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2019 Quarterly Status Report – HCPCS Code E1390

A summary report for claims reviewed between July 1, 2019 and September 30, 2019 follows: 

An analysis of the claim denials shows that the top 10 reasons a determination was made not to pay the claim were:

Rank Reason for Denial Percent*
1 The medical record documentation does not support the blood gas study was obtained while the beneficiary was in a chronic stable state. Refer to LCD L33797. 33.71%
2 The medical record documentation does not support the treating physician has determined that the beneficiary has a severe lung disease or hypoxia related symptoms that might be expected to improve with oxygen therapy. Refer to LCD L33797. 27.56%
3 The medical record documentation does not support that alternative treatment measures have been tried or considered and deemed clinically ineffective prior to initiating home oxygen therapy. Refer to LCD L33797. 19.13%
4 The medical record documentation does not support a valid blood gas study obtained during exercise. Refer to LCD L33797. 10.48%
5 The documentation does not include a valid CMN in which section A and B is completed appropriately and signed and dated by the practitioner. Refer to LCD L33797. 7.06%
6 The medical record documentation does not support the beneficiary was seen and evaluated by the treating physician within 30 days prior to the date of initial certification. Refer to LCD L33797. 6.38%
7 The medical record documentation does not support a valid blood gas study obtained at rest. Refer to LCD L33797. 5.24%
8 The medical record documentation is not authenticated (handwritten or electronic) by the author. Refer to Medicare Program Integrity Manual 3.3.2.4 5.01%
9 The medical record documentation does not support a valid blood gas study obtained during sleep. Refer to LCD L33797. 3.42%
10 The documentation does not include verification that the equipment was lost, stolen, or irreparably damaged in a specific incident. Refer to 100-04. 2.96%

Total percentage will be greater than 100% because some claims were denied for multiple reasons.

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