Same or Similar Denials: How to avoid it?

By Donna Youngblood, RN

Same or similar denials occur when claims information is checked against the patient’s CMN history. This will indicate when equipment is “same or similar” to that piece of equipment being billed on the claim. An example of same and similar items includes a K0800 (power operated vehicle) and a K0823 (Group 2 power mobility device) or an E0140 (walker with trunk support) and a K0003 (lightweight manual wheelchair).

These types of denials can be avoided early on when providing DME equipment to patients. The most important part in preventing this type of denial is by having a thorough intake process. Suppliers are encouraged to use an intake form to assure all necessary information is obtained prior to dispensing DME items. Such information may include:

  • Patient’s correct Health Insurance Claim Number (HICN);
  • Whether the patient has other insurance
  • If the patient currently has or had this type of equipment or similar equipment in the past;
  • When the item(s) were received and if the item(s) have been returned;

It is the suppliers’ responsibility to check the Supplier Interactive Voice Response (IVR) system or portal to determine if same or similar HCPCS are on file for a patient within the previous five years or specific reasonable useful lifetime (RUL) for the item. In the event that same or similar is suspected, a supplier must provide a proper Advance beneficiary Notice of Noncoverage (ABN) for each item likely to be denied as not medically necessary.