License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition

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POINT AND CLICK LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT")

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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 between January 1 and March 31, 2024. The error rate for this quarter is 39.43%. The top eight 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.	54.29%
2.	The beneficiary was in an acute care hospital or skilled nursing facility on this date of service.	15.71%
3.	The documentation does not have a valid Standard Written Order (SWO).	12.86%
4.	We did not receive any medical record documentation.	5.71%
5.	The medical records received lack sufficient information concerning the beneficiary's condition to determine if medical necessity coverage criteria were met.	4.29%
6.	The SWO is missing a description of the item.	2.86%
7.	There is not a valid handwritten or electronic signature by the author of the medical record.	2.86%
8.	The medical record documentation has corrections or changes that do not follow accepted record keeping principles.	1.43%

*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: May 21, 2024

License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition

AMA Disclaimer of Warranties and Liabilities.

CMS Disclaimer

POINT AND CLICK LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT")

Commodes Pre-Pay Review Quarterly Status Report

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