Intervention "C" codes, Refusal to Fill Table 2 FEEDBACK
FHIR mapping
FOR CONSIDERATION: MedicationDispense..notPerformedReason TBD: This was present in FHIRv5, but not present in R4. Consider an extension for pre-adoption? Currently mapped as an intervention code; we can manage via its own value set if we wish.
Definition: Indicates the reason why a dispense was not performed. This is a detected issue - we can use these exact codes as there is only an example binding. Lamar - agrees these can move out of intervention and move into this field.
**Usage: These are currently on the Intervention Code List, sent today as interventions, along with a SSC (eg 1 - Refuse to Fill).
Codes
| CPHA Code | Description | FHIR Refuse to Fill |
|---|---|---|
| CA | Prior Adverse Reaction | |
| CB | Previous Treatment Failure | |
| CD | Therapeutic Duplication | |
| CF | Falsified or Altered Prescription | |
| CH | Dangerously High Dosage | |
| CI | Significant Drug Interaction | |
| CL | Sub-therapeutic Dose | |
| CM | Suspected Multi-pharmacy/Multi doctor | |
| CO | Potential Overuse/Abuse |
CPHA Spec, Table 2 wording
DUR intervention procedures taken or identify that special coverage and payment rules are being claimed
Table 2 contains INTERVENTION & EXCEPTION CODES which the provider (pharmacy) uses to communicate various cautionary concerns to the processor.
These Codes and Code Values are included in Field D.65.03, Intervention Codes. (Claim Request). of the Pharmacy Claim Standard. Other Codes and Code Values can be assigned by CPhA upon the request of a provider, processor or payor. Providers may communicate the messages represented by these codes as a part of the initial submission or in response to requests or rejections by the processor
** These are typically used for Refusal to Fill situations in BC**
APPENDIX 3 PHARMACEUTICAL SERVICE and CAUTION CODE TABLES
(updated March 2011)
There has been an increasing interest, by both the providers and purchasers of pharmaceutical products and
services, to communicate information with respect to drug utilization review, pharmacist interventions and
enhanced treatment outcomes. This Appendix has been prepared to serve as a guideline to the use of the
Pharmacy Claim Standard. The objectives are:
- to draw attention to potential treatment problems which are detected by reference to the claim processor's history and information data base
- to communicate potential problems identified by provider's observations with respect to the prescription, patient compliance or drug utilization and to report interventions to enhance therapeutic outcomes, prevent adverse effect and misuse and to promote appropriate use
- to identify special services supplied by the provider
- to report the result, or outcome, of interventions made by the provider
- to indicate the level of service for which the provider is to be compensated.|
The following discussion is intended to achieve uniformity in the interpretation of the purpose of this Appendix and the use of the individual tables it contains.
This will be conveyed using the FHIR resource Detected Issue. Discuss with Lamar, and review detected issue ???? Lamar, do you always have one of these together with the result code/mitigation??