United States Health Information Knowledgebase


Reason For Service Code

Name:Reason For Service Code
Definition:Code identifying the type of utilization conflict detected by the prescriber or the pharmacist or the reason for the pharmacist's professional service.
Type:Data Element
Registration Authority:National Council for Prescription Drug Programs
Source:National Council for Prescription Drug Programs
Values for: Reason For Service Code
Value Value Meaning
AD Additional Drug Needed - Code indicating optimal treatment of the patient's condition requiring the addition of a new drug to the existing drug therapy
AN Prescription Authentication -Code indicating that circumstances required the pharmacist to verify the validity and/or authenticity of the prescription.
AR Adverse Drug Reaction - Code indicating an adverse reaction by a patient to a drug.
AT Additive Toxicity - Code indicating a detection of drugs with similar side effects when used in combination could exhibit a toxic potential greater than either agent by itself.
CD Chronic Disease Management - The patient is participating in a coordinated health care intervention program.
CH Call Help Desk - Processor message to recommend the receiver contact the processor/plan
CS Patient Complaint/Symptom- Code indicating that in the course of assessment or discussion with the patient, the pharmacist identified an actual or potential problem when the patient presented to the pharmacist complaints or symptoms suggestive of illness requesting evaluation and treatment.
DA Drug-Allergy - Indicates that an adverse immune event may occur due to the patient's previously demonstrated heightened allergic response to the drug product in question.
DC Drug-Disease (Inferred)-Indicates that the use of the drug may be inappropriate in light of a specific medical condition that the patient has. The existence of the specific medical condition is inferred from drugs in the patient's medication history.
DD Drug-Drug Interaction-Indicates that drug combinations in which the net pharmacologic response may be different from the result expected when each drug is given separately.
DF Drug-Food interaction-Indicates interactions between a drug and certain foods.
DI Drug Incompatibility-Indicates physical and chemical incompatibilities between two or more drugs.
DL Drug-Lab Conflict -Indicates that laboratory values may be altered due to the use of the drug, or that the patient's response to the drug may be altered due to a condition that is identified by a certain laboratory value.
DM Apparent Drug Misuse - Code indicating a pattern of drug use by a patient in a manner that is significantly different than that prescribed by the prescriber.
DR Dose Range Conflict - Code indicating that the prescription does not follow recommended medication dosage.
DS Tobacco Use - Code indicating that a conflict was detected when a prescribed drug is contraindicated or might conflict with the use of tobacco products.
ED Patient Education/Instruction -Code indicating that a cognitive service whereby the pharmacist performed a patient care activity by providing additional instructions or education to the patient beyond the simple task of explaining the prescriber's instructions on the prescription.
ER Overuse - Code indicating that the current prescription refill is occurring before the days supply of the previous filling should have been exhausted.
EX Excessive Quantity-Code that documents the quantity is excessive for the single time period for which the drug is being prescribed.
HD High Dose-Detects drug doses that fall above the standard dosing range.
IC Iatrogenic Condition-Code indicating that a possible inappropriate use of drugs that are designed to amerliorate complications caused by another medication has been detected.
ID Ingredient Duplication- Code indicating that simultaneous use of drug products containing one or more identical generic chemical entities has been detected.
LD Low Dose -Code indicating that the submitted drug doses fall below the standard dosing range.
LK Lock In Recipient - Code indicating that the professional service was related to a plan/payer constraint on the member whereby the member is required to obtain services from only one specified pharmacy or other provider type, hence the member is "locked in" to using only those providers or pharmacies.
LR Underuse - Code indicating that a prescription refill that occurred after the days supply of the previous filling should have been exhausted.
MC Drug-Disease (Reported)- Indicates that the use of the drug may be inappropriate in light of a specific medical condition that the patient has. Information about the specific medical condition was provided by the prescriber, patient or pharmacist.
MN Insufficient Duration - Code indicating that regimens shorter than the minimal limit of therapy for the drug product, based on the product's common uses, has been detected.
