In the area of Medical Billing and Coding, any procedure or service that cannot be paid for separately is declined as of co 97. We all know that claim rejections have become one of the most important constraints for efficient revenue cycle management today. Denials not only require additional resources and more time to reprocess, but claim denials delay payments, causing your practice’s cash flow to experience a slowdown. Statistics show that more than $262 billion in medical claims are initially denied, but worse, more than 60% of those denied claims are never even processed again. Which shows that a huge amount is unnecessarily wasted. Today we are going to understand the co 97 code through this article.
Well the good news is that these denials can be reduced to a great extent and it is also possible to manage the denials that do occur effectively. And one of the best things a practicing coder can do is to familiarize themselves with some of the most common denial codes.
What is Co 97 denial code?
CO 97 denial code description, such payment or allowance is disallowed under this service, which was made for any other service or procedure, it is disallowed as co 97. Not originally paid for separately for a procedure or service, it may consist of one procedure code performed in conjunction with another procedure code performed on the same day by the same provider. It may also relate to E&M services that are billed within the global period following a surgical procedure and are not payable separately.
There are a number of services which are usually provided along with other services and are not payable separately. Following are some examples which support this:
- Collection of a blood sample initially to ascertain the health status of the patient which is usually done during the patient’s visit, and hence is not considered separately payable.
- Special transfer, transportation, or handling of a specimen from the doctor’s office to the laboratory is usually not billable separately, as such “additional” care is considered in the pre-existing paid fee schedule.
- E/M services performed within the post-surgery period which are related to that surgery are not payable separately. This is usually 10 days for minor surgery, and usually up to 90 days for major surgery.
How to handle co 97 denial code ?
The good news is that we can prevent Denial Code CO 97 in some cases, we have some solutions for Denial Code CO 97 because there are times when services may be billed separately even if they are not Usually bundled with another service. How to handle co 97 deny code following are few points which you have to follow:
1. First start by checking to see which process code is mutually exclusive, included or bundled. By doing this you will know how to proceed.
2. Once you know which process code is in question, speak with the coding team to see if there is an appropriate modifier that can be used to resubmit your claim.
3. If the claim was already submitted using the appropriate modifier and you feel that your claim has been wrongly rejected, you have the right to appeal the claim with the support of your medical records option is open.
4. It is often useful to speak to the claims department and ask them a few questions regarding the rejected claim, these questions may include:
◆ When was the claim received?
◆When was the claim denied?
◆ Try to find out which process code was inclusive, mutually exclusive or bundled.
◆ Is an appropriate modifier required? If yes, then obtain the appropriate modifier and resubmit your claim as a correct claim. If not, ask for the appeal limit, address and fax number so you can appeal the claim.
◆ Make sure you also have the claim number and call reference number with you.
Denial code Co 97 meaning
CO-97 Denial code means that the procedure or service is not paid for separately because the benefit for the service or procedure is included in the allowance or payment for another procedure or service that has already been awarded.
Causes of co 97 denial code
For the prevention and control of anything, it is necessary to know about its causes, because if we do not know about its causes, then we will not be able to control it. There can be many reasons for the co-97 denial code, about which we are going to know one by one-
Bundled services :
The denial supports that the billed services may have already been submitted as part of another billed service for the same date of service (the services were bundled). Certain medical services may always be included in other services provided or not payable separately.
Rebilled with modifier :
In co-97 denial code sometimes re-billing with modifiers may result in payment for this service.
Billing under Global Surgery:
The cost of care before and after the surgery or procedure is included in the amount approved for that service. Evaluation and Management (E/M) services related to surgery, and performed during the post-surgery period, are not considered separately payable.
Denial code co 97 is a code that prohibits separate payment for certain services and procedures because these procedures and services fall in the category for which separate payment is not necessary. To handle the Denial code co 97, we have to follow many steps given above, due to which we can control it. If we talk about its reasons, then bundled service comes in its most important reasons. So today through this article we have come to know what is the denial code co 97, how it can be handled, what is the reason for it, etc.
Q1. For which services and procedures will not be payable separately.
Ans. E/M services performed during the post-surgery period that are related to surgery are not considered separately payable.
Collection of a blood sample is usually done during the patient’s visit, and therefore is not payable separately.
Extended hours codes/after normal hours codes are not payable separately in a facility that operates 24 hours a day.