care tobFacilityCode: '013' tobFacilityCodeDesc: Hospital Outpatient note: Clinic or ED Visit. Paid a separate APC. '400': description: Wrong codetype content: application/json: schema: $ref: '#/components/schemas/PhysicianDocs' example: error: - The code provided ('9999') in this web service request is not a valid 'cpt' code. warning: [] info: [] '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: Revenue code crosswalk not found content: application/json: schema: $ref: '#/components/schemas/PhysicianDocs' example: error: [] warning: [] info: - Revenue code crosswalk not found for the code (99999) entered. '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /codetype/{codetype}/{code}/{xwalkcodetype}: get: tags: - Revenue Code summary: Rev Codes to CPT/HCPCS Crosswalk operationId: getprocCodes parameters: - name: codetype in: path description: The codetype needed to identify the type of code required: true schema: type: string enum: - revenue - name: code in: path description: The code value for the respective codetype required: true schema: type: string example: '0250' - name: xwalkcodetype in: path description: 'The xwalkcodetype value ' required: true schema: type: string enum: - cpt - hcpcs - name: start in: query description: start parameter must be a non negative value and default value is 0 schema: type: integer format: int32 default: 0 - name: maxresults in: query description: maxresults parameter must be a non negative value and default value is 100 schema: type: integer format: int32 default: 100 responses: '200': description: Successful Response content: application/json: schema: $ref: '#/components/schemas/RevenueCodeToProcedure' example: item: - code: '90296' desc: Diphtheria antitoxin, equine, any route tobFacilityCode: '013' tobFacilityCodeDesc: Hospital Outpatient note: This code is not covered by Medicare when submitted on any outpatient claim. link: [] '400': description: Start value is negative content: application/json: schema: $ref: '#/components/schemas/RevenueCodeToProcedure' example: error: - Start value is negative. warning: [] info: [] '401': description: Not Authorized content: application/json: example: timestamp: '2022-07-06T16:34:39.385Z' error: Unauthorized status: 401 '404': description: No cpt/hcps crosswalk codes found content: application/json: schema: $ref: '#/components/schemas/RevenueCodeToProcedure' example: error: [] warning: [] info: - No cpt/hcps crosswalk codes found for the given revenue code you entered. '405': description: Method Not Allowed - Request method not supported content: application/json: example: timestamp: '2022-07-07T15:28:34.152Z' status: 405 error: Method Not Allowed '503': description: Service Unavailable /application.wadl/{path}: get: operationId: getExternalGrammar parameters: - name: path in: path required: true schema: type: string responses: default: description: default response content: application/xml: {} /application.wadl: get: operationId: getWadl responses: default: description: default response content: application/vnd.sun.wadl+xml: {} application/xml: {} components: schemas: Items: type: object properties: item: type: array items: type: string xml: name: items Cci: required: - cciColumn1 - cciColumn2 type: object properties: cciColumn2: type: array xml: name: cci-column2 items: $ref: '#/components/schemas/CciColumn2' cciColumn1: type: array xml: name: cci-column1 items: $ref: '#/components/schemas/CciColumn1' xml: name: cci CciColumn1: type: object properties: modifierAllowed: type: boolean xml: name: modifier-allowed reason: type: string code: type: string xml: attribute: true href: type: string xml: attribute: true CciColumn2: type: object properties: modifierAllowed: type: boolean xml: name: modifier-allowed reason: type: string code: type: string xml: attribute: true href: type: string xml: attribute: true Cdi: required: - cdiDoc type: object properties: cdiDoc: type: array xml: name: cdi-doc items: $ref: '#/components/schemas/CdiDoc' xml: name: cdi CdiDoc: type: object properties: url: type: string pdftitle: type: string sourcetitle: type: string associatedcodes: type: string ClaimLineEdit: required: - description - editConflict - editType - mnemonic type: object properties: description: type: string editConflict: type: string xml: name: edit-conflict editType: type: string xml: name: edit-type mnemonic: type: string line: type: integer format: int32 xml: attribute: true ClaimResponse: type: object properties: edit: type: array items: $ref: '#/components/schemas/ClaimLineEdit' claimId: type: string xml: name: claim-id attribute: true ClaimResponses: required: - claimResponse type: object properties: claimResponse: type: array xml: name: claim-response items: $ref: '#/components/schemas/ClaimResponse' xml: