All Purpose 3 in 1 Commode

This is a commode chair that may also be used as an overthe-toilet safety frame. For Medicare coverage it may only be used by patients who are unable to reach the bathroom part of the time. All equipment designed for use IN the bathroom is non-covered by Medicare (secondary payors will often pay as primary – check secondary coverage).

HCPCS Code:

E0163 – Bedside commode
E0168 – Heavy duty bedside commode

Category:

Inexpensive/Routinely
Purchased

Common Diagnosis:

(check for current coding)

714.0 Rheumatoid Arthritis
432.9 Intra Cerebral Hemorrhage
428.0 Congestive Heart Failure
342.9 Hemiplegia Right/Left
496 COPD

Coverage Information

Requires a Detailed Written Order

Patient must be incapable of utilizing regular toilet facilities

Patient must be confined to a single room or to one level of their home environment

Patient is confined to the home and the home has no toilet facilities

E0168: An extra wide/heavy duty commode chair (E0168) is covered for a patient who weighs 300 pounds or more. When using this code, the supplier must have documentation in their records that the patient’s weight (within one month of providing the commode) is 300 pounds or more.

Note 1: Wheeled commodes (E0164 / E0166) are not considered medically necessary and therefore are NOT covered. If patient requests a wheeled commode explain coverage guidelines and offer an upgrade through use of the Advance Beneficiary Notice (ABN) form.

Note 2: ALL commodes require KX modifier to document that patient is incapable of utilizing regular toilet facilities as defined above.

Documentation Requirements: in addition to the basic Medicare documentation (proof of delivery, AOB, etc.) the detailed written order form must contain the patient’s name, the start date of the order, and a description of the item.