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:
- 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 5, 2024

