How To Fix Denial Code 233 | Common Reasons, Next Steps & How To Avoid It

Denial Code 233 (CARC) means that a claim has been denied because the services or charges are related to the treatment of a hospital-acquired condition or preventable medical error. Below you can find the description, common reasons for denial code 233, next steps, how to avoid it, and examples.

2. Description

Denial Code 233 is a Claim Adjustment Reason Code (CARC) and is described as ‘Services/charges related to a hospital-acquired condition or preventable medical error’. This denial code indicates that the insurance company will not make the payment for the billed services or charges because they are associated with a condition or error that could have been prevented during the patient’s hospital stay. In simpler terms, the claim is not payable because the services or charges are deemed to be the responsibility of the hospital.

2. Common Reasons

The most common reasons for denial code 233 are:

1. Hospital-Acquired Conditions: Denial code 233 may be triggered when the services or charges are directly related to a condition that the patient acquired during their hospital stay. These conditions are considered preventable, and the insurance company will not cover the associated costs.
2. Preventable Medical Errors: If the services or charges are a result of a preventable medical error made during the patient’s hospitalization, denial code 233 may be applied. This could include errors in medication administration, surgical mistakes, or other preventable incidents that led to additional services or charges.
3. Lack of Documentation: Insufficient documentation to support that the services or charges are unrelated to a hospital-acquired condition or preventable medical error can result in denial code 233. If the necessary documentation is not provided, the insurance company may assume that the services or charges are indeed related to the condition or error.
4. Incorrect Coding: Inaccurate coding of the services or charges can also lead to denial code 233. If the coding does not clearly indicate that the services or charges are unrelated to a hospital-acquired condition or preventable medical error, the claim may be denied.
5. Policy Exclusions: Some insurance policies may have specific exclusions for certain hospital-acquired conditions or preventable medical errors. If the services or charges fall under these exclusions, denial code 233 may be applied.

3. Next Steps

You can address denial code 233 as follows:

1. Review Documentation: Thoroughly review the documentation related to the services or charges that were denied under code 233. Ensure that there is sufficient evidence to support that they are unrelated to a hospital-acquired condition or preventable medical error.
2. Appeal the Denial: If you believe that the denial was made in error or that the services or charges are indeed unrelated to a hospital-acquired condition or preventable medical error, file an appeal with the insurance company. Provide any additional documentation or information that supports your case.
3. Consult with the Hospital: If the denial is related to a hospital-acquired condition or preventable medical error, consult with the hospital’s billing department or administration. They may be able to provide additional information or documentation to support your appeal.
4. Seek Legal Advice: In some cases, it may be necessary to seek legal advice if you believe that the denial is unjust or if you encounter difficulties in resolving the issue. An attorney specializing in healthcare law can guide you through the appeals process and help protect your rights.

4. How To Avoid It

To avoid denial code 233 in the future, consider the following:

1. Prevent Hospital-Acquired Conditions: Implement strategies and protocols to prevent hospital-acquired conditions. This may include proper infection control measures, patient education, and regular staff training.
2. Ensure Accurate Documentation: Maintain accurate and detailed documentation of the patient’s hospital stay, including any incidents or conditions that may arise. Clear and comprehensive documentation can help support that the services or charges are unrelated to a hospital-acquired condition or preventable medical error.
3. Proper Coding: Ensure that the services or charges are coded accurately and specifically to indicate that they are unrelated to a hospital-acquired condition or preventable medical error. Regularly review coding guidelines and stay updated on any changes or updates.
4. Review Insurance Policies: Familiarize yourself with the insurance policies of your patients. Be aware of any exclusions or limitations related to hospital-acquired conditions or preventable medical errors. This knowledge can help you determine if certain services or charges may be denied under code 233.

5. Example Cases

Below are two examples of denial code 233:

• Example 1: A patient undergoes surgery and develops a surgical site infection during their hospital stay. The insurance company denies the claim for the additional services required to treat the infection under code 233, stating that it is a hospital-acquired condition.
• Example 2: A medication error occurs during a patient’s hospitalization, resulting in an adverse reaction that requires additional medical attention. The insurance company denies the claim for the additional services under code 233, deeming it a preventable medical error.

Source: Claim Adjustment Reason Codes