Denial claim - CO 97 - CO 97 Payment adjusted because this procedure/service is not paid separately.

CO 97 Payment adjusted because this procedure/service is not paid separately.

Explanation:

• The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated.

Solution :

Denial indicates services billed may have already been submitted as part of another service billed for the same date of service (services were bundled). Please make note of quarterly updates to the National Correct Coding Initiative (CCI) edits .

• The purpose of NCCI edits is to ensure the most comprehensive codes are billed, rather than component parts.

Some services may always be bundled into other services provided or not separately payable. For instance:

• E/M services conducted during the post-op period of a surgery that are related to the surgery are considered not separately payable.

• Collection of a blood specimen is usually conducted during a patient encounter, and therefore is not separately payable.

• Extended hours codes (common after-hour codes) are not separately payable in a facility which operates 24-hours a day.

• Special handling, conveyance or transfer of a specimen to a laboratory from a physician's office is not usually separately payable, as this type of "extra" care is considered within the payment fee schedules.

Posted in: Denial and action,Inclusive - not paid seperately denial