For incorrectly denied or underpaid Original bills, DaisyBill advises filing a Second Review.
Official Medical Fee Schedule
99358, 99359 (add-on code)
EOR Denial Reason
Does not fall under the fee schedule guidelines of a reimbursable report.
Second Review Reason (SBR-1 Form)
Recommended Reason (example of 99214 incorrectly downcoded to 99213)
The AMA CPT Definition of 99358 is as follows: Prolonged evaluation and management service before and/or after direct patient care; first hour. For dates of service on or after 3/1/2017 RBRVS indicate 99358 with a payment status code of "A" payable.
Please pay accordingly.
e-Booklet: 99358 and 99359 Resource Notebook
Every request for Second Review submitted from DaisyBill is compliantly submitted using both a completed DWC Form SBR-1, as well as a compliant modified CMS 1500.