name: claim-responses Claim: required: - dateOfBirth type: object properties: clientClaimIdentifier: type: string xml: name: id attribute: true dateOfService: type: string format: date-time xml: name: service-date dateOfBirth: type: string format: date-time xml: name: birth-date gender: type: string enum: - Male - Female taxonomy: type: string payer: type: string claimLineList: type: array items: $ref: '#/components/schemas/ClaimLine' claimOrder: type: integer format: int32 providerSpeciality: type: string engineClaim: $ref: '#/components/schemas/PhysicianClaim' xml: name: claim ClaimLine: type: object properties: lineNumber: type: integer format: int32 dateOfServiceBegin: type: string format: date-time xml: name: service-begin-date dateOfServiceEnd: type: string format: date-time xml: name: service-end-date procedureCode: type: string xml: name: procedure-code modifiers: type: array items: type: string diagnosticType: type: string xml: name: diagnostic-type attribute: true enum: - ICD_9_V_1 - ICD_10_CM diagnosticCodes: type: array xml: name: diagnostic-code items: type: string xml: name: diagnostic-code placeOfService: type: string xml: name: place-of-service units: type: integer format: int32 i9V1Codes: type: array items: type: string allDiagCodes: type: array items: type: string engineClaimLine: $ref: '#/components/schemas/ClaimLine' xml: name: claim-line PhysicianClaim: type: object properties: clientClaimIdentifier: type: string dateOfService: type: string format: date-time dateOfBirth: type: string format: date-time gender: type: string enum: - Male - Female taxonomy: type: string payer: type: string claimLineList: type: array items: $ref: '#/components/schemas/ClaimLine' nationalProviderId: type: string providerSpeciality: type: string CodeHistory: type: object properties: changeEffectiveDate: type: string xml: name: ChangeEffectiveDate status: type: string xml: name: Status changeSummary: type: string xml: name: ChangeSummary fullInfo: type: string xml: name: FullInfo char48Info: type: string xml: name: Char48Info char35Info: type: string xml: name: Char35Info codeHistoryReferences: $ref: '#/components/schemas/CodeHistoryReferences' CodeHistoryReferences: type: object properties: notInAmaBook: type: string xml: name: NotInAmaBook retroactive: type: string xml: name: Retroactive CompleteCodeHistory: required: - codeHistory type: object properties: codeHistory: type: array xml: name: code-history items: $ref: '#/components/schemas/CodeHistory' xml: name: complete-code-history CodeProperties: type: object properties: desc35: type: string xml: name: desc-35 desc48: type: string xml: name: desc-48 desc255: type: string xml: name: desc-255 descFull: type: string xml: name: desc-full descLay: type: string xml: name: desc-lay codingTip: type: string xml: name: coding-tip documentationTip: type: string xml: name: documentation-tip reimbursementTip: type: string xml: name: reimbursement-tip xml: name: code-properties ColorCodes: required: - modifier51Exempt type: object properties: newCode: type: string xml: name: new-code revisedCode: type: string xml: name: revised-code reinstatedCode: type: string xml: name: reinstated-code resequencedCode: type: string xml: name: resequenced-code optumAddonCode: type: string xml: name: optum-addon-code modifier51Exempt: type: array xml: name: modifier-51-exempt items: type: string xml: name: modifier-51-exempt maleProcedure: type: string xml: name: male-procedure femaleProcedure: type: string xml: name: female-procedure unlistedCode: type: string xml: name: unlisted-code ascPaymentIndicator: type: string xml: name: asc-payment-indicator ascPaymentIndicatorDescription: type: string xml: name: asc-payment-indicator-description moderateSedation: type: string xml: name: moderate-sedation medicalUnlikelyEdits: type: string xml: name: medical-unlikely-edits ageRestrictions: type: string xml: name: age-restrictions maternity: type: string modifier63Exempt: type: string xml: name: modifier-63-exempt addOn: type: string xml: name: add-on serviceNotCoveredByMedicare: type: string xml: name: service-not-covered-by-medicare opsiCode: type: string xml: name: opsi-code coSurgeryAllowed: type: string xml: name: co-surgery-allowed assistAtSurgeryAllowedWithDocumentation: type: string xml: name: assist-at-surgery-allowed-with-documentation assistAtSurgeryAllowed: type: string xml: name: assist-at-surgery-allowed cliaWavedTest: type: string xml: name: clia-waved-test carrierPriced: type: string xml: name: carrier-priced teamSurgeryAllowed: type: string xml: name: team-surgery-allowed mulitplePxReductionGuidelinesApply: type: string xml: name: mulitple-px-reduction-guidelines-apply endoscopicMultiplePxGuidelinesApply: type: string xml: name: endoscopic-multiple-px-guidelines-apply