OA-233: Hospital-Acquired Condition or Preventable Medical Error
The HAC adjustment was applied during COB. Verify POA indicators.
What Does OA-233 Mean?
With OA, the HAC adjustment appeared during coordination of benefits.
CARC 233 indicates the payer identified a condition or complication that was acquired during the hospital stay (not present on admission) and reduced payment accordingly. Under CMS's Hospital-Acquired Conditions (HAC) Reduction Program and similar commercial payer policies, hospitals do not receive additional payment for certain preventable conditions that develop during the inpatient stay.
HACs include conditions like catheter-associated urinary tract infections, surgical site infections, falls, pressure ulcers, and other preventable complications. The Present on Admission (POA) indicator is critical — conditions present at admission are not subject to HAC reductions.
Common Causes
| Cause | Frequency |
|---|---|
| Informational adjustment for HAC reporting The HAC-related adjustment is reported as an informational OA item | Common |
How to Resolve
- Review POA coding Verify the condition's POA status.
- Appeal if incorrect Correct POA coding and submit to the appropriate payer.
Appeal with documentation correcting the POA indicator if the condition was present on admission.
How to Prevent OA-233
- Ensure accurate POA coding for all payers
General Prevention
- Maintain accurate POA reporting across all payers
- Implement HAC prevention programs
Also Filed As
The same CARC 233 may appear with different Group Codes:
Related Denial Codes
Sources
- https://x12.org/codes/claim-adjustment-reason-codes
- https://www.mdclarity.com/denial-code/233
- https://portal.ct.gov/-/media/ohs/health-it-advisory-council/apcd-advisory-group/data-submission-guide-workgroup/meeting-materials/6-30-22/carc-codes_final.pdf
- Codes maintained by X12. Visit x12.org for official definitions.