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N233 Remark Code: Incomplete or Invalid Operative Report

N233 means the operative note or report sent for the surgery was incomplete or invalid, for example unsigned, missing the procedure details, or describing a different procedure than the one billed.

Quick facts

Code
N233 (RARC N233)
Status
Active In use since August 1, 2004; last modified July 1, 2008.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): The surgical service was denied or held because the operative report did not support it. The provider fixes the documentation issue; the patient is not responsible.
Official description
Incomplete/invalid operative note/report.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N233 means

The operative report is the primary evidence for surgical billing. It shows what was done, why, and by whom. N233 means the payer had the report in hand but it did not adequately support the claim. The remark commonly pairs with CARC 252, and sometimes with CARC 150 when the report supports a less extensive procedure than billed.

What reviewers flag

  • No surgeon signature, or a report marked preliminary.
  • The procedure, laterality, or number of lesions or levels in the report differs from the codes and units on the claim.
  • A modifier like 22 (increased procedural services) was billed but the report does not explain the added work.
  • An assistant surgeon was billed but not named in the report.
  • The report is from a different date or case.

How to fix it

  1. Compare the claim’s procedure codes, modifiers, and units with the report’s description.
  2. If the claim overstated what the report supports, correct the claim and submit it with resubmission code 7 and the original claim number.
  3. If the report is incomplete, ask the surgeon for an addendum, clearly dated when written, that clarifies the existing record.
  4. Resend the signed report and any addendum through the payer’s attachment channel with a short cover letter pointing to the relevant passages.

How to prevent it

Code surgery only from signed operative reports, and have coders query surgeons when the report and planned codes don’t match. For modifier-heavy cases, the NCCI and modifier guide explains what documentation should support.

Codes that may appear with N233

  • CO-252 (An attachment/other documentation is required to adjudicate this claim/service.): Documentation, the operative report, is required and was not usable.
  • CO-50 (These are non-covered services because this is not deemed a 'medical necessity' by the payer.): The payer could not confirm medical necessity from the report.
  • CO-150 (Payer deems the information submitted does not support this level of service.): The information provided does not support the level of service billed.
  • M29 (Missing operative note/report.): The operative note or report was missing entirely.
  • N214 (Missing/incomplete/invalid history of the related initial surgical procedure(s).): History of a related initial surgical procedure was missing or invalid.
  • N236 (Incomplete/invalid pathology report.): The pathology report was incomplete or invalid.

N233 FAQ

What should an operative report contain?

Generally the pre- and post-operative diagnoses, procedure performed, surgeon and assistants, anesthesia, findings, technique, specimens, complications, and the surgeon's signature and date.

What if the report describes more than was billed?

That is usually not a problem for N233. The issue is when the report does not describe what was billed, such as an additional procedure or modifier.

Can I send a dictated but unsigned report?

Most payers want an authenticated report. Get the surgeon's signature before resending.