CO 97 Denial Code Solution – Bundled With Another Procedure

When it comes to medical billing, people who are well-versed with the topic would know that there are two genres- the PR category and the CO-category. Co 97 denial code description is represented in medical billing as

Procedure or Service Isn’t Paid for Separately or it is bundled with another procedure or services.

The ‘CO’ stands for contractual obligation and this is what the payer has to adjust off. There are unique codes for each instance and hence this makes the procedure much more convenient.

Most of us are covered by a different kind of medical plan, however, the coding help a lot. Many times when there is denial, there are feedbacks and they mention the codes.

These codes are always unique and deciphering the number one would be able to tell what they stand for. The CO 97 Denial Code is one such code!

What Does The Denial Code 97 Meaning?

When it comes to the 97 CO Denial Code it precisely stands for denial when the products or services cannot be separately paid for.

Wondering what this might mean? This signifies that the service of the product has already been covered under some other segment and hence the claim cannot be paid separately.

There might be a number of instances that one can mention under this genre. For eg., when it comes to blood collection one cannot claim for the convenience charge because that is inclusive.

Again E/M services that one might take after surgery cannot be put out separately for billing. Having a knowledge of these codes helps you to understand what the denial was for. In case you feel there is some kind of misconception, you can always proceed to get the same adjustment.

We already have read in detail what the CO 97 Denial Code stands for and what can be the proper applications of the same. However, there can be some variations and hence it is always advised that you get the same check.

Every day there are a lot of claims that are made and getting your claim denied just gets the entire proforma slowed down.

Also Read : CO 109 Denial Code - Service Not Covered by this Payer 
                  : CO 4 Denial Code
                  : CO 5 Denial Code | Procedure in Inconsistent with POS

Why are these Codes so Important?

If you have a fair idea of how the entire concept of medical billing works, you would know that it is an extensive process. Nonetheless, it becomes quite tough for an individual to maintain the records.

To make the process easier, there are some universal codes affixed to each situation for a more efficient Claim-Addressal. As individuals, it is very crucial that even if you do not have detailed knowledge of the same, you build up some relevant ideas into the field.

This will help you to assess what the mistake was and how you can make the process much easier for the next time.

The Denial Code CO 97 is very important and there are certain other demarcations as well. However, if you read with precision it would not be a big task to understand what the intricacies are. These codes are used quite in a unanimous way and hence it means the same thing no matter where you belong to in particular.  

How to handle Co 97 denial code in Medical billing

If you get a denial of co 97 in medical billing claim in that case there are some scenarios and facts please follow as below

1– Insurance denied as procedure or service is included with another service so it cant be paid separately.

2- Sometimes we need to bill some procedures with specific modifiers to avoid this type of denial.

3- Need to sent claim to the coding department for review which is the appropriate modifier to apply on CPT to getting paid separately.

4– Some times we know the correct modifier applied E/M codes need 25 modifier so if have instructions as per SOP we can add modifier and rebill a corrected claim.

Verify that the codes used on the claim are accurate and appropriate. Ensure that there are no unbundling issues, where separate components of a service are billed individually when they should be included in a single code.

5- For more information on modifiers and respective CPT please visit List of Modifiers in Medical Billing

Appeal the Denial:

After checking all things and claim still denied due to bundled and If you believe the denial is incorrect or if there is additional information that can support the separate billing of the services, consider filing an appeal. Include any relevant documentation, such as medical records or notes, to demonstrate the necessity of billing the services separately.

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  • NSingh (MBA, RCM Expert)

    The author and contributor of this blog "NSingh" is working in Medical Billing and Coding since 2010. He is MBA in marketing and Having vaste experience in different scopes of Medical Billing and Coding as AR-Follow-up, Payment Posting, Charge posting, Coding, etc.