bilateralSurgeryAllowed: type: string xml: name: bilateral-surgery-allowed stvxPackaged: type: string xml: name: stvx-packaged bloodAndBloodProducts: type: string xml: name: blood-and-blood-products brachytherapySources: type: string xml: name: brachytherapy-sources mayBePaidThroughCompositeApc: type: string xml: name: may-be-paid-through-composite-apc contractorDiscretion: type: string xml: name: contractor-discretion notCoveredOrValidForMedicare: type: string xml: name: not-covered-or-valid-for-medicare quantityAlert: type: string xml: name: quantity-alert specialCoverageInstructions: type: string xml: name: special-coverage-instructions digitRequired4Th: type: string xml: name: digit-required-4th digitRequired5Th: type: string xml: name: digit-required-5th maleDiagnosis: type: string xml: name: male-diagnosis femaleDiagnosis: type: string xml: name: female-diagnosis unspecifiedDiagnosisCode: type: string xml: name: unspecified-diagnosis-code otherSpecifiedDiagnosisCode: type: string xml: name: other-specified-diagnosis-code adultDiagnosis: type: string xml: name: adult-diagnosis maternityDiagnosis: type: string xml: name: maternity-diagnosis newbornDiagnosis: type: string xml: name: newborn-diagnosis pediatricDiagnosis: type: string xml: name: pediatric-diagnosis hivRelated: type: string xml: name: hiv-related duplicatePrimaryDx: type: string xml: name: duplicate-primary-dx unacceptablePrincipalDx: type: string xml: name: unacceptable-principal-dx manifestationCodeNotAPrimaryDx: type: string xml: name: manifestation-code-not-a-primary-dx comorbidityOrComplication: type: string xml: name: comorbidity-or-complication majorComplication: type: string xml: name: major-complication reviseNoteNotBook: type: string xml: name: revisedcode-note-not-ama-book newCptNotAmaBook: type: string xml: name: newcptcode-not-ama-book modifier95: type: string xml: name: modifier-95 tpackaged: type: string vcodeAsPrimaryDx: type: string xml: name: color-codes Link: type: object properties: href: type: string xml: attribute: true value: type: string Icd10CmColorCodes: type: object properties: newCode: type: string xml: name: new-code revisedCode: type: string xml: name: revised-code characterRequired4Th: type: string xml: name: character-required-4th characterRequired5Th: type: string xml: name: character-required-5th characterRequired6Th: type: string xml: name: character-required-6th characterRequired7Th: type: string xml: name: character-required-7th characterRequiredX7Th: type: string xml: name: character-required-x7th maleDiagnosis: type: string xml: name: male-diagnosis femaleDiagnosis: type: string xml: name: female-diagnosis unspecifiedDiagnosisCode: type: string xml: name: unspecified-diagnosis-code otherSpecifiedDiagnosisCode: type: string xml: name: other-specified-diagnosis-code adultDiagnosis: type: string xml: name: adult-diagnosis maternityDiagnosis: type: string xml: name: maternity-diagnosis newbornDiagnosis: type: string xml: name: newborn-diagnosis pediatricDiagnosis: type: string xml: name: pediatric-diagnosis hivRelated: type: string xml: name: hiv-related unacceptablePrincipalDx: type: string xml: name: unacceptable-principal-dx manifestationCodeNotAPrimaryDx: type: string xml: name: manifestation-code-not-a-primary-dx comorbidityOrComplication: type: string xml: name: comorbidity-or-complication majorComplication: type: string xml: name: major-complication questionablePdx: type: string xml: name: questionable-pdx hospitalAcquiredCondition: type: array xml: name: hospital-acquired-condition items: type: string xml: name: hospital-acquired-condition conditionalHospitalAcquiredCondition: type: array xml: name: conditional-hospital-acquired-condition items: type: string xml: name: conditional-hospital-acquired-condition zcodeIndicator: type: string xml: name: icd-10-cm-color-codes Icd10pcsColorCodes: type: object properties: newCode: type: string xml: name: new-code revisedCode: type: string xml: name: revised-code maleDiagnosis: type: string xml: name: male-diagnosis femaleDiagnosis: type: string xml: name: female-diagnosis mappingToIcd9Code: type: string xml: name: mapping-to-icd9-code procedureInconsistentLOS: type: string xml: name: procedure-inconsistent-los nonCoveredByMedicare: type: string xml: name: noncovered-medicare nonORProcedure: type: string xml: name: non-OR-procedure limitedCoverageProcedure: type: string xml: name: icd-10-pcs-color-codes EntityTag: type: object properties: value: type: string weak: type: boolean MediaType: type: object properties: type: type: string subtype: type: string parameters: type: object additionalProperties: type: string wildcardType: type: boolean wildcardSubtype: type: boolean MultivaluedMapStringObject: type: object properties: empty: type: boolean