CO-97: Service Included in Another (Bundling)
The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. This is a bundling denial.
Why Claims Get Denied with CO-97
Denial code CO-97 is triggered when the benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. this is a bundling denial. Understanding the root causes helps prevent future denials and strengthens your appeal when one occurs.
Procedure is bundled into a more comprehensive procedure per CCI edits
E/M service on the same day as a procedure without modifier 25
Lab panel components billed separately instead of as the panel
Global surgical period includes the billed follow-up service
How to Appeal CO-97
If the services are truly distinct and separately identifiable, append the appropriate modifier (25, 59, XE, XS, XP, XU) and resubmit with documentation showing why the services are distinct. Reference CCI edits to confirm whether an unbundling modifier is allowed for the code pair.
Documentation Required for Appeal
A successful appeal of CO-97 requires thorough documentation. Gather these items before drafting your appeal letter:
Documentation showing distinct, separately identifiable services
CCI edit reference showing modifier is allowed for the code pair
Separate clinical notes for each service
Operative report distinguishing separate procedures
How to Prevent CO-97 Denials
Check CCI edits before billing multiple procedures on the same date of service. Use modifier 25 when a significant, separately identifiable E/M is performed on the same day as a procedure. Bill lab panels rather than individual components when applicable.
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