Appendix B—Intervention Codes

The Intervention and Exception Codes field (in the ZCD segment of PharmaNet) provides additional information that may be used by PharmaNet to override normal adjudication rules when the circumstances are appropriate.

The following codes approved by the Canadian Pharmacy Association should be used when appropriate; for example, for submitting reversals, claiming fees for special services related to refusing to fill, or overriding a prescription known to be a duplicate.

Intervention/Exception Codes

Intervention Code	Meaning
AA	Fill despite prior substance use
AB	Benefit outweighs risk
AE	ADE report erroneous
AI	ADE alert inappropriate
AK	ADE acknowledged and prescription changed
AR	ADE refuted
AT	ADE resolved/treated
BP	Bypass processor edit
CA	Prior adverse reaction
CB	Previous treatment failure
CC	Allergy to product is on record
CD	Therapeutic duplication
CE	Product choice is not reasonable
CF	Falsified or altered prescription
CG	Rx not filled, days supply is unsuitable
CH	Dangerously high dose
CI	Significant drug interaction
CJ	Product is not effective
CK	Quantity prescribed is not rational
CL	Sub-therapeutic dose
CM	Suspected multi-pharmacy/multi-doctor
CO	Potential overuse/abuse
CP	Prescription is too old
CS	Was preauthorized by telephone
DA	Secondary claim - orig to prov plan
DB	Secondary claim - orig to other carriers
DC	Out-of-pocket expense paid by insured
DD	Out-of-pocket expense paid by insured spouse
DE	Adjudicate to $0.00 as requested
DF	Medication billed via family member ID
DG	Same product - billed for different Rx
DH	Rx synchronized pursuant to rule 19
DI	Advanced, pharmacy closed on renewal date
DJ	Advanced, unable to deliver on renewal date
DK	Exception, drug used in 2 separate locals
DL	Exception, need drug for medical appointment
DM	Exception, renewal preauthorized by RAMQ
DN	Exception, long-term Rx preauthorized by RAMQ
DO	Changed dosage - dosage too high
DP	Drug cost verified - invoice to follow
DQ	Professional fee is appropriate
DR	Request for coverage review
DU	For drug utilization review only
DV	Applied to prov plan and approved
DW	Applied to prov plan and rejected
DX	Applied to prov plan, decision pending
DY	Not eligible for prov plan coverage
EA	Pharmacist authorized off-hours claim
EB	Supplementary renewal - prescriber absent
ED	Exception drug status - prescriber choice
EO	Early renewal, exception status indicated
EP	Exception drug status - pharmacist choice
EQ	Valid reason to exceed days supply limit
ER	Override days supply limit for period
ES	Override concurrent therapy requirement
ET	Override questionable concurrent therapy
EU	Provincial coverage waived by patient
EV	Co-pay not collected - item is exempt
FA	Expect treatment period to change
FB	Second service required same day
FC	RAMQ re-authorized anticipated renewal
HT	Home parenteral therapy
IA	For asthma & chronic pulmonary diseases
IB	Chronic pulmonary disease is not controlled
IM	Immunization not administered in pharmacy
IX	Covered indication is absent or inconsistent
LU	Start new limited use authorization
MA	Long-term care filled early for stat holiday
ME	Valid claim - primary validation level
MF	Valid claim - historical validation level
MG	Override - various reasons
MH	Override - prescriber ID
MI	No interchangeable available at less than or equal to BAP plus 10 PCT
MJ	Government pharmacy - authorized claim
MK	Good faith emergency coverage established
ML	Good faith standard coverage established
MM	Replacement claim, drug cost only
MN	Replacement claim, due to dose change
MO	Valid claim - value $500.00 to $999.99
MP	Valid claim - value $1000.00 to $9999.99
MQ	Valid claim - quantity over limit
MR	Replacement, item lost or broken
MS	Non-formulary benefit
MT	Trial Rx program
MU	Limited use product
MV	Vacation supply
MW	Valid reason to exceed good faith limit
MX	Long-term care PRN order
MY	Long-term care Rx split for compliance
MZ	Required prior therapy documented
NA	Valid claim - primary validation level
NB	Valid claim - validation on file
NC	Patient SDP eligibility confirmed
ND	Trial prescription balance
NE	Ineligible for trial Rx
NF	Override - quantity appropriate
NG	Drug interchanged - Y2K shortage
NH	Initial Rx program declined
NI	Dosage changed
NJ	Formulation change
NK	Directions for use modified
NL	Renewal of prescription
NM	Therapeutic substitution
NN	Emergency supply of medication
NO	Emergency contraceptive
NR	Non-returnable drug reimbursement
PA	Valid health card version code
PB	Name entered is consistent with card
PC	Patient does not meet exception criteria
PS	Professional care service
RA	Due to ADE alert
RC	Prescription cancelled by physician
RD	Defer clinical decision
RE	Claim reversed - data entry error
RO	Override alert
RR	Prescription refused by patient
RU	Claim reversed - not called for
SA	Prescribed safer alternative
SL	Second-line drug prescribed by specialty
SV	Approved by prov plan, bypass other programs
SW	Rejected by prov plan -bypass other programs
SX	Pending prov plan, bypass other programs
TB	ECO therapy lost, broken or spoiled by patient
TC	ECO therapy begun Friday a.m. at hospital
TP	ECO therapy with change of dosage
TR	ECO therapy lost, broken or spoiled by carrier
TS	Maintain product stability for short term
UA	Consulted prescriber and filled Rx as written
UB	Consulted prescriber and changed dose
UC	Consulted prescriber and changed instructions 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
UI	Consulted other source, Rx filled as written
UJ	Consulted other sources, altered Rx and filled
UK	Consulted other sources, Rx not filled
UL	Rx not filled - pharmacist decision
UM	Consulted prescriber, Rx not filled
UN	Assessed patient, therapy is appropriate
UO	Valid reason to use alternative therapy
UP	First-line therapy ineffective
UQ	First-line therapy not tolerated by patient
UT	Treatment of acute condition
UU	Therapeutic emergency
UX	Emergency dispensing fee limit override
UY	Extemp mixture dispensing fee limit override
VC	Trial Rx program refused by patient
VD	Patient unavailable to receive trial Rx balance
VE	Treatment of acute condition
VF	Trial Rx balance urgently needed
VG	Professional service fee not to be paid
VH	Trial Rx refused by physician
VI	Trial Rx refused by pharmacist
VJ	Trial Rx refused by patient's agent
VK	Trial balance not filled
VL	Consulted MD, patient return requested
VM	Trial not tolerated, referred patient to MD
VN	Trial not tolerated, patient advised MD
VO	Trial ineffective, referred patient to MD
VP	Trial ineffective, patient advised MD
VQ	Trial OK, no side effects/concerns
VR	Trial OK, concerns OK after counselling
VS	Other outcome or intervention
VT	Trial not required - adequate Dr.'s sample
VU	Do not contact patient re evaluation
VV	Patient agrees to evaluation contact
VW	Therapy changed or discontinued
VX	Clinical condition/symptoms improving
VY	Patient reports side effects or ADR
VZ	More time required to assess therapy
XA	Reversal amount error
XB	Previously rejected transaction not found
XC	Provider transaction date valid for OLT