Скачать или смотреть How to Prevent Denial Code CO 97

In my last video, I went over denial code CO 97. This particular denial code occurs because the benefit for a service or procedure provided is included in the payment for another service or procedure that has already been billed.

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But there are instances where if the procedure or service is distinct or unrelated to the major procedure or service, or performed during a postoperative period, you can code it separately. This is where modifiers come into play, more specifically modifier 59 and 79. In this video we are going to go over these particular modifiers, what they mean, and how they can help prevent receiving denial code CO 97.

The Centers for Medicare & Medicaid Services states that you can’t report a procedure separately that was done at the same time as an additional procedure. So long as the service or procedure takes place in an anatomically related area using the same surgical approach.

But as I said before, if the service is unrelated to the main service provided, you can code it separately. This is when modifier 59 becomes handy! Modifier 59 represents:
A different patient encounter.
Different Session.
Different surgery or procedure.
Different organ system or site.
Separate lesions.
Separate area or injury.
Or separate excision/incision.

If procedures are performed during the postoperative period, unrelated to the original surgery, you will need modifier 79.

It’s important to note that you will not be able to unbundle all procedures with the use of these modifiers. You cannot unbundle code pair edits that have a “0” modifier indicator.

Although these modifiers are meant to help, avoiding denial code CO 97 isn’t always possible.

However you can lower the likelihood of running into it by asking the right questions. Before you separately code a service or procedure, makes sure to ask these 5 questions:
Is this separate procedure or service a part of another major procedure or service?
Is the separate procedure or service performed independently?
Is the separate service or procedure unrelated to the major service or procedure?
Is the separate procedure or service considered distinct?
Is the separate procedure or service performed on the contralateral or ipsilateral side, same orifice/incision, and same organ?
If you answer yes to any of these questions, it may be possible to bill the service or procedure separately.

Employers know that a modernized experience is essential when it comes to working with patients and collecting revenue. Utilizing clearinghouses and claim scrubbing can help you instantly spot errors within your claims.
Helpful technology aside, learning about common denial codes is one of the best ways to keep your practice’s bottom line safe. Equipping your team with the necessary tools to prevent denials will help you improve efficiency and give you a competitive edge in today’s professional climate.

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