37 lines
1.4 KiB
YAML
37 lines
1.4 KiB
YAML
version: 1
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# Corrélation Actes CCAM / Diagnostics CIM-10
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# ------------------------------------------
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# VETO-27 : Acte chirurgical sans diagnostic justificatif
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rules:
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- name: "Appendicectomie"
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atih_ref: "Guide Méthodologique MCO : Justification clinique des actes chirurgicaux (Catégorie 06)"
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procedure_patterns: ["HHFA", "HHPA"]
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required_diagnosis: ["K35", "K36", "K37", "K38"]
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severity: "HARD"
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- name: "Cholécystectomie"
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atih_ref: "Guide Méthodologique MCO : Justification clinique des actes chirurgicaux (Catégorie 07)"
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procedure_patterns: ["HFCA"]
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required_diagnosis: ["K80", "K81", "K82"]
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severity: "HARD"
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- name: "Stent Coronaire"
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atih_ref: "Guide Méthodologique MCO : Justification clinique des actes interventionnels (Catégorie 05)"
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procedure_patterns: ["DZQM", "DDAF"]
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required_diagnosis: ["I20", "I21", "I22", "I23", "I24", "I25"]
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severity: "HARD"
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- name: "Hystérectomie"
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atih_ref: "Guide Méthodologique MCO : Justification clinique des actes chirurgicaux (Catégorie 13)"
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procedure_patterns: ["JFCA", "JFFA", "JFMA"]
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required_diagnosis: ["D25", "N80", "C53", "C54", "C55", "N85", "N92"]
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severity: "HARD"
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- name: "Prothèse de hanche"
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atih_ref: "Guide Méthodologique MCO : Justification clinique des actes chirurgicaux (Catégorie 08)"
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procedure_patterns: ["NEKA"]
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required_diagnosis: ["M16", "S72"]
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severity: "HARD"
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