Incorrect Reimbursement: CCI Edit

When an original bill is incorrectly denied or underpaid, DaisyBill advises filing a Second Review. 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.

To store language for Request for Second Review reasons, use DaisyBill’s Second Bill Review Library. When a CCI Edit is incorrectly cited as a reason for $0 reimbursement, we recommend language similar to the Second Review reason below.

Incorrect Reimbursement: CCI Edit

Official Medical Fee Schedule

Any

CPT Code(s)

Any

Payable

Yes

EOR Denial Reason

No separate payment was made because the value of the service is included within the value of another service performed on the same day.

Second Review Reason (SBR-1 Form)

Recommended Reason

CCI Edit incorrectly cited as reason for $0 reimbursement. § 9789.12.13  Correct Coding Initiative.  (d) Physician NCCI Edits are published by CMS on its website at:

https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html “Physician CCI Edits”. See section 9789.19 for the adopted version of the Physician CCI Edits, by date of service.

Optional: Attached is a copy of an OVERTURN IBR Decision indicating this incorrect denial will be overturned when reviewed by IBR.

Recommended Supporting Documents (IBR Decisions)

DaisyBill Resources

Webinar: Requests for Second Review

Webinar: Second Review Strategy Kit, Part I

Webinar: Second Review Strategy Kit, Part II

DaisyBill Solution

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.

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