additionalProperties: type: array items: type: object MultivaluedMapStringString: type: object properties: empty: type: boolean additionalProperties: type: array items: type: string NewCookie: type: object properties: name: type: string value: type: string version: type: integer format: int32 path: type: string domain: type: string comment: type: string maxAge: type: integer format: int32 expiry: type: string format: date-time secure: type: boolean httpOnly: type: boolean sameSite: type: string enum: - NONE - LAX - STRICT Response: type: object properties: entityTag: $ref: '#/components/schemas/EntityTag' mediaType: $ref: '#/components/schemas/MediaType' metadata: type: object properties: empty: type: boolean additionalProperties: type: array items: type: object length: type: integer format: int32 location: type: string format: uri language: type: object properties: language: type: string displayName: type: string country: type: string variant: type: string script: type: string unicodeLocaleAttributes: uniqueItems: true type: array items: type: string unicodeLocaleKeys: uniqueItems: true type: array items: type: string displayLanguage: type: string displayScript: type: string displayCountry: type: string displayVariant: type: string extensionKeys: uniqueItems: true type: array items: type: string iso3Language: type: string iso3Country: type: string date: type: string format: date-time lastModified: type: string format: date-time headers: type: object properties: empty: type: boolean additionalProperties: type: array items: type: object closed: type: boolean status: type: integer format: int32 entity: type: object links: uniqueItems: true type: array items: $ref: '#/components/schemas/Link' cookies: type: object additionalProperties: $ref: '#/components/schemas/NewCookie' allowedMethods: uniqueItems: true type: array items: type: string statusInfo: $ref: '#/components/schemas/StatusType' stringHeaders: type: object properties: empty: type: boolean additionalProperties: type: array items: type: string StatusType: type: object properties: reasonPhrase: type: string family: type: string enum: - INFORMATIONAL - SUCCESSFUL - REDIRECTION - CLIENT_ERROR - SERVER_ERROR - OTHER statusCode: type: integer format: int32 UriBuilder: type: object Icd10CmCodeSpecificGuideline: type: object properties: year: type: string title: type: string guideline: type: string Icd10CmCodeSpecificGuidelines: type: object properties: icd10CmCodeSpecificGuideline: type: array xml: name: icd-10-cm-code-specific-guideline items: $ref: '#/components/schemas/Icd10CmCodeSpecificGuideline' xml: name: icd-10-cm-code-specific-guidelines Icd10pcsCodeSpecificGuideline: type: object properties: year: type: string title: type: string guideline: type: string Icd10pcsCodeSpecificGuidelines: required: - icd10pcsCodeSpecificGuideline type: object properties: icd10pcsCodeSpecificGuideline: type: array xml: name: icd-10-pcs-code-specific-guideline items: $ref: '#/components/schemas/Icd10pcsCodeSpecificGuideline' xml: name: icd-10-pcs-code-specific-guidelines IndexSearchResult: type: object properties: term: type: string level: type: integer format: int64 codes: type: string IndexSearchResults: required: - indexSearchResult type: object properties: indexSearchResult: type: array xml: name: index-search-result items: $ref: '#/components/schemas/IndexSearchResult' xml: name: index-search-results CodeRange: type: object properties: headers: type: string rangeId: type: integer format: int32 xml: name: range-id rangeItem: type: array xml: name: range-item items: $ref: '#/components/schemas/RangeItem' link: type: array items: $ref: '#/components/schemas/Link' xml: name: code-range RangeItem: type: object properties: code: type: string description: type: string tabulardata: $ref: '#/components/schemas/Tabulardata' href: type: string xml: attribute: true Tabulardata: type: object properties: dataLine: type: array xml: name: data-line items: type: string xml: name: data-line TermSearchResult: required: - code type: object properties: code: type: string rank: type: integer format: int64 desc: type: string descFull: type: string xml: name: desc-full href: type: string xml: attribute: true codeType: type: integer format: int32 TermSearchResults: type: object properties: termSearchResult: type: array xml: name: term-search-result items: $ref: '#/components/schemas/TermSearchResult' link: type: array items: $ref: '#/components/schemas/Link' xml: name: term-search-results Node: required: - code type: object properties: node: type: array items: $ref: '#/components/schemas/Node' code: type: string rank: type: integer format: int64 desc: type: string descFull: type: string xml: name: desc-full href: type: string xml: attribute: true hrefBeg: type: string xml: name: href-beg attribute: true hrefEnd: type: string xml: name: href-end attribute: true TermSearchGroups: type: object properties: termSearchGroup: type: array xml: name: term-search-group items: $ref: '#/components/schemas/Node' xml: name: term-search-groups CodingSupportResource: required: - code - document - referencedContentExample - referencedDocumentType - title type: object properties: code: type: string referencedDocumentType: type: string xml: name: referenced-document-type title: type: string referencedContentExample: type: string xml: name: referenced-content-example document: type: string CodingSupportResources: type: object properties: codingSupportResource: type: array items: $ref: '#/components/schemas/CodingSupportResource' xml: name: codingSupportResources Contractor: required: - contractorName - contractorNumber - contractorPart - contractorType - regionCode - regionName type: object properties: regionCode: type: string xml: name: region-code regionName: type: string xml: name: region-name contractorName: type: string xml: name: contractor-name contractorPart: type: string xml: name: contractor-part contractorType: type: string xml: name: contractor-type contractorNumber: type: string xml: name: contractor-number ContractorList: required: - contractor type: object properties: contractor: type: array items: $ref: '#/components/schemas/Contractor' xml: name: contractor-list ContractorPolicies: type: object properties: policy: type: array items: $ref: '#/components/schemas/Policy' xml: name: contractor-policies Policy: type: object properties: status: type: string effectiveDate: type: string xml: name: effective_date endDate: type: string xml: name: end_date title: type: string url: type: string code: type: string cmsId: type: string xml: attribute: true CodeGroup: type: object properties: paragraph: type: string codeInfo: type: array xml: name: code-info items: $ref: '#/components/schemas/CodeInfo' CodeInfo: required: - code - description type: object properties: code: type: string description: type: string type: type: string xml: attribute: true ContractorPolicyDetails: required: - policyInfo type: object properties: policyInfo: $ref: '#/components/schemas/PolicyInfo' ncdCodingInformation: $ref: '#/components/schemas/NcdCodingInformation' lcdCodingInformation: $ref: '#/components/schemas/LcdCodingInformation' xml: name: contractor-policy-details Covered: type: object properties: codeInfo: type: array xml: name: code-info items: $ref: '#/components/schemas/CodeInfo' numcodes: type: integer format: int32 xml: attribute: true toomanycodes: type: boolean xml: attribute: true Denied: type: object properties: codeInfo: type: array xml: name: code-info items: $ref: '#/components/schemas/CodeInfo' numcodes: type: integer format: int32 xml: attribute: true toomanycodes: type: boolean xml: attribute: true DiagnosticCodes: type: object properties: supportingMedicalNecessity: $ref: '#/components/schemas/SupportingMedicalNecessity' notSupportingMedicalNecessity: $ref: '#/components/schemas/NotSupportingMedicalNecessity' LcdCodingInformation: type: object properties: typeOfBillCodes: $ref: '#/components/schemas/TypeOfBillCodes' revenueCodes: $ref: '#/components/schemas/RevenueCodes' procedureCodes: $ref: '#/components/schemas/ProcedureCodes' diagnosticCodes: $ref: '#/components/schemas/DiagnosticCodes' NcdCodingInformation: type: object properties: procedureCodes: $ref: '#/components/schemas/ProcedureCodes' diagnosticCodes: $ref: '#/components/schemas/DiagnosticCodes' NotSupportingMedicalNecessity: type: object properties: codeGroup: type: array xml: name: code-group items: $ref: '#/components/schemas/CodeGroup' numcodes: type: integer format: int32 xml: attribute: true toomanycodes: type: boolean xml: attribute: true PolicyInfo: required: - effectiveDate - title - url type: object properties: title: type: string effectiveDate: type: string xml: name: effective-date expirationDate: type: string xml: name: expiration-date url: type: string contractorNum: type: string xml: name: contractor-num attribute: true cmsId: type: string xml: name: cms-id attribute: true contractorPart: type: string xml: name: contractor-part attribute: true contractorType: type: string xml: name: contractor-type attribute: true icpPolicyId: type: integer format: int32 policyType: type: string ProcedureCodes: type: object properties: codeGroup: type: array xml: name: code-group items: $ref: '#/components/schemas/CodeGroup' numcodes: type: integer format: int32 xml: attribute: true toomanycodes: type: boolean xml: attribute: true RevenueCodes: type: object properties: codeInfo: type: array xml: name: code-info items: $ref: '#/components/schemas/CodeInfo' SupportingMedicalNecessity: type: object properties: codeGroup: