Intervention Result "U" codes Outcomes Table 4
For Provider Use - Field D.65.03) Intervention Codes.
This is a subset of the "Intervention Codes"
(updated March 1996)
TABLE 4
Table 4 contains INTERVENTION OUTCOMES. These will be communicated, by the provider, through Field D.65.03, to indicate what action was taken as the result of an intervention. This allows the processor to assess the service provided and approve the appropriate level of compensation. Field D.65.03 (Intervention & Exception codes) provides for the submission of two codes in the same communication. Additional Codes and Code Values may be requested from CPhA if required.
Detected Issue, Mitigation Code
Consider the Mitigation code set used by PrescribeIT; -
FHIR Definition: Indicates an action that has been taken or is committed to to reduce or eliminate the likelihood of the risk identified by the detected issue from manifesting. Can also reflect an observation of known mitigating factors that may reduce/eliminate the need for any action. Link to value set below
Usage: In the second request, when you get a detected issue from the first request that is a rejection for clinical reasons
| CODE | VALUE | Notes |
|---|---|---|
| UA | Consulted Prescriber and Filled Rx as Written | |
| UB | Consulted Prescriber and Changed Dose | |
| UC | Consulted Prescriber and Changed Instruction for Use | |
| UD | Consulted Prescriber and Changed Drug | |
| UE | Consulted Prescriber and Changed Quantity | |
| UF | Patient Gave Adequate Explanation. Rx Filled as Written | |
| UG | Cautioned Patient. Rx Filled as Written | |
| UH | Counselled Patient. Rx Not Filled | Review |
| UI | Consulted Other Source. Rx Filled as Written | |
| UJ | Consulted Other Sources Altered Rx and Filled | |
| UK | Consulted Other Sources. Rx Not Filled | Review |
| UL | Rx Not Filled – Pharmacist Decision | Review |
| UM | Consulted Prescriber, Rx Not Filled | Review |
| UN | Assessed Patient, Therapy is Appropriate |
**UM, UL, UK, UH -- don't make sense - because the claim would not be paid --- ODB is the only one using them.