ActReason
|
Lvl |
Type, Domain name and/or Mnemonic code |
Concept ID |
Mnemonic |
Print Name |
Definition/Description |
1
|
A: ActAccommodationReason |
V17425 |
|
|
Identifies the reason the patient is assigned to this accommodation type
|
2
|
L: (ACCREQNA)
|
17429 |
ACCREQNA |
Accommodation Requested Not Available |
Accommodation requested is not available.
|
2
|
L: (FLRCNV)
|
17430 |
FLRCNV |
Floor Convenience |
Accommodation is assigned for floor convenience.
|
2
|
L: (MEDNEC)
|
17428 |
MEDNEC |
Medical Necessity |
Required for medical reasons(s).
|
2
|
L: (PAT)
|
14880 |
PAT |
Patient request |
The Patient requested the action
|
1
|
A: ActAdjudicationReason |
V19385 |
|
|
Explanatory codes that describe reasons why an Adjudicator has financially adjusted an invoice (claim).
A companion domain (ActAdjudicationInformationCode) includes information reasons which do not have a financial impact on an
invoice (claim).
Example adjudication reason code is AA-CLAIM-0011 - Only Basic Procedure/Test Eligible.
Codes from this domain further rationalizes ActAdjudicationCodes (e.g. AA - Adjudicated with Adjustment), which are used to
describe the process of adjudicating an invoice. For AS - Adjudicated as Submitted, there should be no specification of ActAdjudicationReason
codes, as there are no financial adjustments against the invoice.
|
1
|
A: ActBillableClinicalServiceReason |
V19388 |
|
|
Reason for Clinical Service being performed.
This domain excludes reasons specified by diagnosed conditions.
Examples of values from this domain include duplicate therapy and fraudulent prescription.
|
1
|
A: ActIneligibilityReason |
V19355 |
|
|
Identifies the reason or rational for why a person is not eligibile for benefits under an insurance policy.
Examples are client deceased & adopted client has been given a new policy identifier.
|
2
|
L: (COVSUS)
|
19731 |
COVSUS |
coverage suspended |
When a client has no contact with the health system for an extended period, coverage is suspended. Client will be reinstated
to original start date upon proof of identification, residency etc.
Example: Coverage may be suspended during a strike situation, when employer benefits for employees are not covered (i.e. not
in effect).
|
2
|
L: (DECSD)
|
19729 |
DECSD |
deceased |
Client deceased.
|
2
|
L: (REGERR)
|
19730 |
REGERR |
registered in error |
Client was registered in error.
|
1
|
A: ActInvoiceCancelReason |
V19356 |
|
|
Domain specifies the codes used to describe reasons why a Provider is cancelling an Invoice or Invoice Grouping.
|
2
|
L: (INCCOVPTY)
|
19733 |
INCCOVPTY |
incorrect covered party as patient |
The covered party (patient) specified with the Invoice is not correct.
|
2
|
L: (INCINVOICE)
|
19735 |
INCINVOICE |
incorrect billing |
The billing information, specified in the Invoice Elements, is not correct. This could include incorrect costing for items
included in the Invoice.
|
2
|
L: (INCPOLICY)
|
19734 |
INCPOLICY |
incorrect policy |
The policy specified with the Invoice is not correct. For example, it may belong to another Adjudicator or Covered Party.
|
2
|
L: (INCPROV)
|
19736 |
INCPROV |
incorrect provider |
The provider specified with the Invoice is not correct.
|
1
|
A: SchedulingActReason |
V14879 |
|
|
Reasons for cancelling or rescheduling an Appointment
|
2
|
L: (BLK)
|
14885 |
BLK |
Unexpected Block (of Schedule) |
The time slots previously allocated are now blocked and no longer available for booking Appointments
|
2
|
L: (DEC)
|
14884 |
DEC |
Patient Deceased |
The Patient is deceased
|
2
|
L: (FIN)
|
14882 |
FIN |
No Financial Backing |
Patient unable to pay and not covered by insurance
|
2
|
L: (MED)
|
14883 |
MED |
Medical Status Altered |
The medical condition of the Patient has changed
|
2
|
L: (MTG)
|
14886 |
MTG |
In an outside meeting |
The Physician is in a meeting. For example, he/she may request administrative time to talk to family after appointment
|
2
|
L: (PAT)
|
14880 |
PAT |
Patient request |
The Patient requested the action
|
2
|
L: (PHY)
|
14881 |
PHY |
Physician request |
The Physician requested the action
|
1
|
A: SubstanceAdminSubstitutionReason |
V19377 |
|
|
|
2
|
L: (CT)
|
19989 |
CT |
continuing therapy |
Indicates that the decision to substitute or to not substitute was driven by a desire to maintain consistency with a pre-existing
therapy. I.e. The performer provided the same item/service as had been previously provided rather than providing exactly
what was ordered, or rather than substituting with a lower-cost equivalent.
|
2
|
L: (FP)
|
19990 |
FP |
formulary policy |
Indicates that the decision to substitute or to not substitute was driven by a policy expressed within the formulary.
|
2
|
L: (OS)
|
19987 |
OS |
out of stock |
In the case of 'substitution', indicates that the substitution occurred because the ordered item was not in stock. In the
case of 'no substitution', indicates that a cheaper equivalent was not substituted because it was not in stock.
|
2
|
L: (RR)
|
19988 |
RR |
regulatory requirement |
Indicates that the decision to substitute or to not substitute was driven by a jurisdictional regulatory requirement mandating
or prohibiting substitution.
|
1
|
A: TransferActReason |
V15983 |
|
|
The explanation for why a patient is moved from one location to another within the organization
|
2
|
L: (ER)
|
15984 |
ER |
Error |
Moved to an error in placing the patient in the original location.
|
2
|
L: (RQ)
|
15985 |
RQ |
Request |
Moved at the request of the patient.
|
1
|
A: x_ActEncounterReason |
V19456 |
|
|
|
2
|
L: (MEDNEC)
|
17428 |
MEDNEC |
Medical Necessity |
Required for medical reasons(s).
|
2
|
L: (PAT)
|
14880 |
PAT |
Patient request |
The Patient requested the action
|
1
|
L: (MEDNEC)
|
17428 |
MEDNEC |
Medical Necessity |
Required for medical reasons(s).
|
1
|
L: (PAT)
|
14880 |
PAT |
Patient request |
The Patient requested the action
|