OA-233: Hospital-Acquired Condition or Preventable Error

What Does OA-233 Mean?

OA-233 is used in complex scenarios where the HAC determination involves multiple facilities or when the responsibility for the condition is not clearly assignable to a single provider.

CARC 233 is a quality-based payment denial tied to CMS's Hospital-Acquired Conditions (HAC) Reduction Program and similar payer policies. When a patient develops a condition during their hospital stay — such as a healthcare-associated infection (CAUTI, CLABSI, SSI, VAP), a fall with injury, a stage III/IV pressure ulcer, or a surgical error like wrong-site surgery or a retained foreign object — the payer will not reimburse the additional treatment costs associated with that condition.

The underlying policy rationale is that hospitals should prevent these conditions through proper clinical protocols. CMS and commercial payers use Present on Admission (POA) indicators to determine whether a diagnosis was present before hospitalization. If the POA indicator shows the condition was not present at admission, the payer assumes it was hospital-acquired and applies CARC 233 to deny the additional charges.

This code almost always appears with CO (contractual obligation), meaning the hospital absorbs the cost. The critical question when you see 233 is whether the POA indicators on the original claim were correctly assigned. If the condition was actually present on admission but the POA indicator was missing or incorrect, an appeal with clinical documentation can overturn the denial.

How to Resolve

Verify whether the condition was truly hospital-acquired by reviewing POA indicators and clinical documentation, then appeal with pre-admission evidence or accept the adjustment.

1. Trace the condition's origin Review transfer records and admission documentation from all facilities to determine where the condition was first documented or when it developed.
2. Coordinate with involved facilities Work with transferring or receiving facilities to establish which institution the condition originated in and correct the claims accordingly.

Common RARC Pairings

The RARC code tells you exactly what triggered the OA-233:

How to Prevent OA-233

• Ensure comprehensive condition documentation at every point of transfer between facilities
• Implement standardized admission assessments that capture the patient's full condition status at the time of arrival

Also Filed As

The same CARC 233 may appear with different Group Codes:

Related Denial Codes