|
Last Modified: 12/10/2010
Location: FL, PR, USVI
Business: Part B
CO 97
The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated
(DENIED/REDUCED SERVICE/PROCEDURE NOT PAID SEPARATELY)
(PRE/POST OP CARE INCLUDED IN SURGERY. YOU MAY NOT BILL PATIENT)
(SEPARATE PAYMENT NOT MADE FOR THIS SERVICE. DO NOT BILL PATIENT)
Resources/tips for avoiding this denial
Denial indicates service(s) billed has/have already been paid as part of another service billed for the same date of service (services were bundled).
.• The purpose of NCCI edits is to ensure the most comprehensive codes, rather than component codes, are billed.
If billing for split-care, be sure to apply appropriate modifiers to surgical codes when billing the services to Medicare. Note: Coordinate split-care billing activities with other providers involved in the patient's care, to ensure the surgical code is billed before post-op care, as this will sometimes cause denial issues.
• Modifier 54 indicates pre- and intra-operative services performed.
• Modifier 55 indicates post-operative management services only.
• Modifier 56 indicates pre-op services only
Some services may always be bundled into other services provided or not separately payable. For instance:
• Evaluation and management (E/M) services conducted during the post-op period of a surgery that are related to the surgery are considered not separately payable.
• See the Centers for Medicare & Medicaid Services (CMS) Internet-only manual (IOM), publication 100-04, chapter 12, section 30.6.6 
for additional details.
for additional details.• 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 (e.g., inpatient/outpatient hospital).
• 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.
Resources available through the First Coast Service Options (FCSO) Medicare training Web site (www.fcsomedicaretraining.com) 
:
:• For an introduction to NCCI, access the recording of a FCSO webcast dated October 7, 2010 -- 10/07 -- National Correct Coding Initiative (NCCI) and related denials Part B, located under category "2010 FCSO Medicare Training webcasts" of the FCSO Medicare training Web site , under "Learning and Metrics."
, under "Learning and Metrics."• To understand how billing for services or procedures performed in the global period of a surgery can be affected, complete the free Web-based training (WBT) Introduction to Global Surgery -- Part B
Tips to correct the denied claim
If a modifier is applicable to the claim, apply the appropriate modifier, and resubmit the claim. Be sure to submit only the corrected line. Resubmitting an entire claim will cause a duplicate claim denial.
Please use your browser's back button to return to the referring page. Source: FCSO Education Action Team