MS Missing Information/Clarification-Code indicating that the prescription order is unclear, incomplete, or illegible with respect to essential information.
MX Excessive Duration- Detects regimens that are longer than the maximal limit of therapy for a drug product based on the product's common uses.
NA Drug Not Available-Indicates the drug is not currently available from any source.
NC Non-covered Drug Purchase-Code indicating a cognitive service whereby a patient is counseled, the pharmacist's recommendation is accepted and a claim is submitted to the processor requesting payment for the professional pharmacy service only, not the drug.
ND New Disease/Diagnosis-Code indicating that a professional pharmacy service has been performed for a patient who has a newly diagnosed condition or disease.
NF Non-Formulary Drug-Code indicating that mandatory formulary enforcement activities have been performed by the pharmacist when the drug is not included on the formulary of the patient's pharmacy benefit plan.
NN Unnecessary Drug - Code indicating that the drug is no longer needed by the patient.
NP New Patient Processing-Code indicating that a pharmacist has performed the initial interview and medication history of a new patient.
NR Lactation/Nursing Interaction-Code indicating that the drug is excreted in breast milk and may represent a danger to a nursing infant.
NS Insufficient Quantity- Code indicating that the quantity of dosage units prescribed is insufficient.
OH Alcohol Conflict - Detects when a prescribed drug is contraindicated or might conflict with the use of alcoholic beverages
PA Drug-Age- Indicates age-dependent drug problems.
PC Patient Question/Concern -Code indicating that a request for information/concern was expressed by the patient, with respect to patient care.
PG Drug-Pregnancy-Indicates pregnancy related drug problems. This information is intended to assist the healthcare professional in weighing the therapeutic value of a drug against possible adverse effects on the fetus.
PH Preventive Health Care - Code indicating that the provided professional service was to educate the patient regarding measures mitigating possible adverse effects or maximizing the benefits of the product(s) dispensed; or measures to optimize health status, prevent recurrence or exacerbation of problems.
PN Prescriber Consultation -Code indicating that a prescriber has requested information or a recommendation related to the care of a patient.
PP Plan Protocol - Code indicating that a cognitive service whereby a pharmacist, in consultation with the prescriber or using professional judgment, recommends a course of therapy as outlined in the patient's plan and submits a claim for the professional service provided.
PR Prior Adverse Reaction - Code identifying the patient has had a previous atypical reaction to drugs.
PS Product Selection Opportunity - Code indicating that an acceptable generic substitute or a therapeutic equivalent exists for the drug. This code is intended to support discretionary drug product selection activities by pharmacists.
RE Suspected Environmental Risk- Code indicating that the professional service was provided to obtain information from the patient regarding suspected environmental factors.
RF Health Provider Referral-Patient referred to the pharmacist by another health care provider for disease specific or general purposes.
SC Suboptimal Compliance - Code indicating that professional service was provided to counsel the patient regarding the importance of adherence to the provided instructions and of consistent use of the prescribed product including any ill effects anticipated as a result of non-compliance.
SD Suboptimal Drug/Indication- Code indicating incorrect, inappropriate, or less than optimal drug prescribed for the patient's condition.
SE Side Effect - Code reporting possible major side effects of the prescribed drug.
SF Suboptimal Dosage Form - Code indicating incorrect, inappropriate, or less than optimal dosage form for the drug.
SR Suboptimal Regimen - Code indicating incorrect, inappropriate, or less than optimal dosage regimen specified for the drug in question.
SX Drug-Gender- Indicates the therapy is inappropriate or contraindicated in either males or females.
TD Therapeutic - Code indicating that a simultaneous use of different primary generic chemical entities that have the same therapeutic effect was detected.
TN Laboratory Test Needed -Code indicating that an assessment of the patient suggests that a laboratory test is needed to optimally manage a therapy.
TP Payer/Processor Question Code indicating that a payer or processor requested information related to the care of a patient.
UD Duplicate Drug - Code indicating that multiple prescriptions of the same drug formulation are present in the patient's current medication profile.
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