version: 1

# Corrélation Actes CCAM / Diagnostics CIM-10
# ------------------------------------------
# VETO-27 : Acte chirurgical sans diagnostic justificatif

rules:
  - name: "Appendicectomie"
    atih_ref: "Guide Méthodologique MCO : Justification clinique des actes chirurgicaux (Catégorie 06)"
    procedure_patterns: ["HHFA", "HHPA"]
    required_diagnosis: ["K35", "K36", "K37", "K38"]
    severity: "HARD"

  - name: "Cholécystectomie"
    atih_ref: "Guide Méthodologique MCO : Justification clinique des actes chirurgicaux (Catégorie 07)"
    procedure_patterns: ["HFCA"]
    required_diagnosis: ["K80", "K81", "K82"]
    severity: "HARD"

  - name: "Stent Coronaire"
    atih_ref: "Guide Méthodologique MCO : Justification clinique des actes interventionnels (Catégorie 05)"
    procedure_patterns: ["DZQM", "DDAF"]
    required_diagnosis: ["I20", "I21", "I22", "I23", "I24", "I25"]
    severity: "HARD"

  - name: "Hystérectomie"
    atih_ref: "Guide Méthodologique MCO : Justification clinique des actes chirurgicaux (Catégorie 13)"
    procedure_patterns: ["JFCA", "JFFA", "JFMA"]
    required_diagnosis: ["D25", "N80", "C53", "C54", "C55", "N85", "N92"]
    severity: "HARD"

  - name: "Prothèse de hanche"
    atih_ref: "Guide Méthodologique MCO : Justification clinique des actes chirurgicaux (Catégorie 08)"
    procedure_patterns: ["NEKA"]
    required_diagnosis: ["M16", "S72"]
    severity: "HARD"