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Commodes Pre-Pay Review Quarterly Status Report

Below is the analysis of claim denials for commodes HCPCS codes E0163 and E0165 reviewed July 1 – September 30, 2024. The error rate for this quarter is 36.29%. The top 8 reasons for claim denials are as follows:

Rank Reason Percent
1. The medical record documentation does not support that the patient met one of the 3 criteria for a commode. 64.29%
2. The medical records received lack sufficient information concerning the beneficiary's condition to determine if medical necessity coverage criteria were met. 21.43%
3. The documentation does not have a valid standard written order. 3.57%
4. The file does not have a valid Advance Beneficiary Notice. 3.57%
5. The medical record documentation does not support the detachable arms feature is necessary to facilitate transferring the beneficiary or that the beneficiary has a body configuration that requires extra width. 1.79%
6. We did not receive any medical record documentation. 1.79%
7. The medical record documentation is illegible. 1.79%
8. The medical record documentation is dated after the date of service. 1.79%

*The total percentage will be greater than 100% because some claims denied for multiple reasons.

**The error rate included is an overall average for the supplier specific reviews as a part of the Targeted Probe and Educate program. This is not meant to be an overall error rate for the HCPCS code or policy under medical record review.

Resources:

Updated: November 1, 2024

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