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ActReason A code specifying the motivation, cause, or rationale of an Act, when such rationale is not reasonably representable as an ActRelationship of type "has reason" linking to another Act. Examples: Example reasons that might qualify for being coded in this field might be: "routine requirement", "infectious disease reporting requirement", "on patient request", "required by law". Discussion Most reasons for acts can be clearly expressed by linking the new Act to another prior Act using an ActRelationship of type "has reason". This simply states that the prior Act is a reason for the new Act (see ActRelationship.) The prior act can then be a specific existing act or a textual explanation. This works for most cases, and the more specific the reason data is, the more should this reason ActRelationship be used instead of the reasonCode. The reasonCode remains as a place for common reasons that are not related to a prior Act or any other condition expressed in Acts. Indicators that something was required by law or was on the request of a patient etc. may qualify. However, if that piece of legislation, regulation, or the contract or the patient request can be represented as an Act (and they usually can), the reasonCode should not be used.
Lvl | Type, Domain name and/or Mnemonic code | Concept ID | Mnemonic | Print Name | Definition/Description
--- | --- | --- | --- | --- | ---
1 | A: ActAccommodationReason | A17425 |  |  | Identifies the reason the patient is assigned to this accommodation type
2 | L: (ACCREQNA) | C17429 | ACCREQNA | Accommodation Requested Not Available | Accommodation requested is not available.
2 | L: (FLRCNV) | C17430 | FLRCNV | Floor Convenience | Accommodation is assigned for floor convenience.
2 | L: (MEDNEC) | C17428 | MEDNEC | Medical Necessity | Required for medical reasons(s).
2 | L: (PAT) | C14880 | PAT | Patient request | The Patient requested the action
1 | A: ActAdjudicationReason | A19385 |  |  | 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 | A19388 |  |  | 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 | A19355 |  |  | 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) | C19731 | 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) | C19729 | DECSD | deceased | Client deceased.
2 | L: (REGERR) | C19730 | REGERR | registered in error | Client was registered in error.
1 | A: ActNoImmunizationReason | A19717 |  |  | A coded description of the reason for why a patient did not receive a scheduled immunization. (important for public health strategy
1 | A: ActSupplyFulfillmentRefusalReason | A19718 |  |  | Indicates why a fulfiller refused to fulfill a supply order, and considered it important to notify other providers of their decision. E.g. "Suspect fraud", "Possible abuse", "Contraindicated". (used when capturing 'refusal to fill' annotations)
1 | A: ClinicalResearchReason | A19754 |  |  | Definition:Contains domains for act reasons used in clinical research.
2 | A: ClinicalResearchEventReason | A19755 |  |  | Definition:Specifies the reason that an event occurred in a clinical research study.
3 | L: (RET) | C21623 | RET | retest | Definition:The event occurred so that a test or observation performed at a prior event could be performed again due to conditions set forth in the protocol.
3 | L: (SCH) | C21622 | SCH | scheduled | Definition:The event occurred due to it being scheduled in the research protocol.
3 | L: (TRM) | C21624 | TRM | termination | Definition:The event occurred in order to terminate the subject's participation in the study.
3 | L: (UNS) | C21625 | UNS | unscheduled | Definition:The event that occurred was initiated by a study participant (e.g. the subject or the investigator), and did not occur for protocol reasons.
2 | A: ClinicalResearchObservationReason | A19756 |  |  | Definition:SSpecifies the reason that a test was performed or observation collected in a clinical research study. Note:This set of codes are not strictly reasons, but are used in the currently Normative standard. Future revisions of the specification will model these as ActRelationships and thes codes may subsequently be retired. Thus, these codes should not be used for new specifications.
3 | L: (NPT) | C21628 | NPT | non-protocol | Definition:The observation or test was neither defined or scheduled in the study protocol.
3 | L: (UPT) | C21627 | UPT | per definition | :The observation or test occurred as defined in the research protocol, but at a point in time not specified in the study protocol.
3 | L: (PPT) | C21626 | PPT | per protocol | Definition:The observation or test occurred due to it being defined in the research protocol, and during an activity or event that was scheduled in the protocol.
1 | A: ControlActReason | A19692 |  |  | Identifies why a specific query, request, or other trigger event occurred.
2 | A: ControlActReasonConditionNullify | A19693 |  |  | Indicates why the ConditionaTMs status was changed to Nullified. Examples administrative error, diagnostic error.
1 | A: EligibilityActReasonCode | A19694 |  |  | Identifies the reason or rational for why a person is eligibile for benefits under an insurance policy or progam. Examples: A person is a claimant under an automobile insurance policy are client deceased & adopted client has been given a new policy identifier. A new employee is eligible for health insurance as an employment benefit. A person meets a government program eligibility criteria for financial, age or health status.
2 | A: CoverageEligibilityReason | A19735 |  |  | Definition: Identifies the reason or rational for why a person is eligibile for benefits under an insurance policy or progam. Examples: A person is a claimant under an automobile insurance policy are client deceased & adopted client has been given a new policy identifier. A new employee is eligible for health insurance as an employment benefit. A person meets a government program eligibility criteria for financial, age or health status.
3 | L: (AGE) | C21565 | AGE | age eligibility | A person becomes eligible for a program based on age. Example: In the U.S., a person who is 65 years of age or older is eligible for Medicare.
