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Apply CMS Edit Rules

Source: R/edit_rules.R
edit_rules.Rd

Apply age/sex edits to CC mappings based on CMS edit rules. Edits are applied AFTER initial ICD -> CC mapping but BEFORE hierarchies.

Usage

edit_rules(icd, age = NULL, sex = NULL, model = "C28")

Arguments

icd

<chr> ICD-10-CM diagnosis code

age

<int> Patient's age; Max = 49|17, Min = 2

sex

<chr> Patient's sex; 2 rules for Female ("F/2")

model

<chr> Only one is "C28"

Value

Modified icd_to_cc() output with edits applied

Details

Edit types:

  • invalid: Remove the diagnosis (don't assign any CC)

  • override: Assign a different CC than the default mapping

Examples

icd_to_cc(icd = c("D67", "C50522"), model = "C28", year = 2026L)
#> # A tibble: 2 × 4
#>    year icd_code    cc model_name       
#>   <int> <chr>    <int> <chr>            
#> 1  2026 C50522      23 CMS-HCC Model V28
#> 2  2026 D67        111 CMS-HCC Model V28
edit_rules(icd = c("D67", "C50522"), age = 56L, sex = "F", model = "C28")
#> # A tibble: 2 × 4
#>    year icd_code    cc model_name       
#>   <int> <chr>    <int> <chr>            
#> 1  2026 C50522      22 CMS-HCC Model V28
#> 2  2026 D67        112 CMS-HCC Model V28