CARC 233 Active

PR-233: Hospital-Acquired Condition or Preventable Medical Error

TL;DR

Patient responsibility for a HAC is unusual. Verify the group code assignment.

Action
Review & Decide
Who Pays
Patient
Appeal
No
Patient Impact
Direct Financial
Disclaimer
This content is for informational purposes only and does not constitute professional billing advice. Always verify information against your payer contracts and current coding guidelines. Consult a certified billing specialist for specific claim issues.

What Does PR-233 Mean?

With PR, the patient is responsible for costs related to the hospital-acquired condition. This is unusual — HAC reductions typically affect the provider, not the patient.

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.

How to Resolve

  1. Verify the assignment Contact the payer to confirm PR is correct.
  2. Collect if confirmed If PR is confirmed, communicate the charges to the patient.
Do Not Appeal This Code

Hospital-Acquired Condition or Preventable Medical Error grouped under PR places the financial responsibility on the patient. The specific reason depends on the context of this adjustment — review any accompanying RARC codes for detail. Because this represents a placement of responsibility rather than a coverage denial, an appeal isn't the right action; verify the placement is correct before billing the patient.

How to Prevent PR-233

Also Filed As

The same CARC 233 may appear with different Group Codes:

CO-233 OA-233

Related Denial Codes

PR-13 — Date of Death Precedes Date of Service PR-14 — Date of Birth Follows Date of Service PR-19 — Workers' Compensation Claim PR-20 — Liability Carrier Responsible PR-21 — No-Fault Carrier Responsible

Sources

  1. https://x12.org/codes/claim-adjustment-reason-codes
  2. https://www.mdclarity.com/denial-code/233
  3. 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
  4. Codes maintained by X12. Visit x12.org for official definitions.