Optum I-OCE Edits APIs API

openapi: 3.2.0
info:
  title: CMS Common Facility I-OCE Edits 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: I-OCE Edits APIs
paths:
  /api/cms/facility/{codeType}/diagnosis/{code}/ioce-edits:
    get:
      tags:
      - I-OCE Edits APIs
      summary: Facility - Fetch I-OCE associated with diagnosis i10cm/i9v1 code
      operationId: getIOCEAssociatedForICD10CmI9V1Code
      parameters:
      - name: codeType
        in: path
        required: true
        schema:
          type: string
          enum:
          - i10_cm
          - i9v1
      - name: code
        in: path
        required: true
        schema:
          type: string
        example: A18.14
      - 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: Facility - Detail associated with diagnosis i10cm/i9v1 code
          content:
            application/json:
              example:
                loAge: 15
                hiAge: 124
                validSex: 0
                mspAlert: null
                ecode: 0
                ismentalhealthdx: 0
                ismalignancy: null
        '400':
          description: Bad request
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/Notification'
              example:
                timestamp: '2023-07-14T06:37:03.741+00:00'
                status: 404
                error: Not Found
                message: Not Found
                path: /cmscommonms/api/cms/facility/{codeType:i10_cm|i9v1}/diagnosis/{code}/ioce-edits/invalid
        '500':
          description: Internal server error
          content:
            application/json:
              example:
                timestamp: '2023-07-28T06:36:22.518+00:00'
                path: /cmscommonms/api/cms/facility/{codeType:i10_cm|i9v1}/diagnosis/{code}/ioce-edit
                status: 500
                error: Internal Server Error
                requestId: e36d239e-324
      security:
      - bearerAuth: []
  /api/cms/facility/{codeType}/procedure/{code}/ioce-edits:
    get:
      tags:
      - I-OCE Edits APIs
      summary: Facility - Fetch I-OCE associated with specified cpt hcpcs code
      operationId: getIOCEAssociatedForCptHcpcsCode
      parameters:
      - name: codeType
        in: path
        required: true
        schema:
          type: string
          enum:
          - cpt
          - hcpcs
      - name: code
        in: path
        required: true
        schema:
          type: string
        example: 11920
      - 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: Facility - detail associated with specified I-OCE cpt/hcpcs codecode
          content:
            application/json:
              example:
                code: '15832'
                apc: '5073'
                statusIndicator:
                  code: J1
                  description: Hospital Part B services paid through a comprehensive APC
                paymentIndicator:
                  id: 1
                  description: Paid standard hospital OPPS amount (status indicators J1, J2, R, S, T, U, V, X)
                oceMap:
                  code: '12'
                  description: Questionable covered service
                  editResult: "This edit occurs when the procedure code reported has a questionable covered service indicator. It identifies procedures that are only covered by the Medicare program under certain medical circumstances.\nEXAMPLES:\n 5833 Exc Lipectomy Leg is covered by Medicare only when medically necessary.\n 36469 Injection Spider Veins Face is covered by Medicare only when medically necessary.\n\nThe claim will be suspended."
                  provideAction: A suspended claim is not returned to the provider but will not be processed for payment until the FI makes a determination or obtains further information.
                deductibleNA: false
                maxUnitsAllowed: null
                condBilateral: false
                inBilateral: false
        '400':
          description: Bad request
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/Notification'
              example:
                timestamp: '2023-07-14T06:37:03.741+00:00'
                status: 404
                error: Not Found
                message: Not Found
                path: /cmscommonms/api/cms/facility/{codeType:cpt|hcpcs}/procedure/{code}/ioce-edits/invalid
        '500':
          description: Internal server error
          content:
            application/json:
              example:
                timestamp: '2023-07-28T06:36:22.518+00:00'
                path: /cmscommonms/api/cms/facility/{codeType:cpt|hcpcs}/procedure/{code}/ioce-edit
                status: 500
                error: Internal Server Error
                requestId: e36d239e-324
      security:
      - bearerAuth: []
  /api/cms/facility/ioce-edits:
    get:
      tags:
      - I-OCE Edits APIs
      summary: 'Facility - fetch I-OCE edits '
      operationId: getIOCEEdits
      parameters:
      - 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: Facility - fetch I-OCE edits
          content:
            application/json:
              example:
                content:
                - editNumber: '1'
                  editHospitalType: Both OPPS and non-OPPS edit
                  editDescription: Invalid diagnosis code
                  editResults: 'This edit occurs when the principal diagnosis field is blank, there are

                    no diagnoses listed, or the diagnosis code is not valid for the selected

                    version of the program. Each ICD-9-CM diagnosis code is edited for

                    completeness and validity. Codes without a required fourth or fifth

                    digit are considered invalid. Codes are also checked to insure that they

                    were valid at the time of the patient''s visit. Date validity is tested

                    using the "from date" on the claim. If the claim does not

                    contain at least one diagnosis code, this error is also generated.

