Optum

Optum Code Specific Guidelines API

The Code Specific Guidelines API from Optum — 2 operation(s) for code specific guidelines.

Documentation GitHub OpenAPI

Business capability

Medical Coding Management BC-2870.20

Operations 2

GET /codetype/icd10cm/{code}/code-specific-guidelines Show Color Codes for the given ICD10CM code #

GET /codetype/icd10pcs/{code}/code-specific-guidelines Show Code Specific Guidelines for the given ICD10PCS code #

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OpenAPI Specification

openapi: 3.2.0
info:
  title: Optum Real-Time eContent Web services Code Specific Guidelines API
  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: []
tags:
- name: Code Specific Guidelines
paths:
  /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
components:
  schemas:
    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
    Icd10pcsCodeSpecificGuideline:
      type: object
      properties:
        year:
          type: string
        title:
          type: string
        guideline:
          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
  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