3 | L: (CRIME) | C21558 | CRIME | crime victim | A person becomes eligible for insurance or a program because of crime related health condition or injury. Example: A person is a claimant under the U.S. Crime Victims Compensation program.
3 | L: (DIS) | C21560 | DIS | disability | A person becomes a claimant under a disability income insurance policy or a disability rehabilitation program because of a health condition or injury which limits the person's ability to earn an income or function without institutionalization.
3 | L: (EMPLOY) | C21556 | EMPLOY | employment benefit | A person becomes eligible for insurance provided as an employment benefit based on employment status.
3 | L: (FINAN) | C21564 | FINAN | financial eligibility | A person becomes eligible for a program based on financial criteria. Example: A person whose family income is below a financial threshold for eligibility for Medicaid or SCHIP.
3 | L: (HEALTH) | C21562 | HEALTH | health status | A person becomes eligible for a program because of a qualifying health condition or injury. Examples: A person is determined to have a qualifying health conditions include pregnancy, HIV/AIDs, tuberculosis, end stage renal disease, breast or cervical cancer, or other condition requiring specialized health services, hospice, institutional or community based care provided under a program
3 | L: (VEHIC) | C21559 | VEHIC | motor vehicle accident victim | A person becomes a claimant under a motor vehicle accident insurance because of a motor vehicle accident related health condition or injury.
3 | L: (MULTI) | C21566 | MULTI | multiple criteria eligibility | A person becomes eligible for a program based on more than one criterion. Examples: In the U.S., a child whose familiy income meets Medicaid financial thresholds and whose age is less than 18 is eligible for the Early and Periodic Screening, Diagnostic, and Treatment program (EPSDT). A person whose family income meets Medicaid financial thresholds and whose age is 65 years or older is eligible for Medicaid and Medicare, and are referred to as dual eligibles.
3 | L: (PNC) | C21561 | PNC | property and casualty condition | A person becomes a claimant under a property and casualty insurance policy because of a related health condition or injury resulting from a circumstance covered under the terms of the policy. Example: A person is a claimant under a homeowners insurance policy because of an injury sustained on the policyholderaTMs premises.
3 | L: (STATUTORY) | C21563 | STATUTORY | statutory eligibility | A person becomes eligible for a program based on statutory criteria. Examples: A person is a member of an indigenous group, a veteran of military service, or in the U.S., a recipient of adoption assistance and foster care under Title IV-E of the Social Security.
3 | L: (WORK) | C21557 | WORK | work related | A person becomes eligible for insurance or a program because of a work related health condition or injury. Example: A person is a claimant under the U.S. Black Lung Program.
1 | L: (MEDNEC) | C17428 | MEDNEC | Medical Necessity | Required for medical reasons(s).
1 | A: NonPerformanceReasonCode | A19744 |  |  | The reason the action wasn't performed, e.g. why the medication was not taken. If an action wasn"t performed, it is often clinically important to know why the action wasn"t taken. Examples:Patient refused, clinically inappropriate, absolute contraindication etc.
1 | L: (PAT) | C14880 | PAT | Patient request | The Patient requested the action
1 | A: ReasonForNotEvaluatingDevice | A19636 |  |  | Code assigned to indicate the rationale for not performing an evaluation investigation on a device for which a defect has been reported. Examples include: device received in a condition that made analysis impossible, device evaluation anticipated but not yet begun, device not made by company.
1 | A: ReferralReasonCode | A19743 |  |  | The reason a referral was made. Examples:Specialized Medical Assistance, Other Care Requirements.
1 | A: SchedulingActReason | A14879 |  |  | Reasons for cancelling or rescheduling an Appointment
2 | L: (MTG) | C14886 | 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: (MED) | C14883 | MED | Medical Status Altered | The medical condition of the Patient has changed
2 | L: (FIN) | C14882 | FIN | No Financial Backing | Patient unable to pay and not covered by insurance
2 | L: (DEC) | C14884 | DEC | Patient Deceased | The Patient is deceased
2 | L: (PAT) | C14880 | PAT | Patient request | The Patient requested the action
2 | L: (PHY) | C14881 | PHY | Physician request | The Physician requested the action
2 | L: (BLK) | C14885 | BLK | Unexpected Block (of Schedule) | The time slots previously allocated are now blocked and no longer available for booking Appointments
1 | A: SubstanceAdminSubstitutionNotAllowedReason | A19719 |  |  | Reasons why substitution of a substance administration request is not permitted.
1 | A: SubstanceAdminSubstitutionReason | A19377 |  |  |
2 | L: (CT) | C19989 | 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) | C19990 | 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) | C19987 | 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) | C19988 | 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 | A15983 |  |  | The explanation for why a patient is moved from one location to another within the organization
2 | L: (ER) | C15984 | ER | Error | Moved to an error in placing the patient in the original location.
2 | L: (RQ) | C15985 | RQ | Request | Moved at the request of the patient.
1 | A: x_ActEncounterReason | A19456 |  |  | Administrative reasons for patient encounters. Example:Medical necessity, patient request and dependency.
2 | L: (MEDNEC) | C17428 | MEDNEC | Medical Necessity | Required for medical reasons(s).
2 | L: (PAT) | C14880 | PAT | Patient request | The Patient requested the action

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Last Published: 03/27/2006 3:35 AM

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