Optum

Optum DRG Information APIs API

The DRG Information APIs API from Optum — 6 operation(s) for drg information apis.

Documentation GitHub OpenAPI

Business capability

Operations 6

GET /api/cms/facility/{codetype}/{code}/drgs Fetches the DRG codes for given icd code #

GET /api/cms/facility/mdc/{codetype}/{mdccode}/drg Fetches DRG codes for the given MDC code for icd10 or icd9 codetype #

GET /api/cms/facility/mdc/{codetype}/all Fetches MDC data for icd10 and icd9 #

GET /api/cms/facility/drg/{drg-code}/icd9/cross-codes Fetches the ICD9 specific codes for corresponding DRG cross code #

GET /api/cms/facility/drg/{drg-code}/icd10/cross-codes Fetches the I10 specific codes for corresponding DRG cross code #

GET /api/cms/facility/drg/{codetype}/all Fetches all DRG codes for given code group (icd9/icd10) #

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OpenAPI Specification

openapi: 3.2.0
info:
  title: CMS Common Facility DRG Information APIs API
  description: MicroService that contains CMS related information
  contact:
    name: Ken Kracker
    email: ken.kracker@optum.com
  version: v1.0
servers:
- url: /v1/cmscommonms
tags:
- name: DRG Information APIs
paths:
  /api/cms/facility/{codetype}/{code}/drgs:
    get:
      tags:
      - DRG Information APIs
      summary: Fetches the DRG codes for given icd code
      operationId: drgCodesForIcdCode
      parameters:
      - name: codetype
        in: path
        required: true
        schema:
          type: string
          enum:
          - i9v1
          - i9v3
          - i10_cm
          - i10_pcs
        example: i10_cm
      - name: code
        in: path
        required: true
        schema:
          type: string
        example: I60.00
      - name: limit
        in: query
        required: false
        schema:
          type: integer
          format: int32
          default: 50
      - name: page
        in: query
        required: false
        schema:
          type: integer
          format: int32
          default: 1
      - name: sort
        in: query
        description: Any of these (drgCode,-drgCode) are allowed values.
        required: false
        schema:
          type: array
          items:
            type: string
          default:
          - drgCode
      - name: yyyy-MM-dd
        in: header
        description: Date for which historical data is required
        required: false
        schema:
          type: string
          format: yyyy-MM-dd
      responses:
        '200':
          description: Fetch MCE edits data
          content:
            application/json:
              example:
                content:
                - drgCode: '020'
                  fullDescription: Intracranial Vascular Procedures with Principal Diagnosis of Hemorrhage with MCC
                  mdc: '1'
                  mdcDescription: Diseases And Disorders Of The Nervous System
                  medSurg: S
                  gmLos: '10.2'
                  amLos: '14.1'
                  relativeWeight: '8.4524'
                  nationalPayment: '54042.79'
                - drgCode: '021'
                  fullDescription: Intracranial Vascular Procedures with Principal Diagnosis of Hemorrhage with CC
                  mdc: '1'
                  mdcDescription: Diseases And Disorders Of The Nervous System
                  medSurg: S
                  gmLos: '6.3'
                  amLos: '9.0'
                  relativeWeight: '6.1414'
                  nationalPayment: '39266.76'
                - drgCode: '022'
                  fullDescription: Intracranial Vascular Procedures with Principal Diagnosis of Hemorrhage without CC/MCC
                  mdc: '1'
                  mdcDescription: Diseases And Disorders Of The Nervous System
                  medSurg: S
                  gmLos: '2.5'
                  amLos: '3.9'
                  relativeWeight: '3.4767'
                  nationalPayment: '22229.25'
                totalCount: 3
        '404':
          description: Not found
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/Notification'
              example:
                timestamp: '2024-04-12T13:52:54.478+00:00'
                status: 404
                error: Not Found
                trace: 'org.springframework.web.servlet.resource.NoResourceFoundException: No static resource api/cms/cms/facility/cpt/99213/drgs.'
      security:
      - bearerAuth: []
  /api/cms/facility/mdc/{codetype}/{mdccode}/drg:
    get:
      tags:
      - DRG Information APIs
      summary: Fetches DRG codes for the given MDC code for icd10 or icd9 codetype
      operationId: fetchDRGCodeListForMDC
      parameters:
      - name: codetype
        in: path
        required: true
        schema:
          type: string
          enum:
          - icd9
          - icd10
      - name: mdccode
        in: path
        required: true
        schema:
          type: string
        example: 1
      - name: limit
        in: query
        required: false
        schema:
          type: integer
          format: int32
          default: 50
        example: 150
      - name: page
        in: query
        required: false
        schema:
          type: integer
          format: int32
          default: 1
      - name: yyyy-MM-dd
        in: header
        description: Date for which historical data is required
        required: false
        schema:
          type: string
          format: yyyy-MM-dd
      responses:
        '200':
          description: Fetch MDC Data for icd9 and icd10
          content:
            application/json:
              example:
                content:
                - drgCode: '927'
                  fullDescription: Extensive Burns or Full Thickness Burns with Mechanical Ventilation 96+ Hours with Skin Graft
                  relativeWeight: '15.5499'
                - drgCode: '928'
                  fullDescription: Full Thickness Burn with Skin Graft or Inhalation Injury with CC/MCC
                  relativeWeight: '5.3820'