type: array xml: name: code-group items: $ref: '#/components/schemas/CodeGroup' numcodes: type: integer format: int32 xml: attribute: true toomanycodes: type: boolean xml: attribute: true TypeOfBillCodes: type: object properties: codeInfo: type: array xml: name: code-info items: $ref: '#/components/schemas/CodeInfo' Region: type: object properties: value: type: string regionCode: type: string xml: name: region-code attribute: true Regions: type: object properties: region: type: array items: $ref: '#/components/schemas/Region' xml: name: regions Entry: required: - cpt - definition - hcpcs - icd9 - synonyms type: object properties: definition: type: string icd9: type: string cpt: type: string hcpcs: type: string synonyms: type: string term: type: string xml: attribute: true IngenixCodersDictionary: required: - entry type: object properties: entry: type: array items: $ref: '#/components/schemas/Entry' xml: name: optum360-coders-dictionary Drg: required: - code - description - mdc - mdcDescription - medSurg type: object properties: code: type: string description: type: string mdc: type: string mdcDescription: type: string medSurg: type: string xml: name: drg-cross-code DrgList: type: object properties: drg: type: array items: $ref: '#/components/schemas/Drg' xml: name: drg-cross-code-list DrgCodeDesc: type: object properties: descFull: type: string xml: name: desc-full codeType: type: string xml: name: code-type mdc: type: string xml: name: MDC mdcDesc: type: string xml: name: MDC-desc medSurg: type: string xml: name: med-surg gmLos: type: string xml: name: gm-los amLos: type: string xml: name: am-los relativeWeight: type: string xml: name: relative-weight nationalPayment: type: string xml: name: national-payment xml: name: code-properties CmsHccEsrdPace: type: object properties: hccCode: type: string xml: name: hcc-code desc: type: string href: type: string xml: attribute: true CmsHccV12: type: object properties: hccCode: type: string xml: name: hcc-code desc: type: string href: type: string xml: attribute: true CmsHccV22: type: object properties: hccCode: type: string xml: name: hcc-code desc: type: string href: type: string xml: attribute: true CmsHccVx: type: object properties: hccCode: type: string xml: name: hcc-code desc: type: string href: type: string xml: attribute: true DiagnosisCodeList: required: - cmsHccEsrdPace - cmsHccV12 - cmsHccV22 - cmsHccVx - rxHcc - rxHccV04 type: object properties: cmsHccV22: type: array xml: name: cms-hcc-v22 items: $ref: '#/components/schemas/CmsHccV22' cmsHccVx: type: array xml: name: cms-hcc-vx items: $ref: '#/components/schemas/CmsHccVx' cmsHccV12: type: array xml: name: cms-hcc-v12 items: $ref: '#/components/schemas/CmsHccV12' cmsHccEsrdPace: type: array xml: name: cms-hcc-esrd-pace items: $ref: '#/components/schemas/CmsHccEsrdPace' rxHccV04: type: array xml: name: rx-hcc-v04 items: $ref: '#/components/schemas/RxHccV04' rxHcc: type: array xml: name: rx-hcc items: $ref: '#/components/schemas/RxHcc' xml: name: diagnosis-code-list RxHcc: type: object properties: hccCode: type: string xml: name: hcc-code desc: type: string href: type: string xml: attribute: true RxHccV04: type: object properties: hccCode: type: string xml: name: hcc-code desc: type: string href: type: string xml: attribute: true Hcc: required: - cmsHccEsrdPace - cmsHccV12 - cmsHccV22 - rxHcc - rxHccV04 type: object properties: cmsHccV22: type: array xml: name: cms-hcc-v22 items: $ref: '#/components/schemas/CmsHccV22' cmsHccVx: type: array xml: name: cms-hcc-vx items: $ref: '#/components/schemas/CmsHccVx' cmsHccV12: type: array xml: name: cms-hcc-v12 items: $ref: '#/components/schemas/CmsHccV12' cmsHccEsrdPace: type: array xml: name: cms-hcc-esrd-pace items: $ref: '#/components/schemas/CmsHccEsrdPace' rxHccV04: type: array xml: name: rx-hcc-v04 items: $ref: '#/components/schemas/RxHccV04' rxHcc: type: array xml: name: rx-hcc items: $ref: '#/components/schemas/RxHcc' xml: name: hcc CategoryNotes: required: - subSection type: object properties: subSection: type: array xml: name: sub-section items: $ref: '#/components/schemas/SubSection' ChapterNotes: required: - categoryNotes - subSection type: object properties: subSection: type: array xml: name: sub-section items: $ref: '#/components/schemas/SubSection' categoryNotes: $ref: '#/components/schemas/CategoryNotes' CodeNotes: required: - categoryNotes - subSection type: object properties: subSection: type: array xml: name: sub-section items: $ref: '#/components/schemas/SubSection' categoryNotes: $ref: '#/components/schemas/CategoryNotes' CodeRangeNotes: required: - categoryNotes - subSection type: object properties: subSection: type: array xml: name: sub-section items: $ref: '#/components/schemas/SubSection' categoryNotes: $ref: '#/components/schemas/CategoryNotes' Icd10CmInstructionalNotes: required: - categoryNotes - chapterNotes - codeNotes - codeRangeNotes - sectionNotes type: object properties: sectionNotes: $ref: '#/components/schemas/SectionNotes' chapterNotes: $ref: '#/components/schemas/ChapterNotes' categoryNotes: $ref: '#/components/schemas/CategoryNotes' codeRangeNotes: $ref: '#/components/schemas/CodeRangeNotes' codeNotes: $ref: '#/components/schemas/CodeNotes' xml: name: icd10-cm-instructional-notes SectionNotes: required: - categoryNotes - subSection type: object properties: subSection: type: array xml: name: sub-section items: $ref: '#/components/schemas/SubSection' categoryNotes: $ref: '#/components/schemas/CategoryNotes' SubSection: type: object properties: header: type: string note: type: array items: type: string InstructionalNote: required: - note type: object properties: header: type: string note: type: array items: type: string InstructionalNotes: type: object properties: instructionalNote: type: array xml: name: instructional-note items: $ref: '#/components/schemas/InstructionalNote' xml: name: instructional-notes Icd10Code: required: - code type: object properties: code: type: string desc: type: string tips: type: string premierPick: type: string xml: name: premier-pick billTogether: type: string xml: name: bill-together href: type: string xml: attribute: true Icd10Mapping: type: object properties: node: type: array items: $ref: '#/components/schemas/Icd10Code' xml: name: icd-10-mapping Icd9Code: required: - code type: object properties: code: type: string desc: type: string tips: type: string premierPick: type: string xml: name: premier-pick billTogether: type: string xml: name: bill-together href: type: string xml: attribute: true Icd9Mapping: type: object properties: node: type: array items: $ref: '#/components/schemas/Icd9Code' xml: name: icd-9-mapping Contractors: type: object properties: type: $ref: '#/components/schemas/Links' fi: $ref: '#/components/schemas/Links' ca: $ref: '#/components/schemas/Links' na: $ref: '#/components/schemas/Links' nb: $ref: '#/components/schemas/Links' xml: name: Contractors Links: type: object properties: link: type: array xml: name: Link items: $ref: '#/components/schemas/Link' Code: type: object properties: policy: type: array items: $ref: '#/components/schemas/Policy' value: type: string xml: attribute: true Policies: type: object properties: code: type: array items: $ref: '#/components/schemas/Code' link: type: array items: $ref: '#/components/schemas/Link' xml: name: policies Ama: type: object properties: code: type: string description: type: string Modifier51Exempt: required: - ama - optum360 type: object properties: optum360: type: array items: $ref: '#/components/schemas/Optum360' ama: type: array items: $ref: '#/components/schemas/Ama' xml: name: modifier-51-exempt Optum360: type: object properties: code: type: string description: type: string ModifierProperty: required: - sources type: object properties: description: type: string definition: type: string usage: type: string sources: $ref: '#/components/schemas/Sources' physician: $ref: '#/components/schemas/Links' facility: $ref: '#/components/schemas/Links' opps: $ref: '#/components/schemas/Links' asc: $ref: '#/components/schemas/Links' ambulance: $ref: '#/components/schemas/Links' dme: $ref: '#/components/schemas/Links' mpfs: $ref: '#/components/schemas/Links' xml: name: modifier-property Source: type: object properties: value: type: string type: type: string xml: attribute: true SourceRationale: type: object properties: value: type: string type: type: string xml: attribute: true Sources: required: - source - sourceRationale type: object properties: source: type: array items: $ref: '#/components/schemas/Source' sourceRationale: type: array xml: name: source_rationale items: $ref: '#/components/schemas/SourceRationale' ModifierDesc: type: object properties: descFull: type: string xml: name: desc-full usage: type: string definition: type: string xml: name: code-properties Modifiers: type: object properties: physician: $ref: '#/components/schemas/Links' facility: $ref: '#/components/schemas/Links' opps: $ref: '#/components/schemas/Links' mpfs: $ref: '#/components/schemas/Links' asc: $ref: '#/components/schemas/Links' ambulance: $ref: '#/components/schemas/Links' dme: $ref: '#/components/schemas/Links' xml: name: modifiers Fee: required: - global type: object properties: global: type: string prof: type: string tc: type: string Mpfs: required: - mpfsFee type: object properties: mpfsFee: $ref: '#/components/schemas/Fee' mpfsRvu: $ref: '#/components/schemas/Rvu' xml: name: mpfs Rvu: required: - global type: object properties: global: $ref: '#/components/schemas/RvuType' prof: $ref: '#/components/schemas/RvuType' tc: $ref: '#/components/schemas/RvuType' RvuType: type: object properties: totalRvu: type: string xml: name: total-rvu workRvu: type: string xml: name: work-rvu peRvu: type: string xml: name: pe-rvu mpRvu: type: string xml: name: mp-rvu GlobalInfo: required: - global - intraoperative - postoperative - preoperative type: object properties: preoperative: type: string xml: name: Preoperative intraoperative: type: string xml: name: Intraoperative postoperative: type: string xml: name: Postoperative global: type: string xml: name: Global xml: name: global-info Code1: type: object properties: description: type: string reason: type: string modifier: type: string primarysecondary: type: string notes: type: string value: type: string xml: attribute: true Code2: type: object properties: description: type: string reason: type: string modifier: type: string primarysecondary: type: string notes: type: string value: type: string xml: attribute: true Conflict: type: object properties: code1: $ref: '#/components/schemas/Code1' code2: $ref: '#/components/schemas/Code2' name: type: string message: type: string Multicci: required: - conflict type: object properties: conflict: type: array items: $ref: '#/components/schemas/Conflict' xml: name: multicci ExcludesNotes: required: - note type: object properties: excludesHeader: type: string xml: name: excludes-header note: type: array items: $ref: '#/components/schemas/Note' ExcludesNotes1: required: - note type: object properties: excludesHeader1: type: string xml: name: excludes-header-1 note: type: array items: $ref: '#/components/schemas/Note' ExcludesNotes2: required: - note type: object properties: excludesHeader2: type: string xml: name: excludes-header-2 note: type: array items: $ref: '#/components/schemas/Note' IncludesExcludesNotes: type: object properties: includesNotes: $ref: '#/components/schemas/IncludesNotes' excludesNotes: $ref: '#/components/schemas/ExcludesNotes' excludesNotes1: $ref: '#/components/schemas/ExcludesNotes1' excludesNotes2: $ref: '#/components/schemas/ExcludesNotes2' xml: name: includes-excludes-notes IncludesNotes: required: - note type: object properties: includesHeader: type: string xml: name: includes-header note: type: array items: $ref: '#/components/schemas/Note' Note: type: object properties: content: type: string indentation: type: integer format: int32 xml: attribute: true OPPSCrossCode: required: - code - description - effectiveDate - referenceCrossCode type: object properties: code: type: string description: type: string referenceCrossCode: type: string xml: name: reference-cross-code effectiveDate: type: string xml: name: effective-date xml: name: opps-cross-code OPPSCrossCodeList: type: object properties: oppsCrossCodes: type: array xml: name: opps-cross-code items: $ref: '#/components/schemas/OPPSCrossCode' xml: name: opps-cross-code-list OptumSpecialtyArticle: required: - articleText - articleTitle - code - date - issue - source - year type: object properties: code: type: string year: type: string issue: type: string source: type: string articleTitle: type: string xml: name: article-title date: type: string articleText: type: string xml: name: article-text abstract: type: string OptumSpecialtyArticles: type: object properties: optumSpecialtyArticle: type: array items: $ref: '#/components/schemas/OptumSpecialtyArticle' xml: name: optumSpecialtyArticles PhysicianDoc: required: - text type: object properties: title: type: string text: type: string PhysicianDocs: type: object properties: physicianDoc: type: array xml: name: physician-doc items: $ref: '#/components/schemas/PhysicianDoc' xml: name: physician-docs RevCodeDesc: type: object properties: desc35: type: string xml: name: desc-35 desc48: type: string xml: name: desc-48 desc255: type: string xml: name: desc-255 descFull: type: string xml: name: desc-full xml: name: code-properties Item: type: object properties: code: type: string desc: type: string tobFacilityCode: type: string xml: name: tob-facility-code tobFacilityCodeDesc: type: string xml: name: tob-facility-code-desc note: type: string codetype: type: string xml: attribute: true ProcedureCodesToRevenue: type: object properties: item: type: array items: $ref: '#/components/schemas/Item' xml: name: procedure-codes-to-revenue RevenueCodeToProcedure: type: object properties: item: type: array items: $ref: '#/components/schemas/Item' link: type: array items: $ref: '#/components/schemas/Link' xml: name: revenue-code-to-procedure securitySchemes: bearerAuth: type: http scheme: bearer ws_auth: type: oauth2 flows: authorizationCode: authorizationUrl: https://idx.linkhealth.com/auth tokenUrl: https://idx.linkhealth.com/auth/token scopes: scope-1: required scope for API access x-readme: explorer-enabled: true proxy-enabled: true