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What is the meaning of the CMS Medicare Claim Denial Reason Code?:
CO-97, CO/97, CO97
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What is the meaning of the CMS Medicare Claim Denial Reason
Code?: CO-97, CO/97, CO97 - The benefit for this service is included
in the payment/allowance for another service/procedure that has
already been adjudicated
Your Action and How to Avoid this Kind of Denial:
1. Check if there is a bundling issues
2. Always make sure you are up-to-date with the CCI Edits. Remember that
an indicator "0" means you can not append a modifier on that particular
procedure code and can not be billed separately.
3. Check if the services (evaluation and management encounter and/or
other procedures) is related and within the post global surgical period;
4. It could also be that it is included during the pre-op period
Check out these Modifiers and Find out How you can appropriately (and
ethically) Utilize them:
Modifier 25
Modifier 24
Modifier 59
Useful References: CPT Code Books, CMS Website (www.cms.gov),
CCI Quarterly Updates, CPT Assistant Publications, Diagnosis Code
Books
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