                - drgCode: '929'
                  fullDescription: Full Thickness Burn with Skin Graft or Inhalation Injury without CC/MCC
                  relativeWeight: '2.3344'
                - drgCode: '933'
                  fullDescription: Extensive Burns or Full Thickness Burns with Mechanical Ventilation 96+ Hours without Skin Graft
                  relativeWeight: '2.7557'
                - drgCode: '934'
                  fullDescription: Full Thickness Burn without Skin Graft or Inhalation Injury
                  relativeWeight: '1.5748'
                - drgCode: '935'
                  fullDescription: Nonextensive Burns
                  relativeWeight: '1.4717'
                totalCount: 6
        '404':
          description: Not found
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/Notification'
              example:
                timestamp: '2024-05-16T07:02:57.183+00:00'
                status: 404
                error: Not Found
                trace: 'org.springframework.web.servlet.resource.NoResourceFoundException: No static resource api/cms/facility/mdc/cpt/1/drg.'
        '500':
          description: Internal server error
          content:
            application/json:
              example:
                timestamp: '2024-05-16T07:15:00.252+00:00'
                status: 500
                error: Internal Server Error
                path: cmscommonms/api/cms/facility/mdc/icd9/1/drg
                message: 'java.lang.IllegalArgumentException: Page index must not be less than zero'
      security:
      - bearerAuth: []
  /api/cms/facility/mdc/{codetype}/all:
    get:
      tags:
      - DRG Information APIs
      summary: Fetches MDC data for icd10 and icd9
      operationId: fetchMCEEdits_1
      parameters:
      - name: codetype
        in: path
        required: true
        schema:
          type: string
          enum:
          - icd9
          - icd10
      - name: limit
        in: query
        required: false
        schema:
          type: integer
          format: int32
          default: 50
        example: 150
      - name: page
        in: query
        required: false
        schema:
          type: integer
          format: int32
          default: 1
      - name: filter
        in: query
        required: false
        schema:
          type: string
      - name: yyyy-MM-dd
        in: header
        description: Date for which historical data is required
        required: false
        schema:
          type: string
          format: yyyy-MM-dd
      responses:
        '200':
          description: Fetch MDC Data for icd9 and icd10
          content:
            application/json:
              example:
                content:
                - code: '11'
                  fullDescription: Diseases And Disorders Of The Kidney And Urinary Tract
                  version: '41.1'
                  releaseDate: '2024-04-01 00:00:00'
                totalCount: 1
        '404':
          description: Not found
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/Notification'
              example:
                timestamp: '2024-05-09T07:02:57.183+00:00'
                status: 404
                error: Not Found
                trace: 'org.springframework.web.servlet.resource.NoResourceFoundException: No static resource api/cms/facility/mdc/cpt/all.'
        '500':
          description: Internal server error
          content:
            application/json:
              example:
                timestamp: '2024-05-09T07:15:00.252+00:00'
                status: 500
                error: Internal Server Error
                path: cmscommonms/api/cms/facility/mdc/icd10/all
                message: 'java.lang.IllegalArgumentException: Page index must not be less than zero'
      security:
      - bearerAuth: []
  /api/cms/facility/drg/{drg-code}/icd9/cross-codes:
    get:
      tags:
      - DRG Information APIs
      summary: Fetches the ICD9 specific codes for corresponding DRG cross code
      operationId: getI9CodesForDrgCode
      parameters:
      - name: drg-code
        in: path
        description: Drg Cross Codes
        required: true
        schema:
          type: string
        example: '001'
      - name: limit
        in: query
        required: false
        schema:
          type: integer
          format: int32
          default: 50
        example: 150
      - name: page
        in: query
        required: false
        schema:
          type: integer
          format: int32
          default: 1
      - name: filter
        in: query
        required: false
        schema:
          type: string
      - name: yyyy-MM-dd
        in: header
        description: Date for which historical data is required
        required: false
        schema:
          type: string
          format: yyyy-MM-dd
      responses:
        '200':
          description: Fetches the ICD9 specific codes for corresponding DRG cross code
          content:
            application/json:
              example:
                content:
                - code: '174.0'
                  codeDescription: Malignant neoplasm of nipple and areola of female breast
                - code: '175.0'
                  codeDescription: Malignant neoplasm of nipple and areola of male breast
                totalCount: 2
        '400':
          description: Bad request
          content:
            application/json:
              example:
                error:
                - 'filter : length must be between 2 and 180'
                warning: null
                info: null
        '500':
          description: Internal server error
          content:
            application/json:
              example:
                timestamp: '2023-07-27T08:10:07.573+00:00'
                status: 500
                error: Internal Server Error
                path: /cmscommonms/api/cms/facility/drg/582/icd9/cross-codes
      security:
      - bearerAuth: []
  /api/cms/facility/drg/{drg-code}/icd10/cross-codes:
    get:
      tags:
      - DRG Information APIs
      summary: Fetches the I10 specific codes for corresponding DRG cross code
      operationId: getI10CodesForDrgCode
      parameters:
      - name: drg-code
        in: path
        description: Drg Cross Codes
        required: true
        schema:
          type: string
        example: '001'
      - name: yyyy-MM-dd
        in: header
        description: Date for which historical data is required
        required: false
        schema:
          type: string
          format: yyyy-MM-dd
      responses:
        '200':
          description: Fetches the I10 specific codes for corresponding DRG cross code
          content:
            application/json:
              example:
              - sortOrder: '1'
                term: Heart Transplant Operating Room Procedures
                codes:
                - code: 02YA0Z0
                  codeTypeId: '32768'
                  term: Transplantation of Heart, Allogeneic, Open Approach
                  exceptionFlag: N
                - code: 02YA0Z1
                  codeTypeId: '32768'
                  term: Transplantation of Heart, Syngeneic, Open Approach
                  exceptionFlag: N
                - code: 02YA0Z2
                  codeTypeId: '32768'
                  term: Transplantation of Heart, Zooplastic, Open Approach
                  exceptionFlag: N
              - sortOrder: '2'
                term: OR
                indent: '2'
                codes:
                - code: 02RK0JZ
                  codeTypeId: '32768'
                  term: Replacement of Right Ventricle with Synthetic Substitute, Open Approach
                  exceptionFlag: N
        '400':
          description: Bad request
          content:
            application/json:
              example:
                error:
                - 'drgCode : length must be between 3 and 3'
                warning: null
                info: null
        '500':
          description: Internal server error
          content:
            application/json:
              example:
                timestamp: '2023-07-27T08:10:07.573+00:00'
                status: 500
                error: Internal Server Error
                path: /cmscommonms/api/cms/facility/drg/001/icd10/cross-codes
      security:
      - bearerAuth: []
  /api/cms/facility/drg/{codetype}/all:
    get:
      tags:
      - DRG Information APIs
      summary: Fetches all DRG codes for given code group (icd9/icd10)
      operationId: drgCodesAll
      parameters:
      - name: codetype
        in: path
        required: true
        schema:
          type: string
          enum:
          - icd9
          - icd10
      - name: limit
        in: query
        required: false
        schema:
          type: integer
          format: int32
          default: 50
      - name: page
        in: query
        required: false
        schema:
          type: integer
          format: int32
          default: 1
      - name: filter
        in: query
        required: false
        schema:
          type: string
      - name: sort
        in: query
        description: Any of these (drgCode,-drgCode) are allowed values.
        required: false
        schema:
          type: array
          items:
            type: string
          default:
          - drgCode
      - name: yyyy-MM-dd
        in: header
        description: Date for which historical data is required
        required: false
        schema:
          type: string
          format: yyyy-MM-dd
      responses:
        '200':
          description: Fetch MCE Edits Data
          content:
            application/json:
              example:
                content:
                - drgCode: '010'
                  fullDescription: Pancreas Transplant
                  mdc: PRE
                  mdcDescription: Pre MDC
                  medSurg: S
                  gmLos: '7.8000'
                  amLos: '9.6000'
                  relativeWeight: '4.0849'
                  nationalPayment: '22055.4800'
                - drgCode: '011'
                  fullDescription: Tracheostomy for Face, Mouth, and Neck Diagnoses with MCC
                  mdc: PRE
                  mdcDescription: Pre MDC
                  medSurg: S
                  gmLos: '11.3000'
                  amLos: '14.1000'
                  relativeWeight: '4.7380'
                  nationalPayment: '25581.7400'
                - drgCode: '012'
                  fullDescription: Tracheostomy for Face, Mouth, and Neck Diagnoses with CC
                  mdc: PRE
                  mdcDescription: Pre MDC
                  medSurg: S
                  gmLos: '8.4000'
                  amLos: '10.0000'
                  relativeWeight: '3.3293'
                  nationalPayment: '17975.7900'
                totalCount: 3
        '400':
          description: Bad request
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/Notification'
              example:
                error:
                - 'filter : length must be between 2 and 180'
                warning: null
                info: null
        '404':
          description: Not found
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/Notification'
              example:
                timestamp: '2024-04-12T13:52:54.478+00:00'
                status: 404
                error: Not Found
                trace: 'org.springframework.web.servlet.resource.NoResourceFoundException: No static resource api/cms/facility/drg/icd9/all.'
      security:
      - bearerAuth: []
components:
  schemas:
    Notification:
      type: object
      properties:
        error:
          type: array
          items:
            type: string
        warning:
          type: array
          items:
            type: string
        info:
          type: array
          items:
            type: string
  securitySchemes:
    bearerAuth:
      type: http
      scheme: bearer
      bearerFormat: JWT
x-readme:
  explorer-enabled: true
  proxy-enabled: true