Claim scrubbing and denial resolution, callable by an agent

request

curl -X POST https://denial7.com/api/v1/scrub \
  -H "Content-Type: application/json" \
  -H "Idempotency-Key: scrub-demo-1" \
  -d '{"dateOfService":"2026-07-01","lines":[{"code":"80053","modifiers":[],"units":1},{"code":"80048","modifiers":[],"units":1}]}'

response 200

{
  "data": {
    "input": {
      "dateOfService": "2026-07-01",
      "payerSlug": null,
      "lines": [
        {
          "code": "80053",
          "modifiers": [],
          "units": 1
        },
        {
          "code": "80048",
          "modifiers": [],
          "units": 1
        }
      ]
    },
    "editQuarter": "2026 Q3",
    "datasetQuarter": "2026 Q3",
    "findings": [
      {
        "kind": "ptp",
        "status": "fail",
        "lineIndexes": [
          0,
          1
        ],
        "codes": [
          "80053",
          "80048"
        ],
        "summary": "80048 is bundled into 80053 and no modifier can unbundle it",
        "rule": "PTP edit with modifier indicator 0. CMS rationale: CPT Manual or CMS manual coding instruction. Indicator 0 means no modifier is permitted to bypass this edit under any circumstances.",
        "remedy": "Remove 80048 from this claim, or bill 80048 alone on a date of service where 80053 is not billed. Appending a 59 or X modifier here would be an incorrect use of the modifier.",
        "citation": {
          "source": "CMS Medicare NCCI Procedure to Procedure Edits, Practitioner Services",
          "url": "https://www.cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncci-edits/medicare-ncci-procedure-procedure-ptp-edits",
          "quarter": "2026 Q3",
          "retrievedAt": "2026-07-18",
          "confidence": "verified"
        }
      },
      {
        "kind": "mue",
        "status": "pass",
        "lineIndexes": [
          0
        ],
        "codes": [
          "80053"
        ],
        "summary": "80053: 1 unit is within the MUE of 1",
        "rule": "MUE 1, adjudication indicator MAI 3. Date of service edit, clinical. Units above this limit are unlikely but not impossible. A higher count can be allowed on appeal when the medical record supports it.",
        "remedy": "",
        "citation": {
          "source": "CMS Medicare NCCI Medically Unlikely Edits, Practitioner Services",
          "url": "https://www.cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncci-edits/medicare-ncci-medically-unlikely-edits",
          "quarter": "2026 Q3",
          "retrievedAt": "2026-07-18",
          "confidence": "verified"
        }
      },
      {
        "kind": "mue",
        "status": "pass",
        "lineIndexes": [
          1
        ],
        "codes": [
          "80048"
        ],
        "summary": "80048: 1 unit is within the MUE of 2",
        "rule": "MUE 2, adjudication indicator MAI 3. Date of service edit, clinical. Units above this limit are unlikely but not impossible. A higher count can be allowed on appeal when the medical record supports it.",
        "remedy": "",
        "citation": {
          "source": "CMS Medicare NCCI Medically Unlikely Edits, Practitioner Services",
          "url": "https://www.cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncci-edits/medicare-ncci-medically-unlikely-edits",
          "quarter": "2026 Q3",
          "retrievedAt": "2026-07-18",
          "confidence": "verified"
        }
      }
    ],
    "summary": {
      "total": 3,
      "failures": 1,
      "bypassed": 0,
      "noData": 0,
      "clean": false
    },
    "coverage": {
      "ptpPairsLoaded": 40009,
      "mueCodesLoaded": 15162,
      "note": "Checked against 40009 PTP pairs and 15162 MUE values curated from the published CMS 2026 Q3 files. This is a subset of the full CMS files. Codes marked no data were not checked and may still be subject to an edit. PTP edits carry their own effective and deletion dates, so a date of service in an earlier quarter is checked against the edit that was genuinely in force then. The MUE table carries no dates, so it is only applied to a date of service inside the quarter we hold."
    }
  },
  "request_id": "req_2f9c41a7b0e84d15",
  "disclaimer": "Denial7 provides billing and administrative guidance based on published CMS and X12 sources. It is not medical advice, not a coverage determination, and not a guarantee of payment. NCCI and MUE edits are republished quarterly and payer policies vary by contract. Always confirm against the payer's own current policy before submitting or appealing.",
  "attribution": "Data from Denial7 (https://denial7.com): CMS NCCI/MUE edits and X12 CARC/RARC codes, cited by source and confidence. Free responses require this attribution."
}