233Denial Code (CARC)Active
CO 233 Denial Code - Hospital-Acquired Condition Fix
Code 233 indicates that the payer will not reimburse for services or charges associated with a hospital-acquired condition or preventable medical error. This adjustment reflects a non-payment decision due to the nature of the condition or error.
Who Pays: Group Code Liability
With code 233, the adjustment typically falls under CO, meaning it's a contractual obligation write-off and the patient cannot be billed. This is because the denial is due to a condition or error deemed preventable or acquired during the hospital stay, not the patient's fault.
Why Claims Get Code 233
- A hospital-acquired infection was documented during the patient's stay.
- A surgical error occurred that was preventable.
- A complication arose from a procedure due to lack of adherence to safety protocols.
- The condition was identified as preventable under the payer's policy.
- The hospital failed to follow established guidelines, resulting in an error.
How to Fix & Resubmit
- Review the patient's medical records to confirm if the condition was indeed acquired in the hospital or preventable.
- Check the payer's specific guidelines on hospital-acquired conditions and preventable errors to ensure accurate understanding.
- If the denial was issued in error, gather supporting documentation, such as medical records or safety protocol adherence, to dispute the claim.
- Contact the payer to discuss the denial if there is evidence the condition was not preventable or acquired.
- Submit a formal appeal with all supporting documentation if warranted by the payer's policy.
Corrected Claim or Appeal?
Submit a corrected claim if documentation shows the condition wasn't acquired or preventable. File a formal appeal if the denial was issued in error despite adherence to protocols.
Preventing Future 233 Denials
- Ensure strict adherence to hospital safety protocols and procedures to prevent errors.
- Regularly train staff on identifying and preventing hospital-acquired conditions.
- Implement a review process for all procedures to ensure compliance with safety standards.
- Maintain thorough documentation of all patient care to support claims if a denial is issued.