Denial code CO 97 defines in Medical Billing or RCM as services performed denied due to bundled with another services so not paid separately.
Denial Code CO-97 means “Bundled or included in the payment for another service/procedure already adjudicated.”
Reason for Claim denied as Bundled:
Incorrect Modifier:
This is very common reason for getting denial of CO-97 as bundled. So need to check the services performed append with correct modifier.
Bundling Services:
Some services performed separately but considered as they are bundled with each other and their payment is also paid once, not twice. In this case claim denied as bundled.
Example – Post operative care is part of global period
Duplicate Billed Services:
Sometimes some services billed more than one with same DOS, so they denied as bundled.
Note- NCCI (National Correct Coding Initiative) edits bundle certain services together so need to check the procedure codes as per NCCI rules.
How to Handle CO 97 Bundled Denial Code?
When received the denial code CO 97 bundled in claim we have to follow some steps as mentioned below,
- Check EOB first for exact reason and procedure and diagnostic information which denied as CO-97 bundled.
- Verify Modifiers used in claim, for remove bundle condition we use modifiers 59 (Distinct Procedural Service) for surgery and modifier 25 for E/M codes.
- Use NCCI (Correct Coding Initiative) tables to verify if the two codes can be billed together.
- Resubmit claim with correct modifier.
- Sometimes need to submit appeal with medical records in bundling case, so before appeal call to insurance ask each and every detail required for appeal. Confirm mailing address, Fax number, Appeal format etc.
- Denial code CO 97 is a common denial and if executive is not able to understand the exact reason of denial, then call to insurance company, they will provide all information and details of the denial. This is apply for all denials in medical billing. Getting denial again and again is loss of revenue and effort so need to fulfill all needs in minimum attempt.