Highlights
Office Managers, Medical Billers and Medical Coders
What is the meaning of the CMS Medicare Claim Denial Reason Code?:
CO-97, CO/97, CO97

    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