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:
- Commode Chairs Online Education Course
- Commodes Documentation Checklist
- Commodes – LCD (L33736)
- Commodes – Policy Article (A52461)
- Standard Documentation Requirements for All Claims Submitted to DME MACs (A55426)
- Supplier Manual Chapter 3 – Supplier Documentation
Updated: November 1, 2024