Commodes Pre-Pay Review Quarterly Status Report
Below is the analysis of claim denials for commodes HCPCS codes E0163 and E0165 reviewed between April 1 and June 30, 2024. The error rate for this quarter is 32.89 %. The top nine reasons for claim denials are as follows:
Rank | Reason | Percent |
---|---|---|
1. | The medical record documentation does not support that one of the three criteria have been met for a commode. | 44.34% |
2. | The medical records received lack sufficient information concerning the beneficiary’s condition to determine if medical necessity coverage criteria were met. | 26.24% |
3. | The beneficiary was in an acute care hospital or skilled nursing facility on this date of service. | 16.29% |
4. | The documentation does not have a valid Standard Written Order (SWO). | 5.43% |
5. | There is not a valid handwritten or electronic signature by the author of the medical record. | 2.26% |
6. | We did not receive any medical record documentation. | 2.26% |
7. | The date on the medical record documentation is after the date of service. | 0.90% |
8. | The documentation submitted is incomplete. | 0.45% |
9. | This item or service is denied non-covered. | 0.45% |
*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: July 30, 2024