In medical billing, understanding claim messages is key. One common claim message is CO-97: Services Included in Another Procedure. This code can seem hard at first, but it is simple when broken down. It helps providers and patients know why a service was not paid separately. This article explains what CO-97: Services Included in Another Procedure means, why it happens, and how to manage it.

What CO-97 Means

The code CO-97: Services Included in Another Procedure is a claim adjustment reason. It tells you that the service billed is already part of another service. Insurance companies use this code to avoid paying twice for the same care. In short, the service is not paid for alone because it is part of a bigger procedure.

For example, if a doctor bills for a basic exam and also bills for a more complex procedure that already includes the exam, the insurance may return the claim with CO-97: Services Included in Another Procedure. This does not mean the service was wrong. It just means it is part of another service that is already covered.

Why CO-97 Happens

There are many reasons why CO-97: Services Included in Another Procedure appears on a claim. Here are the most common:

Bundled Services: 

Some procedures include smaller services. For example, surgery may include anesthesia, lab tests, and follow-up care. Billing these separately can trigger CO-97.

Coding Rules: 

Insurance companies follow strict coding rules. If two codes overlap, one may be denied with CO-97.

Duplicate Billing: 

If a provider bills the same service twice for the same date, the second claim may get CO-97.

Incorrect Modifiers: 

Modifiers tell payers when a service is separate. If missing or wrong, CO-97 can appear.

Understanding these reasons can help reduce errors and avoid payment delays.

Examples of CO-97

Let’s look at a few examples. Suppose a patient has a minor procedure, such as a skin biopsy. The biopsy may include local anesthesia. If the provider bills separately for anesthesia, the insurance may deny it with CO-97: Services Included in Another Procedure.

Another example is a dental cleaning. If the cleaning is part of a routine exam, billing both separately may trigger CO-97. The key is to know which services are already included in larger procedures.

How to Prevent CO-97

Preventing CO-97 requires careful billing practices. Here are steps to reduce these denials:

Check Coding Manuals: 

Always check the CPT or HCPCS manual. Know which services are bundled.

Use Modifiers Correctly: 

Some procedures allow modifiers to show a service is separate. Using them correctly can prevent CO-97.

Avoid Duplicate Billing: 

Make sure the same service is not billed more than once on the same day.

Educate Staff: 

Billing staff should understand CO-97 rules. Training reduces mistakes.

Preventing CO-97 can save time, avoid claim rejections, and improve revenue.

Conclusion

Understanding CO-97: Services Included in Another Procedure is important for smooth billing. This claim code shows that a service is part of another service and is not paid separately. Knowing why CO-97 happens, how to prevent it, and how to handle denials can save time and money. Providers should check coding rules, use modifiers properly, and educate staff to reduce CO-97 claims. Patients should be aware that some services are included in larger procedures to avoid confusion.

CO-97 may seem tricky, but with clear knowledge, it becomes manageable. It is part of keeping billing accurate and fair. Contact West Virginia Medical billing for effortless work, which will cause no stress to the provider or the patient.

FAQs

Is the CO-97 payment included in the allowance for another service procedure?

The CO-97 denial code is a common issue in medical billing that signifies a service isn’t separately payable because its cost is already included in the payment for another previously processed procedure or service.

Can you bill a patient for CO 97?

This service/report cannot be billed separately.

When a denial is received for CO 9,7, this typically indicates that the procedure is bundled or considered incidental.

Denial Code CO 97 occurs because the benefit for the service or procedure is included in the allowance or payment for another procedure or service that has already been adjudicated.