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 Reasons. 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
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)
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. 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)
- IBR Case Overturn CCI Edit CPT 73030-LT
- IBR Case Overturn CCI Edit CPT 99354, 96101-59
- IBR Case Overturn CCI Edit CPT 96101
Webinar: Request for Second Review
Webinar: Second Review Strategy Kit, Part I
Webinar: Second Review Strategy Kit, Part II
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.