This HCPC code had a 28 percent denial rate last year, and three of the top denial reason codes were related to "same or similar equipment" issues,* including:
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CO150-Payer deems the information submitted does not support this level of service;
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CO151-Payment adjusted because the payer deems the information submitted does not support this many/frequency of services; and
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CO179-Patient has not met the required waiting requirements.
To represent same or similar denials, these codes are combined with the M3 remark code that the denial is due to the fact that "the equipment is the same or similar to equipment already being used." In Medicare's view, the patient has more than one blood glucose monitor, so the one most recently provided will not be covered.
These codes indicate that many providers apparently aren't verifying whether the patient has purchased a monitor from another supplier within the last five years. But all four DME MACs offer the ability to check for same or similar equipment via their CSI CMN option or through their IVR phone application. To utilize the CSI option, you must sign up with network service providers such as IVANS, Nebo Systems or VisionShare (applicable charges will apply). See your DME MAC Web site for a complete listing of network service vendors for your jurisdiction.
Also, make sure your intake personnel know how to check for same or similar equipment via CSI or IVR. Researching whether there is a previous monitor on file prior to filing the claim will allow the patient to complete an ABN. If the claim is going to be filed non-assigned and an ABN has been signed, you can collect cash at the time of delivery rather than receiving a denial on the claim and adjusting off the balance.
*The denial reason code descriptions/definitions for "same or similar" denials may vary by DME MAC.
Based on analysis of claims for high-dollar codes — those where the total amount paid exceeds $500,000 during a three-month period — processed for RemitDATA customers during the second quarter of 2009. Source: RemitDATA, 866/885-2974, www.remitdata.com
Read more Working Down Denials columns.
Sarah Hanna is a reimbursement consultant and vice president of ECS Billing & Consulting, Tiffin, Ohio, and specializes in proper billing protocols, Medicare coverage guidelines and billing office procedures. You can reach her at 419/448-5332 or sarahhanna@bright.net.
