Supported Edit Types¶

The MCE detects ~35 edit types from the CMS Java MCE 2.0. The tables below list the key edits by category.

Diagnosis edits¶

Edit	Type	Trigger
`INVALID_CODE`	PREPAYMENT	Code not in CMS master for discharge date
`SEX_CONFLICT`	PREPAYMENT	Code restricted by patient sex
`AGE_CONFLICT`	PREPAYMENT	Code restricted by patient age
`E_CODE_AS_PDX`	PREPAYMENT	External cause code used as principal diagnosis
`MANIFESTATION_AS_PDX`	PREPAYMENT	Manifestation code used as PDX
`UNACCEPTABLE_PDX`	PREPAYMENT	Code unacceptable as principal diagnosis
`NONSPECIFIC_PDX`	POSTPAYMENT	Non-specific PDX (suppressed if patient died)
`DUPLICATE_OF_PDX`	PREPAYMENT	Secondary diagnosis is same as PDX
`REQUIRES_SDX`	PREPAYMENT	PDX requires an accompanying secondary diagnosis
`QUESTIONABLE_ADMISSION`	PREPAYMENT	Questionable admission diagnosis code
`WRONG_PROCEDURE_PERFORMED`	PREPAYMENT	Wrong procedure performed flag
`UNSPECIFIED`	PREPAYMENT	Unspecified diagnosis code
`MEDICARE_IS_SECONDARY_PAYER`	POSTPAYMENT	Medicare Secondary Payer flag

Procedure edits¶

Edit	Type	Trigger
`NON_COVERED`	PREPAYMENT	Procedure not covered by Medicare
`LIMITED_COVERAGE`	PREPAYMENT	Limited coverage procedure
`BILATERAL`	POSTPAYMENT	Bilateral procedure without bilateral PDX
`OPEN_BIOPSY`	POSTPAYMENT	Open biopsy without prior closed biopsy
`INCONSISTENT_WITH_LENGTH_OF_STAY`	PREPAYMENT	Procedure inconsistent with LOS
`NONSPECIFIC_OR`	POSTPAYMENT	Non-specific OR procedure
`QUESTIONABLE_OBSTETRIC_ADMISSION`	PREPAYMENT	C-section or vaginal delivery admission

Validation edits¶

Edit	Type	Trigger
`INVALID_AGE`	PREPAYMENT	Age out of valid range
`INVALID_SEX`	PREPAYMENT	Invalid sex value
`INVALID_DISCHARGE_STATUS`	PREPAYMENT	Invalid discharge status code

Example¶

import msdrg

with msdrg.MceEditor() as mce:
    # E-code as principal diagnosis triggers an edit
    result = mce.edit({
        "discharge_date": 20250101,
        "age": 65, "sex": 0, "discharge_status": 1,
        "pdx": {"code": "V0001XA"},
        "sdx": [], "procedures": []
    })

print(result["edit_type"])         # "PREPAYMENT"
print(result["edits"][0]["name"])   # "E_CODE_AS_PDX"
print(result["edits"][0]["count"])  # 1

Note

The full list of ~35 edit types is defined in the CMS MCE 2.0 specification. The edits listed above are the most commonly encountered. Additional edits exist for specialized clinical scenarios and are fully implemented in the engine.