                    EXAMPLES: 2785 is an invalid code;  2780 needs a fifthdigit.; and 5678

                    Peritonitis NEC is invalid for service dates on or after October 1,2005.

                    Return claim to provider (RTP).'
                  providerAction: 'The provider should resubmit the claim once the problem(s) is/are

                    corrected.'
                - editNumber: '2'
                  editHospitalType: Both OPPS and non-OPPS edit
                  editDescription: Diagnosis and age conflict
                  editResults: 'This edit occurs when the diagnosis code includes an age range, and the

                    age reported is outside the range.  It indicates that the diagnosis code is inconsistent with the patient''s age. Age categories are as

                    follows:Newborn (age = 0) Pediatric (age = 0 to 17 years) Maternity (age

                    = 12 to 55 years) Adult (age=15 to 124) All ages (age 0 to 124 )

                    EXAMPLES: G0466  Abnormal Fetal Heart Rate Pre-Labor is appropriate only

                    for newborn patients. 33181 Reyes Syndrome is appropriate for pediatric

                    patients only. 63390 Ectopic Pregnancy without intrauterine pregnancy is

                    appropriate for maternity patients only. 501 Asbestosis is appropriate

                    only for adults.Return claim to provider (RTP).'
                  providerAction: The provider should resubmit the claim once the problem(s) is/are corrected.
                  editNumberLink:
                    value: '2'
                    href: /api/cms/facility/ioce-edits/codes-associated-with-edit/2
                totalCount: 2
        '404':
          description: Not found
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/Notification'
              example:
                timestamp: '2023-07-14T06:37:03.741+00:00'
                status: 404
                error: Not Found
                message: Not Found
                path: /cmscommonms/api/cms/facility/ioce-edits/99213
        '500':
          description: Internal server error
          content:
            application/json:
              example:
                timestamp: '2023-07-28T06:36:22.518+00:00'
                path: /cmscommonms/api/cms/facility/ioce-edits
                status: 500
                error: Internal Server Error
                requestId: e36d239e-324
      security:
      - bearerAuth: []
  /api/cms/facility/ioce-edits/codes-associated-with-edit/{edit-number}:
    get:
      tags:
      - I-OCE Edits APIs
      summary: 'Facility - fetch codes associated with specified I-OCE edit number '
      operationId: getCodesAssociatedForEdit
      parameters:
      - name: edit-number
        in: path
        required: true
        schema:
          type: integer
          format: int32
        example: 2
      - name: sort
        in: query
        description: Any of these (code,-code) are allowed values, default is -code
        required: false
        schema:
          type: array
          items:
            type: string
          default:
          - code
      - name: limit
        in: query
        required: false
        schema:
          type: integer
          format: int32
          default: 50
        example: 150
      - name: page
        in: query
        required: false
        schema:
          type: integer
          format: int32
          default: 1
      - name: filter
        in: query
        required: false
        schema:
          type: string
      - name: yyyy-MM-dd
        in: header
        description: Date for which historical data is required
        required: false
        schema:
          type: string
          format: yyyy-MM-dd
      responses:
        '200':
          description: Facility - codes associated with specified fetch I-OCE edit number
          content:
            application/json:
              example:
                content:
                - code: A18.14
                  codeDescription: Tuberculosis of prostate
                - code: A18.15
                  codeDescription: Tuberculosis of other male genital organs
                totalCount: 2
        '400':
          description: Bad request
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/Notification'
              example:
                timestamp: '2023-07-14T06:37:03.741+00:00'
                status: 404
                error: Not Found
                message: Not Found
                path: /cmscommonms/api/cms/facility/ioce-edits/codes-associated-with-edit/test
        '500':
          description: Internal server error
          content:
            application/json:
              example:
                timestamp: '2023-07-28T06:36:22.518+00:00'
                path: /cmscommonms/api/cms/facility/ioce-edits/codes-associated-with-edit/2
                status: 500
                error: Internal Server Error
                requestId: e36d239e-324
      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