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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 34.74%. The top 10 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. 65.56%
2. The medical records received lack sufficient information concerning the beneficiary’s condition to determine if medical necessity coverage criteria were met. 21.85%
3. No medical record documentation was received. 3.31%
4. The supplier indicates the item(s) were billed in error. 3.31%
5. The documentation does not have a valid order. 1.99%
6. The medical record documentation is dated after the date of service. 1.32%
7. The medical record documentation is illegible. 0.66%
8. The order is missing a description of the item. 0.66%
9. 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. 0.66%
10. The beneficiary was in an acute care hospital or skilled nursing facility on this date of service. 0.66%

*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 5, 2024

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