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Denial Code CO-97 is used in medical billing to indicate that a claim has been denied because the billed service is considered part of another service that has already been processed. This means that the cost of the billed procedure is included in the payment for another related service, and therefore no additional payment is warranted.
Understanding Denial Code CO-97 is crucial for physical therapy clinics and healthcare providers. It highlights the importance of accurately coding services to ensure proper reimbursement. Identifying when a service overlaps with another can help clinics avoid future denials and streamline their billing processes.
Example of a Claim Denied with CO-97
For instance, a physical therapy clinic submits claims for the following services on the same day:
In this case, the claim for CPT 97530 (Therapeutic Activities) is denied under CO-97, as the payer considers it part of the service covered by CPT 97110 (Therapeutic Exercise). To correct this, the clinic should resubmit the claim with Modifier 59 for CPT 97530 to indicate it is a distinct service. As a result, the claim is paid after resubmission with the appropriate modifier.
Let’s have a look at the most common causes of CO-97 denials.
Understanding these reasons can help clinics better prepare their billing practices to avoid CO-97 denials.
To resolve CO-97 denials, follow these steps:
Step 1: Review the Denial
Analyze the denial notice to understand why the claim was rejected. Look for specific codes or notes indicating the reason.
Step 2: Investigate Potential Causes
Determine if the billed service is part of another procedure already covered, if there was a mistaken separate submission, or if the service is considered integral to another. Ensure proper identification of bundled services.
Step 3: Correct Billing
If applicable, append the appropriate modifier (like Modifier 59) to indicate that the service is distinct from the bundled procedure.
Step 4: Resubmit the Claim
Submit the corrected claim with the modifier and any additional documentation needed to justify the separate payment.
Step 5: Follow Up
After resubmission, monitor the status of the claim to ensure it is processed correctly and paid.
This step-by-step guide can help PT clinics effectively address CO-97 denials and enhance their billing practices.
SPRY empowers clinics to proactively prevent CO-97 denials by optimizing claims management and enhancing documentation accuracy. By automating critical processes and providing real-time error alerts, SPRY allows clinics to focus on delivering excellent patient care while safeguarding their revenue.
Optimized Claim Management
SPRY's automated scrubbing and real-time payer alerts work proactively to ensure claims accuracy, highlighting potential errors to prevent denials such as CO-97.
Streamlined Documentation
With SPRY Scribe’s automated and customizable SOAP notes, along with auto-select CPT and ICD codes, clinics can easily align documentation with payer standards, reducing errors tied to billing codes.
Integrated Insurance Verification
By integrating insurance data directly into the billing system, SPRY avoids duplicate entries and minimizes mistakes, ensuring cleaner claim submissions and reducing denial rates.
To learn more about how SPRY can streamline your operations and reduce the risk of claim denials, schedule a demo today!
What does Denial Code CO-97 mean?
Denial Code CO-97 indicates that a claim has been denied because the billed service is considered part of a previously processed service.
Why are claims denied under CO-97?
Claims are often denied under CO-97 due to bundled services, incorrect submissions for separate payments, or failing to follow billing guidelines related to previously adjudicated services.
How can I resolve a CO-97 denial?
To resolve a CO-97 denial, verify the relationships between the billed services, correct any coding errors, and consider adding appropriate modifiers to clarify the distinct nature of the services.
How can SPRY help prevent CO-97 denials?
SPRY aids in preventing CO-97 denials through streamlined billing processes, automated documentation, and real-time error alerts, ensuring accurate claims submission.
What should I do if I receive a CO-97 denial?
Review the denied claim to identify the bundled services, correct the billing as necessary, and resubmit the claim with appropriate modifiers for re-evaluation by the payer
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